I just read in Library Journal, the article Rx For Medical Libraries: How can we ensure that small medical libraries continue to provide good medicine? by Cheryl R. Banick.

Banick is concerned over the fate of the community hospital and small university affiliated hospitals. The big academic medical center libraries will always be around stock full of the "fantastic techno-goodie, eresources, and space," but what will happen to the smaller hospital libraries.

She sees four main risks to medical libraries.

1. Deprofessionalization - Banick believes one of the biggest factors jeopardizing medical libraries is the fact that JCAHO does NOT require a professional librarian for a hospital's library or information services. Even though JCAHO "expects the hospital to provide effective services for other departments with someone from those fields." Banick uses the example that the head of nursing must be a nurse practitioner with experience in the field. Because JCAHO requires this, hospitals meets their requirements. Because JCAHO does not require a degreed librarian, or value towards the hospital is cheapened.
   
   Where is MLA!??!!? What have they done to lobby JCAHO and the powers that be that we are important and hospitals should have ALA accredited librarians? This standard is nothing new. It isn't like JCAHO whipped it out of a tall black hat and surprised all of us.
   
2. Failure to Outreach - This is the era of the informed patient. "There's a consumer health revolution out there, backed by a National Library of Medicine National Institute of Health directive to meet patients' health information needs. Librarians, you must connect with patients." Banick offers some examples as to how librarians can get out of their office and start serving patients. She suggests: have hospital staff refer patients to the library with InfoRx, visit patients in waiting and hospital rooms (Krafty's note: take a wireless laptop and take advantage of the hospital's wireless network), flyers, bookmarks, in-house television and phone system note there is a librarian to help, network with the local public library.
   
   Don't forget to outreach to hospital staff as well. "Be proactive with the clinical staff, especially those who are involved with quality patient care issues. Often the clinical staff is so busy putting out daily fires they don't have the time to be preventive. Your expertise and assistance can be most beneficial here. Provide information on FDA warnings, best practices, the ORYX performance measurement, standards, guidelines, patient incidents or sentinel events, and torts." Banick suggests: sending a welcome letter to new staff describing your services, visit departments, be there for grand rounds or morning report, hold search clinics, a blog or wiki seminar, and push hot news using RSS feeds.
   
   I remember one librarian on Medlib (I think) a while ago made the suggestion to celebrate other professions months/days. So if it is heart awareness month, go to the cardiology department bring snacks, show them things that can make their jobs at the hospital easier, and market your services. I thought this was an awesome idea.
   
3. Culture Shifts - Banick believes medical librarians "must redesign the medical library experience for the customer. Librarians can shine as the techno-geek resource for computer questions." Medical librarians are a valuable resource for information on databases, the Internet, citation management software, etc. become the tech guru. Banick suggests: establish instant messaging for staff who need questions answered but can't get to the library, send message to their handhelds, loan PDAs, laptops.
   
   This is a pet peeve of mine. Not with what Banick says, because she is right, we need to be more technology driven and show that we are more than just a book place. The problem is that a majority of these same small libraries that Banick worries about, have serious technology problems and limitations due to their own hospital's IT department. How many hospital librarians are forbidden from even creating Intranet or Internet pages!? How many hospital librarians are prohibited from allowing users to access web mail (yahoo, gmail, hotmail, AOL)!? How many hospital librarians are even allowed to load software on to the library computers?! How many hospital librarians are force to forego certain electronic resources because the IT department combined the IP address ranges for multiple small system hospitals?!!? Many hospital librarians are the kids on the outside looking through the candy shop's window. We desperately want to get our libraries up to the 21st century but our own institution's policies are handicapping us.
   
   I am one of those librarians. I am the kid looking through the candy shop window. What the candy shop owners (my hospital system's IT department) didn't realize is that I once tasted the sweets of technology and I am going to do my damnedest to get inside that candy store. I just had a very good conversation with my hospital's IT rep. He wanted to tell me that he has been very happy to have me working with him and that he is impressed my knowledge and information. He said I am asking questions and raising issues with things they had never known existed or needed to be addressed. I stood a little taller after that, and it has just strengthened my resolve to get into that technology candy store.
   
4. Budget Crunches - According to Banick, "Budgets pressures are bad, but we are worse at justifying them to management. We need to talk in terms of 'return on investment." Librarians are ill prepared and miserable at demonstrating the true market value to their administrators. Hospital librarians are still stuck in a rut of reporting circulation statistics, ILLs, number of reference questions, number of searches. Whoop-de-freaking-doo! If I am a hospital administrator who knows nothing about libraries I am going to be seriously unimpressed or not even care that my librarian just told me the library circulated X amount of books. Banick suggests that medical librarians document how the library services actually reduced hospital costs by using a better drug/procedure, reduced length of stay, saved staff time.
   
   In my October 30, 2005 post, What Becomes of our Research, I noted that Theresa M. Cuddy wrote the article, Value of hospital libraries: the Fuld Campus study, in the J Med Libr Assoc. 2005 October; 93(4): 446-449. Cuddy was able to determine that her services were used to support patient care 32% of the time, support presentations 14% of the time, and develop policy and procedures 11% of the time.
   
   Armed with that information, librarians can then assess a monetary figure to their results. Julia M. Esparza and Donna M. Record at the Health Science Library, Deaconess Health System, Evansville, IN presented a poster at MLA 2005, Showing the Money: Utilizing Dollar Values to Show a Library's Value and Increase the Budget! (pg 55 of 80 in the PDF). Esparza and Record used dollar values listed in the Wall Street Journal to assign values to each service they provided. Using this information, they proved that their small 500 bed hospital library (1 librarian and 1.7 paraprofessionals) provided over $74,000 worth of services. Using this dollar value (something that everybody including administrators understand) they received a 13% budget increase.

It is hard for hospital librarians to do this. Most hospital librarians are solo or have few staff. We feel pulled in every direction and there never seems to be enough time in the day. But it is time make time, get out of offices and start doing some of these things. Can we do it all at once? No. But we have got to at least start. It will be hard, but in a race for survival of the fittest, getting fit is going to be hard.