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Rethinking Hospital Libraries: A response to Elaine Martin’s recent post on the NER blog.

A message from Marianne Burke, Director, Dana Medical Library, University of Vermont:

Though I share Elaine Martin’s concern for the future of medical libraries and librarians, her conclusion that we are in real trouble and need to re-invent ourselves ignores our successes: the changes, and contributions we are making and the innovations we have introduced. Better questions are those like “What problems are we encountering?” and “How should librarians and hospital libraries move into the future”?  Elaine contends that the work already done by the NNLM-NER and others to promote change and save libraries, has been unsuccessful and of little value since many libraries have closed anyway.

I would argue that NNLM/NER has done an admirable job of developing the concept of the Hospital Knowledge Services Center (HKSC).  With NNLM/NER staff and innovative New England hospital librarians, the NNLM/NER developed two toolkits: an audit template and a Field Guide, that provide guidance to librarians to reframe their library services and organizations.  Some librarians have successfully repositioned services and programs to according to this framework.   The flaw in the HKSC strategy may be that the toolkits are directed to and have been promoted only to hospital librarians and not to hospital administrators or any hospital organizations. An audit of an institution’s information needs from the administrator’s  and provider’s point of view, rather than the librarian’s, would take the emphasis off “saving the Library” and place it on the value and true costs of  knowledge-based information services.

We, as a profession, may have focused too much on keeping all libraries open or saving all librarian jobs. Are we sure that information services should be bundled in one service center or provided only by librarians?  Is medical literature –derived information as opposed to other sources such as calculators and order sets linked still primary? To shift focus and answer these questions, medical librarians should organize collaborative frameworks with hospital administrators, health care providers, and others to consider together with us the information use and access needs for quality health care and identify roles, responsibilities, and true costs.

This would seem a natural endeavor to be led by the NN/LM and the RML’s.

Recently the multi-site hospital library value study [Marshall, Sollenberger et al, JMLA,2013] and a Colorado – Missouri hospital study [Sievert, Burhans et al 2011, J Hosp Lib]  have shown the impact of library-presented medical information and librarian services on patient-related care.  These studies, and evidence-based practice and quality care requirements imbedded in the ACA, would argue for library and librarian type services, but the connection has not yet been made successfully to hospitals and policy makers.  Despite the evidence and need for knowledge-based content, many hospital administrations have cut or eliminated library services, but others have not eliminated all services and some seek out-sourced services.

Last October, administrators from three Vermont hospitals called me, as Director of the UVM Dana Medical Library (DML), to say that they were eliminating the librarian position, dropping out of DOCLine, or limiting subscribed content.  Those administrators wished to continue information services by becoming members of the DML’s income-expense based document delivery and outreach service.  They still wanted services and collections for provider knowledge support but they also “had to” substantially reduce costs.

DML had already begun to assess how our fees were covering the expense of providing services. We realized that many expenses such as professional and staff labor, overhead, and collection support were not “fully loaded.” We are now revising our fee structure to cover costs and whether it is feasible to provide services to hospitals in our current fee-for-service-model. One Vermont hospital administrator is struggling with how to provide information services. She was ordered to reduce the FTE of the librarian position, but continues to have collections funds, may retain DOCLine membership, and hire contract rather than permanent staff.  How should she proceed? Is there a consultant who could help her work through an HKSC audit of information needs of that institution to come up with a plan?

One of NNLM’s goals is “To promote awareness of, access to, and use of biomedical information resources for health professionals and the public…”  I would argue that when a hospital terminates the librarian, and cancels all or most subscriptions, the providers in that institution become underserved health professionals. Advocacy for health information access by these professional should be a concern of NNLM.

Another NNLM goal is “To develop collaborations among Network members and other organizations to improve access to and sharing of biomedical information resources.”  Even without a librarian or DOCLine membership, hospitals are still providing or seeking some information services.  Shouldn’t they be considered affiliate NNLM members and be afforded some level of consultation or follow-up from the RML or designated resource library?

There are huge changes taking place in health care systems that are beyond the control of any one profession. Those organizations and professionals who are committed to access to health information, evidence-based practice, patient safety, and quality improvement should all participate in the development of a mutual understanding of the value and future of health information access and hospital knowledge services.

What are the next steps? I have suggested a few: Include hospitals without libraries in RML affiliation, identify consultants to work with hospital administrators to audit information needs; charge the true cost of providing information services to hospitals through contracts or fees. On the state and national level, organize symposia of interested hospital and health leaders, including librarians, to identify needs across perspectives and disciplines.  Statewide initiatives to provide health information to licensed health professionals such as HEAL-WA in Washington State should be examined as models for the processes and politics involved.

Let’s focus less on the demise of medical libraries, and more on the big picture.  For those of us still working in libraries, consider the priorities of your institution and the context in which it operates.  Change and add and subtract services without regard to tradition. In New England, let’s examine what has been learned and accomplished without blame or panic, and include the whole health care community in systematic thinking and next steps.


Marianne Burke

Director, Dana Medical Library

University of Vermont

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