Hospital Libraries are More than a Cost Center

The cost of health care is expensive. Hospitals want to treat patients in a cost efficient manner without sacrificing patient care. It is a balancing act. The hospital librarian can help with that balancing act.

An article published in Health Information & Libraries Journal, describes how clinical librarians providing information to hospital staff in the critical care unit can improve patient care, time savings, and may generate a positive return on investment.

The study was conducted in the United Kingdom, so there may be differences depending on the country your hospital library is in. Over the course of 15 months, they found that librarian intervention and activities generated a positive ROI of £1.18–£3.03 for every £1 invested. (For the American readers that is a ROI of $1.49-$3.83 for every $1.26 invested, depending on currency values.)

The clinical librarian spent 15 hours per week split across a 5 day work week (Monday-Friday) providing the following intervention services/activities.

  • Pop-up library (rounding on the floor/wards)
  • Academic study support
  • Evidence searching support
  • Noticeboard
  • Journal club
  • Facebook group.
  • Online journal club
  • Book box

In an email interview for this blog post, Victoria Treadway, the clinical librarian in the study, said the intervention activities were done in accordance to the needs of the week. So one day, time might be spent helping with Journal Club while the other day, time spent might consist of rounding.

So it appears that with a little bit of time, 15 hours out of a 40 hour work week, dedicated to providing services within the critical care unit, the hospital was able to see a positive return on investment. Additional benefits to having a clinical librarian were; time saved for clinical staff (1563 hours 85% of which was nursing), professional development support, and improved patient care. This not not only impacted the budget in terms of cost savings for the NHS but led to an increase in evidence based medicine culture, and improved clinical decision making. (figure 1 of Hartfiel N article)

Libraries and librarians are often thought of an expense rather than a benefit that actually reduces expenses and improves patient care. More of these types of studies are needed, “the development of a core set of validated outcomes would enable a direct comparison of results of future studies.”(Hartfiel N) The ability to compare the results with other institutions librarians would help librarians better illustrate their impact on the hospital, clinical staff, and patients.

Unfortunately, as with most things, due to changes in personnel and Covid-19 this clinical librarian program no longer exists within the hospital impacting the clinical staff. In email correspondence with Dr. Girenda Sadera, “Covid put a dampener on things. Once Victoria left the trust we were not able to replace her on the unit. At present I am aware that the nursing staff are having limited success with obtaining help from the library.”

But there is a silver lining, Treadway mentioned this research had a “wider impact on embedded librarianship at a national level, as it helped to inform the Health Education Gift of Time report which makes a case for expanding embedded librarian roles across England.”

Hopefully the role of the embedded librarian is expanded in England and we see more studies reporting on the impact medical librarians have on increased support of clinical staff, and improved patient care.

For more articles on the impact and value of medical librarian please read:

The value of library and information services in patient care: results of a multisite study. Marshall JG, Sollenberger J, Easterby-Gannett S, Morgan LK, Klem ML, Cavanaugh SK, Oliver KB, Thompson CA, Romanosky N, Hunter S.J Med Libr Assoc. 2013 Jan;101(1):38-46. doi: 10.3163/1536-5050.101.1.007.PMID: 23418404

Measuring Return on Investment in VA Libraries. Jemison K, Poletti E, Schneider J, Clark N, Stone RD. Journal of Hospital Librarianship. 2009 Nov;9(4):379-390. doi: 10.1080/15323260903253803.

Assessing return on investment in health libraries requires lateral thinking. Urquhart C. Health Information and Libraries Journal. 2020 Mar;37(1):1-4. doi: 10.1111/hir.12298

Tools:
Evidence you can use to communicate library value. Medical Library Association. https://www.mlanet.org/page/evidence-you-can-use. Last accessed 6/26/22.

References:
Hartfiel N, Sadera G, Treadway V, Lawrence C, Tudor Edwards R. A clinical librarian in a hospital critical care unit may generate a positive return on investment. Health Information & Libraries Journal. 2021;38(2):97-112. doi:10.1111/hir.12332

Thankful Patient Smiles at Library Staff During Covid-19

During the Spring of 2020 medical libraries were struggling to balance the need to provide information with the need to be safe from covid-19. The response was varied across the profession. Some hospital libraries remained open, some were open to a limited number of people, others were staffed but closed to patrons, while others were physically closed as staff worked remotely.

On June of 2020, the library received a call from the spouse of a thankful patient.

The caller wanted thank the library staff coming in to “man the library” which allowed her to get the books she needed during the pandemic. She wanted to send thanks to everyone contributing patient care, and shared a story about her husband, a current patient.

She revealed her husband had been “visiting” the library while he recovered from heart surgery. He would stop by the library, stand outside the closed glass doors, cry, and smile as he watched the library staff work during pandemic.

According to caller, her husband had triple bypass surgery right next to his main artery and was very close to dying but the doctors used Dr. Floyd D. Loop’s procedure to do her husband’s triple bypass. Because of Dr. Loop and the library having this info available for the doctors to study, her husband was recovering nicely. “He’s a feisty Italian man,” she said.

She credited the doctors and the information the library provided with helping to save her husband’s life. She couldn’t wait to come pick up her book to look through the doors like her husband to thank the library staff.

The call became a bright spot in the gray covid-19 world for the library staff and it illustrates why medical librarians are passionate about what we do.

-If you have a story about the impact of medical librarians, please contact me and I will share it.

Medical Librarian Research Contributions to Guidelines Improves Patient Care

Doctors, nurses, and other members of the patient care team are faced with problems on a daily basis. Some of these problems are easier to solve than others. Some of these require more research to better understand and solve the problem. Clinical guidelines require research to find the highest quality of evidence with the most current, relevant data to determine the appropriate standard of care. Medical librarians are experts at providing that type of research.

In today’s post on a librarian’s impact in hospitals and patients, I would like to present the research done by a librarian at the Oncology Nursing Society who researched and co-authored a clinical practice guideline and a systematic review and meta-analysis.

ONS Guidelines™ for Opioid-Induced and Non-Opioid-Related Cancer Constipation.Rogers B, Ginex PK, Anbari A, Hanson BJ, LeFebvre KB, Lopez R, Thorpe DM, Wolles B, Moriarty KA, Maloney C, Vrabel M, Morgan RL.Oncol Nurs Forum. 2020 Nov 1;47(6):671-691. doi: 10.1188/20.ONF.671-691.PMID: 33063786

Management of Opioid-Induced and Non-Opioid-Related Constipation in Patients With Cancer: Systematic Review and Meta-Analysis.Ginex PK, Hanson BJ, LeFebvre KB, Lin Y, Moriarty KA, Maloney C, Vrabel M, Morgan RL.Oncol Nurs Forum. 2020 Nov 1;47(6):E211-E224. doi: 10.1188/20.ONF.E211-E224.PMID: 33063777

The guidelines included 13 recommendations for the management of opioid-induced and non-opioid-related constipation in patients with cancer. The guidelines were then implemented and their impact was evaluated and published. Translating Evidence to Practice: A Multisite Collaboration to Implement Guidelines and Improve Constipation Management in Patients With Cancer.Ginex PK, Arnal C, Ellis D, Guinigundo A, Liming K, Wade B.Clin J Oncol Nurs. 2021 Dec 1;25(6):721-724. doi: 10.1188/21.CJON.721-724.PMID: 34800103

According to Ginex et al. “Despite the prevalence of OIC (opioid-induced constipation), there is a paucity of research on management strategies.” The clinical practice guideline (PMID: 33063777) was implemented with nurse champions who identified practice gaps and improved the management of constipation among patients with cancer patients who were prescribed opiates. The authors noted that making local practice changes across multiple sites to reflect the national guidelines was not only “feasible but cost-effective.”

As noted in these articles, there were many people who helped research the problem, create the guidelines, and implement them across multiple locations. The librarian was part of the health care team that lead to improving patient care in a cost-effective way. As I mentioned the authors said there was a “paucity of research,” which is academic speak for there was not a lot of information on this topic and what was found, was hard to find. Thankfully they had a medical librarian on their team to find that hard to find research to help them.

Just as hospitals have experts who directly care for patients, it is also important for them to have librarians as experts to do the research and support the patient care teams. I can sew on a button, but you wouldn’t want me to close. You want a doctor who does that all the time. A doctor can find a good article, but if you want to find the evidence to impact patient care, you get a expert who spends everyday searching for evidence…a librarian.

Who knows it might just lead to improved patient care in a cost effective way.

Doctors Still Need the Paper to Help Treat Patients

Librarians often encounter people questioning the need for libraries when “everything is already online.” While a great deal of information is online, there is still a lot out there that isn’t but is still needed to help treat patients.

Here is an example where an older article was necessary to help a doctor treat a patient. (Below is a thank you email, the library received one Monday.)

Dear Librarians,
I requested an obscure article from 1981 on Friday night and received it today – photocopied by hand from a bound volume by your colleagues at the University of Cincinnati. The article has valuable information for the management of a pregnant patient with a rare antibody. It was referenced by a couple of later review articles, but they did not include all of the relevant clinical details that are described in the original paper, and that will be taken into account for our patient’s plan of care. I truly appreciate all of the work that you do to get the requested articles, and that you do it so quickly and seamlessly (from the requestor’s perspective). Thank you especially to your team, and to all of the medical librarians who provide such critical support in an era of exponentially increasing, and sometimes overwhelming, knowledge and publications.     

As the doctor mentioned there were articles available on the rare antibody, but they needed this older article with the “relevant clinical details” that wasn’t online to help treat the patient. This is a great example disproving the assumption that “everything is already online.”

Without the help of the medical librarians and the document delivery staff at the University of Cincinnati, it would have made treating this patient more difficult. These two libraries and the librarians working there helped to make an impact on patient care by providing information that was needed for their care plan.

-Do you have another example of medical librarians impacting healthcare? Please share them and I will profile them in future posts.

Change of Focus

I have kind of been on hiatus with my blog. As you all know a lot has been going on. The changes that covid-19 has brought to libraries, librarians, the office environment, home environment, socially, professionally, etc. has really kind of made things mentally topsy-turvy for me. As a result it has been hard for me to write, I have a ton of half written posts that seem to fizzle midway through as I get distracted or lack inspiration to finish.

However, what has been hanging out it in the back of my mind has been an interest to reshape the blog to focus more on the impact medical librarians have on patient care, the education/knowledge of medical professionals, and people in general. I would like this blog to feature these impact success stories from all around the world.

While I will do my best to seek them out, I am also looking to my fellow medical and health science librarians to help me share these stories, articles, and accomplishments. I feel we as a profession need to do more to make people aware of what a medical librarian can do to improve healthcare. This is my small way of trying to get that word out.

My intention is to have at least one post per month highlighting our impact. I would like to do more but it all depends on examples I can find and the number of submissions I receive. If you have an example you would like featured please send an email to mak1173atsignyahoodotcom with Krafty Library Impact as the subject (in order to avoid spam I intentionally did not hyperlink my email).

I look forward to sharing the good that we do.

-Krafty

Seeking Papers on Technology & Dissemination of Health Sciences Information

The Journal of the Medical Library Association (JMLA) Virtual Projects Section Advisory Committee is seeking current, innovative and notable technology projects in health sciences libraries for the 2021 JMLA Virtual Projects Section. The Virtual Project Section appears on an annual basis in the October issue of JMLA and recognizes projects that exemplify the range and direction of current technology developments in the dissemination of health sciences information. 

To be considered for the Virtual Projects Section, please submit a 200 word abstract of your virtual project, including why it is innovative/notable, and provide a link to your project web page (if possible) that describes or demonstrates the project. Find more information about the submission process and author guidelines for Virtual Projects. http://jmla.mlanet.org/ojs/jmla/about/submissions#authorGuidelines

Send your submissions to the Virtual Projects Section Co-Editor, Michelle Kraft, AHIP, kraftm@ccf.org, by APRIL 23, 2021.

Technology projects must have been implemented within the past two years. Submissions of virtual projects may demonstrate either the implementation of a new technology or a new application of an older technology. The Virtual Project Committee is also interested in submissions that reflect the paradigm shift in libraries intensified the COVID-19 pandemic.

These projects could demonstrate how libraries have leveraged this crisis to manage and create new collections and services to improve their user communities and include but are not limited to:
– Online Service Solutions
– Online Teaching
– Remote Workspace
– Privacy & Security
– Digital Equity, Inclusion & Access

Please consider sharing your knowledge and experience with implementing a new technology to contribute value to your library and encourage and guide your library colleagues!

JMLA Virtual Projects Section Advisory Committee:

Christine Andresen
Emily Hurst
Michelle Kraft, AHIP
Susan Lessick, AHIP, FMLA
Chelsea Misquith
J. Dale Prince, AHIP
Brian Zeli

My NCBI Login Changes in June

Tuesday, I got an email regarding Important Changes to NCBI Accounts Coming in 2021. Basically, NCBI will be transitioning away from NCBI managing logins (My NCBI, SciENcv, and MyBibliography) require people to login to their My NCBI using federated account credential from eRA Commons, Google login, or a university or institutional point of access to login.

While I get that NCBI wants to be out of the password management game, I have some concerns regarding the impact this might have.

The eRA Commons is primarily used by people and institutions for grants. “The eRA Commons is online interface where grant applicants, grantees and federal staff at NIH and grantor agencies can access and share administrative information relating to research grants.” Looking at the institutions listed on their list of federated institutions (login drop down menu on left side), it is primarily all universities and colleges which makes sense since it is for NIH grantees. I counted only 3 hospitals, Cincinnati Children’s Hospital, Mayo Clinic, and Johns Hopkins. Now several large hospitals partner with universities and colleges to do research, so some people at other hospitals might have this type of login through their research with a listed university, but many may not.

Google is a complicated hot mess in hospitals these days. Quite frankly I am surprised that NCBI didn’t realize this. In November, hospitals around the United States blocked access to Google and many social network and file sharing sites. The FBI issued a warning to hospital and health care institutions of credible cyber security threats using Google and other file sharing sites. With Google blocked at a majority of hospitals in the United States, this has the potential to cause problems logging into My NCBI using a Google account. This is not an unfounded concern, some hospital librarians have reported on medlib-l of difficulties using Docline with their Google login.

I emailed NCBI support asking how we could set up our institution so our users could login with an institutional account. I asked if this requires the institution to have single sign-on or if it is possible for libraries with proxy servers to implement something.

This was the response.

“The institutional 3rd party login is set up with InCommon participants and uses the institution’s login system to log users into My NCBI. For example, if a university is a member of InCommon and the institution is listed in the My NCBI login, the user can choose their university from the dropdown and login with their university credentials once their university is linked with My NCBI. If your institution is not already a member of InCommon, please have your network administrator contact InCommon here: https://incommon.org/federation/federation-join/. Once an institution is a participant in InCommon, the network administrator should email info@ncbi.nlm.nih.gov to be added to the list of 3rd party logins.”

InCommon is a fee based service to manage single sign-on, access to cloud and local services, and seamless global collaboration for students, faculty, staff, and researchers. The list of Federation entities is pretty long and still skews heavily to universities and colleges. So your institution must use InCommon to be able to login to MyNCBI via their institution. So hospitals who don’t allow single sign-on or don’t use InCommon for single sign-on will not be able to have their users sign on via their institution.

NCBI support said, “If your system is not able to participate in InCommon, there are other 3rd parties besides Google that will still work with My NCBI. These include eRA Commons for NIH grantees (already discussed above), ORCiD, or login.gov.

Since eRA Commons is for NIH grantees, it would seem ORCiD or login.gov are the best options for most users in hospitals who aren’t NIH grantees. I would guess that most hospital users don’t have ORCiD accounts. While ORCiD is intended as a single ID for researchers, there is no rule (that I know of) that requires you to be a researcher. So that may be an option. Login.gov “offers the public secure and provide online access to participating government programs” and that would be an additional option for hospitals.

It is disappointing that NCBI and NLM don’t seem to understand the access restrictions and issues in hospitals today. Recommending using Google as a login option clearly illustrates this. Most of the other options are also clearly more directed to grant researchers not the average hospital physician or librarian. I also understand NCBI’s desire to get out of the managing personal information (however, limited there is in My NCBI account). There is a definite desire in everyone to have better password management, balancing the desire for one login for everything like Google or single sign-on with the security risks versus managing multiple logins for multiple resources.

It seems that NCBI and NLM make changes to popular programs in vacuum or without consulting of the very people (especially “power users”) who use their products. I feel like the vast majority of hospitals will have to tell their users to use ORCiD or login.gov and will be unable to help their users have single sign-on via their institution.

This lack of understanding and lack of engagement was highlighted as an opportunity/challenge for NLM by the Medical Library Association/Association of Academic Health Sciences Libraries in their response to Request for Information (RFI): Strategic Opportunities and Challenges for the National Library of Medicine, National Institutes of Health. (Read the full text here, login required)

Regarding technological challenges the MLA/AAHSL committee stated:
“More support is needed for a national health information technological infrastructure that enhances interoperability, reduces risk, and maintains privacy and security of information. NLM should have a role in setting standards that prevent hospitals from creating systems that actively obstruct the free flow of health information, and support hospital librarians in their role in ensuring that their institutions meet these standards.
NLM must acknowledge and collaborate with technology companies so hospitals and health care professionals can better utilize the 21st century technologies that NLM and other technology companies are developing, and to ensure they are compliant with current and future federal and state regulations such as HIPAA. Many of the products, services, and initiatives from NLM and technology companies (e.g. data sharing and document sharing/storage) are blocked by institutions because they are considered a risk to healthcare security and HIPAA.”

Regarding the lack of engagement between NLM and users the MLA/AAHSL committee stated:

“Health Science Librarians as Key Stakeholders in the Future of the National Library of Medicine Health sciences librarians across the United States and globally continue to maintain a strong sense of connection to NLM through freely available, high quality resources such as PubMed and other NCBI databases. As “power users”, educators, and promoters of these resources to students, clinicians, and researchers, health sciences librarians have a vested interest in the design and content of these resources. As NLM grows in exciting new directions, health sciences librarians need to know that their voices and feedback are being heard and that we are being engaged in discussions regarding the redesign of current resources (such as PubMed) and the sunsetting of others (such as Genetics Home Reference). Current communication mechanisms, such as the NLM Director’s Musings from the Mezzanine blog, have assisted some, but these mechanisms appear to serve as marketing tools, rather than inviting honest feedback and true transparency. We call for a richer form of dialogue between our associations.”

So we will see in June if this change for My NCBI login is a big deal, or if I am worried about nothing. I hope it is not a big deal. I hope it goes over well with minimal problems. But it still doesn’t change the need for better communication, transparency, understanding, and collaboration between NLM and its core users and supporters.

Metadata Madness

Over the last year my library has been working on implementing a discovery product for our community hospitals’ website and it has been quite an adventure.

We wanted to create a better website to help unlock the siloed information that our library subscribes to. Library users have no clue that Hurst’s the Heart, is only available electronically via McGraw Hill. They could check the catalog, but they don’t. They go on to the library website and type the title in the search box. Now, as librarians, we know that unless you have a discovery system for that search box, the results come from the content on the library website, not within the resources listed on the website. Hurst’s the Heart is not on the library’s website, it is within the McGraw Hill website. I used this ebook as an example, but the same thing is true with other ebooks from other vendors, ejournals, PubMed articles, etc. People try and search the library’s website like it is Google and expect to get results from PubMed or elsewhere.

Librarians have curated and organized their little hearts out trying to make things easily found and navigated on the library website. But library websites seem to be a mystery to users. *Confession* I am a librarian and I am sometimes confused trying to find information on my public library’s site. Like it or not, the users (even savvy ones) expect a Google like experience.

In order to provide this type of search and retrieving ability on the library website, we decided to implement a discovery system. In theory, a user would type in the words heart attack and all of the library resources on heart attacks would be displayed. You would see the ebooks that have heart attack as a topic or chapter, PubMed and CINAHL articles on heart attack, UpToDate or Dynamed results on heart attack, etc. Now, heart attack is a simple search that would yield a lot of stuff, but you get the point. The discovery system would crawl through the library resources and find the items relevant to the search. Thus, unlocking the resources within the silos to be seen on one site, the library site.

However, in order to do this, the library resources MUST HAVE METADATA!!! I know that is a wild concept….the ebooks, articles, documents, videos, etc. all need metadata. The sad, strange truth is that library resources and library vendors have strayed away from good metadata.

Here are some examples:

– OCLC catalog records need EXTENSIVE cleaning and improving before they can go into a catalog. I sit on a large state wide consortium and the people who deal with loading the OCLC records continually lament that OCLC cataloging has really slipped.

– We were informed ProQuest Safari Textbooks MARC records will no longer have subject headings and lack important information for retrieval within the catalog. Incidentally I was told ProQuest was told their new subject-less records were fine by OCLC.

– ProQuest isn’t the only ebook problem vendor. McGraw Hill, ClinicalKey, and other publishers have crappy records as well. They are missing subjects (I am not even talking about MeSH…that is totally not there), authors, editors, chapters titles, etc.

Things get even worse when we start looking at videos and images. Good quality images or videos can be difficult to find, and think of all of the images and videos that are in our multi-resource platforms.

Looking to the future I get even more concerned. Have you done an “up to the minute” covid-19 literature search recently? If you have, then you will know much of the research out there exists in pre-print. Pre-print is the wild west with metadata. To be clear I am not expecting any sort of indexing like you would find on a MEDLINE record. But depending on the item and the database, titles can be incorrect, authors missing, and the data from the abstract or full text is missing. You may not notice this at first glance, because the title, authors, and abstract/full text are on the screen and can be seen by your eyes BUT try and load that sucker into EndNote and you will see a blank record and “missing data.” This happens a lot with medRxiv records. Another example, you discover a good keyword in the abstract you hadn’t thought of, and you search that word in the database but don’t retrieve the same article you discovered it from. That is because the metadata for that article is missing.

The National Library of Medicine wants to make data sets retrievable and there are a lot of other places that you can search for data sets. IMHO searching for data sets is only slightly worse than searching the pre-print literature. The metadata indicating what data is searchable is all over the place and there are few standards on what metadata is required for databases or search engines to search.

In addition to missing metadata, we have the problem of metadata hoarding. Depending the company you purchase your discovery product from, the product may not do a great job of searching (if it searches at all) other library companies’ products. For example EBSCO’s Discovery does a great job discovering EBSCO products like CINAHL and DynaMed, but it has problems discovering ebooks in ClinicalKey and ProQuest things. Same with ProQuest’s Summon, it does awesome with ProQuest things but falls short with EBSCO and ClinicalKey things. Library vendors are not making their metadata equally available to discovery product vendors. I can sort of understand the reasoning if you have companies with competing discovery products. I may not like it, but I get it. But I don’t understand why ebook and other companies with no discovery product aren’t tripping over themselves to make their metadata available to discovery vendors.

We noticed this metadata hoarding problem when trying to implement our discovery product. What was our duct tape solution? We loaded all of the ebook records for those non-participatory vendors into our catalog and made our catalog discoverable. Now why did I say that was a duct tape solution? Because, the batch catalog records from these companies are often bad, missing key things like subjects, they lack chapter information, and they sure has heck don’t have the full text. The discovery system can only “discover” the ebook from the information within the bad catalog record. So if there is a book with the most perfect chapter on your topic but a poor record, the discovery system will never show the book. *Note* Not all catalog systems will work with a discovery system. The duct tape method I described won’t work if your catalog isn’t compatible. Also, we clean up the poor batch records, so eventually the records are improved, but it isn’t like having good metadata to the full text.

Why am I going on a missing metadata rant?

As more and more things are online and library collections are not browsable on websites, the metadata of these resources becomes essential to their discoverability and usability. If someone does a search and an item can’t be found, it won’t get used. If it doesn’t get used, it gets dropped. Usage stats are paramount to getting resources renewed. Sucky usage stats, and we drop a product like a hot potato. I don’t have the budget to babysit a potentially good tool that isn’t getting used. I have a long wish list of items to take its place in the budget.

We also need the metadata to improve because not everyone uses a library. A lot of researchers use PubMed, Google Scholar, medRxiv, data repositories, and video libraries, for their scholarly purposes. NLM is great for published articles, but has fallen behind in the non-print arena. Publishers and other companies are creating their own metadata “standards” which are far from standard and agreed upon. Due to poor metadata and lack of leadership in metadata standards, we risk having a generation of information lost in a quagmire half done metadata never to be retrieved.

Hot Financial Mess

On July 14th my fellow librarians and I spoke on the webinar, Facilities and Personnel Management While Your Library is Closed, Open, Reopening or Somewhere In-Between. In that webinar one of the things I briefly touched up on was library budget and the impact from covid-19.

Well, brace yourselves medical librarians and library vendors, because 2020 and 2021 are going to be a hot mess financially. So when we say we have no money, please know it is worse that the library has no money. We have no money means our funding agency, our institution and/or state literally has no money.

The only way I can easily discuss it is to break it into two parts, hospitals and universities/colleges. Many had financial problems prior to the pandemic. But all have been impacted financially by the coronavirus but in different ways.

Hospitals:
There had been a shift in recent years where smaller rural or urban, less profitable hospitals have been either bought by larger systems or were closed due to several financial reasons. So the idea that some hospitals have been losing money hasn’t been new. But now with the coronavirus even large previously financially healthy hospital systems have seen losses in the hundreds of millions to billions of dollars.

To sum up the articles listed above, and many others like them, major hospital systems are losing a lot of money due to the coronavirus. Smaller hospitals that were on financially unstable ground have been devastated financially. The AHA estimates that the net financial impact over a 4 month period will be $36.6 billion. Lost revenue from cancelled surgeries, additional costs associated with purchasing PPE, drug shortage costs, wage and labor costs, have all compounded to make it so EVERY hospital in America is losing a lot of money.

The hospitals have second problem related to COVID-19. As millions of Americans lose their jobs they lose their healthcare benefits. That means as people lose their health insurance they won’t be going to doctors, clinics or the hospitals for procedures. They will put it off. And if these unemployed people are in one of the 13 states that did not expand Medicaid under the ACA, that means those unemployed can’t even get health insurance under Medicaid. This translates to even less procedures and money for hospitals at a time when they need it.

University and Colleges:
Like hospitals, there has been a downward financial trend for some universities and colleges that was related to the shrinking number of high school students entering college. The generation following the millennials is significantly smaller. Many colleges had hoped to supplement this downward demographic trend with international students. However, that became problematic as a result of government policies.

The authors of the NBCNews.com article, “A Crisis is looming for US colleges – and not just because of the pandemic” and researchers from The Hechinger Report, used financial data from 2009-2018 and identified more than 500 colleges or universities with warning signs of financial stress, prior to the pandemic. Ohio and Illinois have most institutions in financial jeopardy. Many of the state institutions have NOT climbed back to funding levels prior to the 2008 Great Recession. *Note this data is PRIOR to the coronavirus, the pandemic has exacerbated these 500 colleges financial woes AND has cause financial losses to the rest who are/were financially sound.

Again to summarize the articles above, the coronavirus is impacting more than just revenue from tuition dollars. Colleges and universities were faced with spring room and board refunds. If students cannot return to campus and must do elearning, colleges must still pay the heating, electrical, and other maintenance things that student housing dollars paid for. Disillusioned with spring elearning, many students are reluctant to continue paying tuition to their institution, and electing to do a gap year or get pre-requisite course at their community college for less money.

Then you have sports. Because the NCAA basketball tournament was cancelled, schools and conferences that participated in the tournament lost 62% of $600 million to be dispersed to the schools and conference. If football is cancelled (and it is looking more and more like it will be) that is a possible $4 billion in revenue that will be lost. You may think well that is less money the institutions have to shell out to support sports at the expense of academic and if you are, you are missing a big piece of the financial pie. That is hundreds of millions of dollars that were being distributed to schools that is suddenly gone. Yet the schools are still on the hook for student athlete scholarships, heating, electricity, maintenance of the facilities. IF the school is not one of the 23 public NCAA athletic programs that is considered self sufficient, then that loss of financial support is a double whammy.

What this all boils down to is hospital and academic medical libraries are in a significantly worse financial position than they were in recent years. I am not a financial analyst but I would venture to say that it will be worse than the 2008 Great Recession. It is estimated that roughly $200 billion will be lost from states by June of next year. It is unlikely there will be much support from the state either.

So don’t be surprised if librarians are saying they don’t have any money. They don’t. Now is the time for vendors and librarians to work together to weather this financial storm. Both must be willing to negotiate renewal costs and think creatively. Consider multi-year agreements that have 0% renewal or a cut in price, that can gradually increase in subsequent years. Understand that some very well used resources may still need to be cut. Even if every library resource had 0% renewal price for 2021, but the library has a 20% budget cut, something will have to get cut. Librarians, work with your administration to help them understand if a multi-year agreement is beneficial. Vendors, I am not asking you to go bankrupt (that doesn’t help you or us) but please start thinking out of the box as to how we both can financially afford to be in business together, which might mean less profit in 2021. BTW deferring a full price bill that is due Jan 2021 for April 2021 is NOT help. Our budgets are set for the WHOLE year, so if I don’t have the money to pay your bill in January, I sure as hell won’t have it in April.

We are in for a hot financial mess for 2021 and 2022. Let’s all try to figure this out together so that we have something to build from in the future.

Things I’ve Learned Managing a Library During this Crisis

First I want to recommend Zach Osborne’s post “Hospital Librarianship during the COVID-19 Pandemic” as a really good description of what it is like right now as a hospital librarian. I couldn’t have expressed it better.

I also want to share some of the things I have learned during this time. I think the easiest way is to just do a list.

  • Some key library infrastructure systems do NOT work from home.
    • We found both our ILS (Innovative Interfaces) and Illiad do not allow for us to do back office work (set up accounts, catalog, order articles, etc.) when we aren’t on our institution’s IP range.
      • VPN isn’t the answer because our IP is still our personal Internet Service Provider not the institution’s IP address.
      • We had to create a frustrating work around and that limits the number of people who can get into the systems. But at least it is a work around.
    • NOT everything is available online!!! I can’t stress this enough. There are articles that healthcare people need from the 1990’s that aren’t online.
      • These are older articles on antivirals, ventilators, triage, etc. that are VERY MUCH needed by frontline personnel, researchers, and administration during this pandemic.
      • This is especially difficult to deal with since the National Library of Medicine and many academic medical libraries are not providing ILL’s to these type of articles because they have nobody in their libraries. I feel sick to my stomach that we can’t get people these needed things at this time.
  • Don’t worry about the books. Shocker, a librarian is saying this.
    • Contact your ILS to see if you can set autorenewals for all outstanding items.
    • IF you charge fines, waive them during this time.
    • Establish a procedure for handling returned books. Because people will try and return them now, and they will return them eventually when this is all over.
    • Post signs on your website, book return, and library doors for patrons not to worry about returning and fines.
  • Let staff take their computer monitors, mice, docking stations home so they can be as comfortable working online as possible.
    • Create a document stating the employee has your permission to take the listed items to use as they work from home and they understand that these items must be returned when they return to work on campus.
  • Document everything you can, you never know when and what you will need. Think of how you can show your library’s value during this time if/when there are budget cuts later as a result of the crisis.
    • It is especially important to track any searches, document deliveries, projects, help that you did specifically related to covid-19.
      • This might be difficult if the requestor doesn’t say it is for covid-19 or if it doesn’t have covid-19 in the title. But it is safe to assume topics on ventilators, ARD, antivirals, intubation, and triage can’t be counted. Another “hidden” topic is the larger topic of internal medicine, many people are brushing up on internal medicine as they are reassigned to those floors, so look at those a little closer.
  • Be flexible in your new work space and take breaks and encourage your co-workers and staff to do the same.
    • Nobody sits at their desk at work all day. They walk to meetings, lunch, talk to co-workers, retrive things from the printer, etc. So don’t sit at your home desk all day. Get up, take a quick walk, chat with a co-worker.
    • I can’t remember where I heard this, but make it a goal to reach out to at least 5 people each day (no your pet or the people in your house do not count). It is too easy accidentally socially isolate yourself.
    • Remember nobody is perfect, everybody is having struggles too.
  • Finally do what is right for you, your staff, your library and institution.
    • This means that there isn’t one right way to staff a library during a pandemic. It all depends on balancing your institution’s rules and safety.
      • Some libraries will need everyone to work from home.
      • Some will have a split staff.
      • Some will close the space to patrons but have staff come in.
      • Hospitals may have different staffing rules.
      • Colleges may want the space to be open to students so they can spread out and study/work, but the library staff work remotely.

I know it seems a bit overwhelming but now is also the time to start planning the reopening of the library and resumption of services. Create a brainstorming document where you can list the things you need to think about when you do reopen.

Here is what is on my reopening list so far:

  • Do we need to limit the number of people in the library (including staff)?
  • Does staff need to wear masks? What about patrons?
  • Should we mark off where people should stand waiting/talking to someone at the front desk?
  • Thinking about making “Use Another Computer” or “Use Another Desk/Chair” signs to post at every other spot.

I hope this is helpful and everyone is staying safe.