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Hospitals Need Librarians -- Whether They Know It or Not

A couple of days ago a hospital librarian colleague queried me about a situation she was aware of where a nearby university had arranged with a local hospital to provide access to e-resources to physicians at the hospital that they were trying to recruit as adjuncts.  (Medical schools commonly develop these kind of adjunct or "volunteer faculty" relationships with local physicians, who can then serve as preceptors for med students.  Typically, the docs don't get paid for this, so med schools are always trying to come up with perks that will entice them to continue to participate). 

My colleague was concerned about the impact of these sorts of relationships on hospital libraries, saying, "Add all of this to the new change in the JCAHO guidelines and I believe we are in for many more closings ahead." 

This is a tough one.  We've been seeing a decline in the number of hospital libraries for some years now.  It's driven partly by hospital mergers, partly by cost-cutting on the part of administrators who don't see the value of keeping a library when more and more information is available online.   The JCAHO guidelines that my colleague refers to are from the "Joint Commission" which accredits hospitals.  At one time, they required hospitals to have libraries, but that was changed many years ago to a more general requirement that they have some arrangements for providing knowledge-based information.  In the current round of revisions, they may be weakening that requirement even more.  Now, my colleague looks at this relationship between a hospital and a local university and sees one more potential threat.  She wonders what I think about all of this.

I thought about it for a day or two, and then sent her this:

I don't know enough specifics about the situation you describe to comment on whether any of these moves are good or bad for the various organizations involved, but I think you are probably right that we are going to continue to see hospital libraries closing. We're in a time where there is going to be massive restructuring going on, and whenever that happens in an industry there's going to be considerable upheaval.

I just wrote a blog post on outcomes -- something that I'm very focused on these days. In some of the presentations I've been doing lately, I've been arguing that we put too much emphasis on "libraries" and not enough on "librarians".  Much of the discussion within the hospital library community has been preoccupied with keeping hospital libraries open and, heretical though it may be to say this, I'm not at all sure that's where the focus should be.  I do think that every hospital ought to have a good librarian -- I'm not convinced that means that every hospital needs a library.  But for many librarians, that's nonsensical -- what's a librarian without a library?  In my comments on the JCAHO website regarding the proposed changes I didn't talk about the need for a library at all -- but I said that in this very complicated information age in which we live, every hospital needs a specialist who can assess what the information needs of the institution are, figure out the most cost-effective ways of meeting those needs, and then provide the training and support for people to use those efficiently.  I argued that the need for that is greater now than ever before and that a hospital that doesn't invest in a specialist to help them do that is not going to be managing their decision making processes as efficiently and effectively as they need to.

So what does that mean in practice?  The answer is going to be different in every situation, but in some cases it might mean that it is the hospital librarian who recommends developing partnerships with local universities and who suggests to the administrator that "we should quit spending money on our own licenses because we can be more efficient by developing relationships with other institutions, and then putting our energies here into training and support so that people are using things effectively. We should be developing patient oriented resources so that we're sure that when people leave the hospital they know how to find the information they need to take better care of themselves. We should be very carefully targeting our own funds to meet the needs of those within the institution who are not being well served by the resources available through the other partnerships and alliances we can establish."  But the specifics will be different in every case.

I don't know if any of that is applicable or useful to you in your situation, or if it'll just make you more depressed.  (I hope not!)  I've got a good friend who runs a small local bookstore -- the kind that is going out of business all over the country.  He's thriving and, in fact, is actually making a better profit now than he was for the first ten years he was open.  And he can point to many other independent bookstores around the country who are doing the same.  He's done it by radically rethinking his role in the community.  He and I get together every couple of months to drink a bottle of wine and talk about the similarities in the challenges that we face.  We believe that it is still possible for independent booksellers and for librarians to be successful (although there's no guarantee that whatever you do you'll be successful in any particular setting or situation) -- but it does require radical rethinking.

I'd write more, but I've gotta go. Hang in there....


Margo Coletti

Great post, Scott. I have been watching hospital library departments closing all around me here in the northeast. I agree, we need to emphasise our services, not our space. Taking the arguement a step further, I believe that one reason we have a hard time convincing hospital administrators of the need for our services is that we insist on calling them "library services". As you've pointed out, "librarian" and "library" seem to be synonymous to hospital administrators - and to most librarians. I truly believe that we've got to stop limiting ourselves with our titles and be willing to think of ourselves as knowledge managers or knowledge services directors - or some variation. Careful use of language matters - just ask the Republicans! A change in language worked for medical records (now health information management). In my own hospital, when the name changed, HIM joined the IS department and the director now has a seat at the table. Yesterday, I spoke with one of our oldest HIM managers who told me that the term "medical records" implied "taking down records and refiling them." "We do so much more now!" she said. Sound familiar? “Knowledge Services” is used in the NHS libraries in the UK, and in special libraries here in the US. Why are we so stuck on the Latin word for book? Is the word "library" the most sacred cow of all?

T Scott

Actually, in the presentations I've done recently that talk about the need to quite thinking of library and librarian as synonyms, I also argue strongly that I am a librarian and that the title continues to have real value, because it has a rich history and generally positive connotations. It's true that the image that the general public calls up in relation to the word isn't generally very accurate -- but to a considerable extent that's true for all professions. My guess is that "knowledge manager" call up no connotations at all, positive or negative.

It may well be that in some institutions, in certain cases, a careful name change may be useful. But I remain wary -- if, as you noted in one of your posts on this topic on the HLS list, hospital libraries are fighting for their survival, I don't think changing the terminology is going to make much of a difference. And based on conversations with some of my UK friends, I'm not sure that I'd use the status of NHS libraries as a strong recommendation.

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