Using Evidence in Practice
Modernization of the Care Library by the Belgian Red Cross: Leveraging Digitalization and Volunteers to Reduce Loneliness with Library Services
Gaelle Huysentruyt
Manager Social Activities & Youth
Belgian Red Cross
Mechelen, Belgium
Email: [email protected]
Mathilde Krols
Project Manager Humanitarian Services
Belgian Red Cross
Mechelen, Belgium
Email: [email protected]
Liesbeth Vercammen
Coordinator Volunteering
Belgian Red Cross
Mechelen, Belgium
Email: [email protected]
Fritz Schiltz
Chief of Staff
Belgian Red Cross
Mechelen, Belgium
Email: [email protected]
Philippe Vandekerckhove
Managing Director, Belgian Red Cross
Mechelen, Belgium
Department of Public Health and Primary Care, Faculty of Medicine, KU
Leuven
Leuven, Belgium
Centre for Evidence-Based Health Care, Stellenbosch University
Cape Town, South Africa
Email: [email protected]
Received: 28 Dec.
2021 Accepted: 25 Jan.
2022
2022 Huysentruyt, Krols, Vercammen, Schiltz, and Vandekerckhove. This is an Open Access article
distributed under the terms of the Creative
Commons‐Attribution‐Noncommercial‐Share Alike License 4.0 International (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is
properly attributed, not used for commercial purposes, and, if transformed, the
resulting work is redistributed under the same or similar license to this one.
DOI: 10.18438/eblip30091
Setting
In 1937, the
Belgian Red Cross launched the Care Library, a library service tailored to the
needs of people who are unable to visit a regular library. Although originally
targeted towards in-hospital patients, this service now mainly concerns people
who are staying in residential care centres. The Care Library is essentially a
social activity, aiming to prevent and/or break through loneliness, hence our
slogan: more than a book. This is what distinguishes the Care Library from both
web shops and regular libraries: it brings the library to people unable to
visit in person and allows volunteers to spend time with them.
The central
warehouse contains more than 200,000 materials adapted to the specific target
group of the Care Library. There are also 40,000 books with large print, books
for young people, picture books, and books in other languages for shelters for
asylum seekers operated by the Red Cross. There is also guidance material to
trigger memories. For example, scent boxes are used to play the game bingo.
Every player gets a game board and tries to complete it by correctly guessing
the scent flasks. Other examples include audio bingo games, pictures of
everyday objects, memory games, and puzzles with pictures of the past.
Lending
points become a mini library with a tailored service, thanks to the materials
from the central warehouse and the book tour by more than 700 volunteers.
Lending points have a small adapted part of the library collection they can use
to lend out materials. Seventy-seven percent (77%) of lending points are
residential care centres, 15% are hospitals, and 6% psychiatric centres or
others (2%). Volunteers act as the point of contact between the care location
and the library. As lending point coordinators, they ensure that materials are
requested according to the wishes of the residents, and they make time to speak
to residents. In this way, bonds of trust are created for people in vulnerable
and sometimes lonely situations.
The Belgian Red Cross team manages the collection, delivers tailor-made
packages to the lending points, and trains the volunteers before they go on a
book tour. The volunteers use a book cart with different materials to go on
their book tour. If possible, they go from room to room and speak with the
residents of the care centres. The training of volunteers hence guarantees both
the quality of the collection and the service provided.
Problem
In contrast
to traditional libraries in Belgium, which experienced a 30% drop in number of
operating points between 2008 and 2015 (Statistics Flanders, 2016), there has been
a strong increase in demand for the Care Library. In the past five years, the
number of lending points has increased by almost 40%. A possible explanation is
the shift in the target group. For example, 77% of the people reached by the
lending points are residents of a residential care home. Social contact
therefore plays an even more important role, which distinguishes the Care
Library from traditional libraries. Demographic trends in Belgium point to a
growth of 22% in the number of people over 65 between 2017 and 2027, indicating
a continued shift in the coming years.
The
ever-growing demand poses challenges for the Belgian Red Cross. In addition to
the purchase of materials and the use of the warehouse, Baumol’s law
characterizes a library, like other services, as follows (Baumol & Bowen,
1966): slower growth of labour productivity compared to general productivity
results in relatively high service costs. The Care Library is a free service,
only possible thanks to the daily efforts of volunteers and support from
government funding. A decrease in the number of volunteers in Belgium (20% in
the past five years) was compensated by the deployment of employees, which
further increased the cost. In order to meet this challenge the Belgian Red
Cross invested heavily in the modernization of its central operations.
Evidence
In the case
study of the Care Library, there are two main levels of evidence. First, our
internal research team conducted two systematic reviews of the literature on
the impact of in-person visits and book reading on the well-being and health of
senior citizens. Second, we used a data-driven approach to tailor book
deliveries to residents’ demands. Both systematic reviews are currently under
review. The protocols for these systematic reviews are published and available
online (Laermans et al., 2020a, 2020b).
The
literature review provides a scientific base for the activities of the Care
Library. It includes research on (1) the effect of friendly visiting by a
volunteer on loneliness of residents of an assisted living facility (e.g.
Arthur, Donnan, & Lair, 1973; Reinke &
Holmes, 1988), and (2) on the impact of book reading on the physical and mental
health of older adults (e.g. Bavishi, Slade, &
Levy, 2016; Krell-Roesch et al., 2017). The former
concludes that friendly visits benefit the life satisfaction and self-assessed
health of residents of an assisted living facility, although it should be noted
that further research is needed due to a lack of recent evidence and rather low
quality of available evidence. The latter concludes that reading a book
enhances both the mental health (reduced risk of developing dementia, and
improved social connectedness), and physical health (lower mortality rates) of
older adults. However, caution should be exercised regarding this latter set of
results due to the relatively low quality of available evidence.
A data-driven
approach enables deliveries and new purchases that are better attuned to the
wishes of residents. This is possible through real-time insights into the
collection, but also the size of the lending points (number of beds),
participation (% readers), and areas of interest. Volunteers who are paying
friendly visits can submit data through an online portal, helping the central
team to continuously improve its offerings. By equipping the lending points
with specific materials, personal conversations are facilitated (e.g.
reminiscence books with pictures of the past are used for residents with
dementia).
Implementation
The project
“Optimization Central Library” was launched, with the objective of modernizing
the Care Library, in order to increase its capacity without increasing costs.
The components of this project are shown in the Figure 1.
Figure 1
Modernization of the Care Library in five steps.
The entire
book collection was inventoried in a data warehouse by the Belgian Red Cross
team. Each item in the collection was given a unique code and was linked to
specific characteristics of the material such as its genre. Reporting using
Cognos software allows insight into the stock. To interact with this new source
of information, an application was developed: Zorgbib.be. This application is
publicly available and allows users to consult the collection directly. The
application was developed because the purchase and disposal was
previously based on the perception of the staff, volunteers, and institutions
instead of standardized records. In addition, our customers have changed over
the last years to a specific profile: seniors in care centres. To follow the
growth in lending points for this target group, we needed an optimized stock
system and maximal rotation of the existing collection.
Lending
points can use this application to request a change directly, but they can also
enter their own data (e.g. number of readers). In addition, volunteers can
follow an e-learning training for free before going on a book tour. When a new
lending point is launched or a change is requested, a tailor-made package with
materials is put together by employees and volunteers of the Belgian Red Cross.
When the package is delivered, the used materials are returned and added to the
collection again.
Outcome
The
modernization as described above has improved the quality of the functioning of
the Care Library, increased its reach, and reduced costs. Between 2016 and
2021, the number of conversations, as logged by volunteers in the web-based
application, increased by almost 60% to 158,000 per year. At the same time,
financial resources are made available that can be used elsewhere by the
Belgian Red Cross. By offering training online and automating certain processes
(e.g. requesting a change via an application instead of via email), staffing
could be reduced by almost 40%. Targeted purchases and better stock management
mean that more lending points can be reached with the same materials. At the
same time, the shorter shelf life of books means that less space is needed in
the warehouse. Figure 2 summarizes the increased reach of the care library
(+145% since 2006), while government funding has remained constant during the
same period (+1% after correcting for inflation in the same period).
Figure 2
Evolution of lending points and funding over time.
Reflection
Throughout
the process of modernizing the Care Library, two challenges emerged. First, the
ability to shift to a data-driven approach crucially hinges on the quality of
the data. As volunteers provide data, a complementary training needed to be
developed. Volunteers can now follow online classes to get to know the application,
making sure that data quality is maintained. In addition, volunteers (and
employees) with lower levels of digital literacy are receiving in-person
training, provided by staff of the Belgian Red Cross. Modernizing our process
without supporting our volunteers along the way would limit – or nullify – the
impact of the renewed Care Library.
Second,
cooperation with experienced partners helps to overcome technical difficulties.
Our team working in the Care Library has deep expertise in materials for our
specific target groups, and in training volunteers to prepare for their visits.
However, the team has limited expertise in digital transformations, requiring
an experienced partner to support this transformation process. Because of the
organizational structure of the Belgian Red Cross, support services such as IT,
facilities, and learning and development can be leveraged to successfully
complete this project. For organizations that do not have this scale or
organizational structure, our key recommendation is to find a partner that has
experience in digital transformations such that the library team can fully
focus on its core expertise.
Author Contributions
Gaelle Huysentruyt: Project administration,
Supervision, Writing – review &
editing Mathilde Krols: Project
administration, Writing– review
& editing Liesbeth
Vercammen: Project
administration Fritz Schiltz: Writing – original draft,
Writing – review & editing Philippe Vandekerckhove: Funding acquisition,
Supervision, Writing – review &
editing
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