With Gratitude

What is it like to be feted for a lifetime of work?

I never imagined I’d have the chance to answer that question, but I found out early last month when I received the Morris L. Collen Award from the American College of Medical Informatics at the annual AMIA meeting in San Francisco.

The accompanying celebration was full of the joy of family and friends. My sister Kathleen brought my almost 90-year-old mom out from Philadelphia, and my son, Conor, joined us from Seattle. As a result, my family got to meet my friends, and my friends met my family, creating a delirious mix of my professional, personal, and family lives over a three-day period. I soaked up the excitement, basking in the love and floating on people’s kind and generous words. The experience left me feeling complete and centered in a way I never had before, as if the intersection of these parts of my life simultaneously anchored and inspired me, reminding me where I’ve come from and the countless steps I’ve taken through a career in nursing, academia, and federal service and highlighting how these many threads have woven together to create the person I am and the work I’m doing today.

formal headshot of Dr. Patricia Flatley Brennan with the Collen Award medallion draped around her neck
Patricia Flatley Brennan, Collen Awardee

I also found tremendous joy and satisfaction in the attention the Collen Award brought to the work we do here at NLM and to the remarkable accomplishments of the Library’s previous Collen Award recipients: Don Lindberg, Betsy Humphreys, and Clem McDonald, all of whom were and are exceedingly dedicated to improving health care and biomedicine. Their contributions to the field have helped shape NLM into the trustable resource it is today, and I’m proud to stand in their company.

In fact, part of what drew me here for this phase of my career is to build upon their work providing outstanding, trustable health information in the service of patients and their families. After all, the most important person in the health care process is the patient. He or she is the reason for it all—the research, the training, the technology; the doctors, nurses, and orderlies; the biomedical engineers, informaticists, and medical librarians. We’re all here to improve the health and life of patients.

But there is more to be done.

I will be eternally grateful for the professional recognition I’ve received. The Collen Award is an honor I will treasure, and sharing that honor with my family and friends yielded memories I will cherish for a lifetime. But my work continues, and I’m thankful that it’s here, leading this amazing institution with its almost 1,700 women and men, each serving science and society in their own ways. Thank you all for being a part of my team. The world has never needed our efforts more than it does now.

Two Years and Running Strong

Celebrating another blog birthday

A little over two years ago, I wrote my first post for NLM Musings from the Mezzanine. Since then, we have not missed a single week! (And a couple of weeks we published twice.) I attribute the streak in no small part to my muse and master, Mary Ann Leonard, who ardently translates my drafts into powerful prose and keeps me motivated with content maps, publication calendars, and the occasional inspirational push.

While I’ve authored 70 blog posts in that time, we’ve supplemented that with 37 guest posts from an array of colleagues, from NLM staff to hospital librarians to patient advocates. It’s a privilege to share their perspectives and expertise on topics ranging from biomedical informatics to basketball, with fair use, disaster preparedness, metagenomics and a host of others in between. And I’m happy to open this platform to them to highlight their ideas and expose their accomplishments, issues, challenges, or initiatives to a larger audience.

Out of the 107 posts published so far, I can’t help but have my favorites.  Walk with Me While I Walk with Those who Walked for Freedom allowed me to reflect on how different populations experience health and access to health care.  Vint Cerf inspired me to think about how NLM could deliver its services in outer space, an initiative that could help us better support communities here on Earth that lack electricity or stable internet. And the contributions from hospital librarians highlight the important roles libraries serve in clinical settings.

I regularly monitor how posts are received, whether through comments or social media. Some posts can garner almost one thousand “shares,” while others struggle to get ten. What does that tell me? That perhaps I did not make my point clearly or strongly enough or that the content did not resonate with my readers. But when I hit the mark and my share count goes up, I feel thrilled to have connected with readers and to have conveyed messages they want to share with others.

I like hearing from people who’ve read the blog, and I appreciate the ideas and perspectives I gain from that exchange. Sometimes people post comments on the blog post itself—and I wholeheartedly encourage and welcome your input—but people also approach me at meetings or conferences to mention something they’ve read. My sisters are avid readers, and occasionally a brother or two will join the mix, so family visits can even prompt some discussion of what I’ve written or what’s going on here at the Library.

Regardless of whom I writing to, I’ve learned to consider how readers might perceive what I am saying and to use those insights to clarify my point, reframe the situation, or refine my argument. That process not only improves my writing; it also hones my thinking and helps me see more fully the topic, the situation, or the path ahead, all good things when you’re leading a large, complex institution.

In that way, the blog helps me work through ideas I’m wrestling with, but it also serves as a means of voicing concerns, announcing new initiatives or program changes, or sharing a bit about myself and how I approach my job as library director. But more than anything else, I appreciate the blog’s role as a weekly reminder to step back and contemplate the work we do here and our services to science and society.

In the coming year, I’m going to turn my attention more toward the science side of that equation. You can expect more posts about our expanded investments in basic biomedical informatics and data science research. I’ll keep you informed about new partnerships with domain scientists to build tools that will accelerate discovery. And we’ll be tackling some complex policy issues as well, such as the data life cycle and the Library’s responsibility to support rigor and reproducibility within federally funded research.

Through it all, week in and week out, I’ll continue to use this blog to open a window into the Library, its operations, and its commitment to biomedical discovery and the health of society. See you next Tuesday!

Wanted: Big Hairy Audacious Goals

We have a strategic plan. And that plan has three sound and notable goals. So why do we also need a big hairy audacious goal?

The easy answer is that the Blue Ribbon Panel tasked with reviewing NLM’s intramural research program suggested it.

But the real answer pushes us further: To break the limits on our thinking and spark urgency.

Such a bold, risky goal quickens the pulse, sparks excitement, even kindles a bit of fear.

If we are going to achieve that, then we had better get moving.

But what should that be?

The Blue Ribbon Panel offered three ideas (PDF), each building on NLM’s “remarkable track record of research innovation and impact.”

  1. Next-Gen PubMed
    Make PubMed the discoverability engine for the world. Transform it into the single point of access to an array of information types in the life sciences, including data sets, standards, clinical trials, federal health resources, and data science tools and methods. Integrate sophisticated inference capabilities that identify semantic relationships to pull together related content and deliver active learning capabilities and insights, not just hits.
  2. Computational public health
    Create automated tools for disease surveillance and prediction, combining data from disparate sources, including other federal agencies and global partners. Link clinical and epidemiological data to whole genome sequence data for microbial pathogens to rapidly detect, identify, and mitigate the impact of emerging pathogens, pandemics, or malicious attacks.
  3. Artificial Intelligence in medicine
    Build the tools and data management approaches that draw upon large volumes of personal health data to enable automated and precise diagnoses, prognoses, and patient treatment plans.

Whoa. What?!

Any one of these will take years—and a lot of work, skill, coordination, and even luck—to achieve, but then that’s the idea. Big, hairy, audacious goals aren’t meant to be easy. They’re meant to get us reaching beyond what we thought possible.

In the context of NLM’s intramural research program, the Blue Ribbon Panel highlighted several attributes that such goals should possess:

  • Integrate multidimensional data, including temporally dynamic data
  • Impact many fields of biomedicine (including population health)
  • Challenge experts in user interface and user experience
  • Represent difficult multi- and interdisciplinary research challenges
  • Build on unique strengths at NLM and NIH
  • Provide measures of impact and success
  • Require interactions with other agencies
  • Raise profound informatics and data science research questions
  • Represent a substantial engineering challenge for scaling and dissemination

Can we do it?

The Blue Ribbon Panel thinks so. They noted that NLM has achieved tremendous ambitions in the past, including the Unified Medical Language System, the foundational work that enabled CRISPR-Cas, and machine indexing of the world’s biomedical literature.

But is one of their three suggestions the clear and compelling goal that will get us where we want to be?

NLM will be working with stakeholders to examine that question and to identify and lay the groundwork for its future research agenda, but in the meantime let me ask you:

If you wanted to galvanize research across NLM and inspire the larger scientific community, what would you do? Let us know below.

The Blue Ribbon Panel, comprised of nine external experts in biomedical informatics and data science, was asked to look at the following issues:

    • the strengths and weaknesses of NLM’s intramural research program as a whole
    • the quality of it research and training programs
    • the appropriateness of its organizational structure
    • its relationship to other NIH Institutes and Centers
    • its interactions with NLM’s highly regarded and widely used health information services and tools
    • the effectiveness of its review and evaluation processes
    • the suitability of its research facilities.

NLM has already begun reviewing the Blue Ribbon Panel’s recommendations (PDF) and charting a course forward. I’ll keep you apprised of our steps and strategies over the coming year.

Thank a Medical Librarian

Celebrating National Medical Librarians Month

“Get the word out. Tell the world what we do!”

I received that earnest and heartfelt request from those attending the Medical Library Association’s Midwest Regional Conference in Cleveland earlier this month. And though I thanked the conference attendees for all they do for NLM—helping us connect with our constituents in hospitals, academic institutions, and communities across middle America—I realized there was more I could do to thank and acknowledge all medical librarians, starting with this blog.

I believe that quality information is essential for improved health. It improves clinical decision making and patient care, boosts the quality of biomedical research, supports patients, families, and caregivers, and reduces health care costs.

And who is responsible for organizing and delivering that essential information?

Medical librarians and their partners in the health information profession.

For that, they deserve our thanks, but even more, they should be acknowledged for the myriad ways they improve health care and biomedical research.

Medical librarians…
  • Curate diverse and valuable collections.
    Librarians make deliberate and systematic choices to select the books, journals, data, and other resources needed for research and clinical care.
  • Catalog, index, and make available acquired materials.
    They make the needle you need findable in the collection haystack by adding relevant and appropriate subject headings or keywords to books, journal articles, data sets, images, and other items, which you can then locate by searching freely available databases like PubMed.
  • Manage access rights.
    Medical librarians support copyright and help maintain the intellectual property of authors, publishers, and database creators as they acquire and license resources on behalf of those who need them.
  • Support data discovery.
    Medical librarians identify and create pathways to data repositories that bolster genomic and biomedical informatics research.
  • Find the hard-to-find.
    Librarians know the ins-and-outs of online searching. They’ve trained for it, learning how different databases are organized and how best to extract precise results. Their expertise will save you time and improve outcomes.
  • Help authors publish.
    Librarians can help researchers at every stage of the publishing journey, from writing, revising, and formatting the paper to selecting appropriate and trustworthy outlets for publication.
  • Preserve materials for the future.
    They ensure the collections so painstakingly assembled are safe, secure, and available now and in the years to come, digitizing print materials, monitoring storage conditions, and conserving brittle, crumbling works.

Of course, to thank a medical librarian you have to find one. I suggest starting with NLM’s National Network of Libraries of Medicine (NNLM). At  over 7,000 sites strong, this network provides a point of presence for medical librarianship in almost every county in the US. Many NNLM members are academic institutions, health science libraries, or hospital or clinic libraries, but an increasing number (over 1,700 now) are public libraries taking on new ways to serve their communities.

They’re not alone.

Medical librarians have long ago left the desk behind and stepped into new roles, whether in health care institutions, academic libraries, or private industry. They are leading patient-and-family information services, becoming a part of the knowledge management resources of large health care systems, serving on patient safety and quality control committees, and joining teams of investigators to manage publications, locate critical data sets, gauge research impact, or write grants. From embedded librarian initiatives and innovative outreach programs, medical librarians are deepening the connection with the people they serve, bringing them shoulder-to-shoulder to share knowledge and solve problems.

They’re doing all this because they, too, believe that quality information is essential for improved health, and they know their skills and training put them in the best position to deliver that information.

That’s not only worthy of thanks but of shout-it-from-the-rooftops support. And not just because I say so, but because the data say so.

So, to provide better care, make better decisions, and save money, ask—and then thank—your medical librarian. They’re experts in helping you succeed.

Communicating and Leading in a Time of Change

Every change management book I’ve ever read stresses the importance of communication during periods of organizational change. Talk to staff often, express your vision, share your excitement, listen to others on the journey. All sage advice.

And we’re certainly following it.

All NLM leaders, from group supervisors to branch chiefs to division heads to me, are communicating a lot—via staff meetings, wiki notices, large town hall meetings, brown-bag discussions, even this blog—as we prepare the National Library of Medicine to meet the future head on. We’re talking and listening, listening and talking, and it helps, opening our eyes to staff concerns and perceptions, along with their hopes (and fears) for the future.

Communicating vision and direction is so important to my leadership responsibilities that I invest a great deal of time and effort in organizing what I plan to say and how I say it. I review talking points with my senior leadership team to make sure I haven’t forgotten anything. I repeatedly rehearse my message, practicing timing and finding the right words to provide reassurance or spark excitement. I solicit staff reactions and allow time in my talks for open discussion (and provide channels for private, written feedback as well). I try to remember all the things I’ve learned about sender/receiver behavior, the importance of eye contact, and the power of nonverbals, including body language and tone of voice.

Despite all that though, what I say is not always what gets heard. After all, even the most carefully honed message has to be heard and understood, and that job falls to the listener. The listener’s daily concerns, tolerance for ambiguity, risk propensity, sense of control, cultural background, and other factors uniquely combine to filter and decode my words into what he or she understands me to be saying. Multiply that by several hundred listeners, and it’s a wonder there’s any alignment at all between what I send out and what is taken in.

To counteract that, I use what in engineering is known as purposeful design to help shape my communication. I carefully consider the range of ways a simple sentence or phrase might be heard by others and think about what aspect of the situation—stress, the presence of others, the nature of the news— might activate various filters and compound the mismatch between what I say and what is heard. I also actively solicit “back talk,” asking people to paraphrase what I’ve said or to tell me what they’ve heard. It takes extra effort, but it can save time in the long run as it uncovers misunderstandings, engages people around the same concept, and ensures we’re all in agreement.

And speaking of “back,” how about walking backward as a communication and leadership strategy? My good friend and mentor John Maeda recently re-shared one of his team leadership messages that featured Pentagon tour guides walking backwards. The guides are trained to lead groups through the building’s maze of hallways while facing them, pointing out important places along the way. John extends the idea to managers, recommending the manager occasionally “walk” facing the team, holding and directing their attention. And, as he wisely notes, “When you are watching where your team’s going, you also need to watch whether they are following.”

So, in this time of change, as we rely on our supervisors and branch chiefs and division heads to communicate vision, listen to staff, and help us move forward, I’m asking them to remember that what they say—what we all say—is often not what is heard and to occasionally walk backwards. The view is enlightening.

Animation credit (walking backwards, top): CC BY Ret Samys