Why is the Hospital Library Disappearing?

This May the Medical Library Association and Association of Academic Health Sciences Libraries released the “Statement on the Global Economic Crisis and its Impact on the Health Sciences Library Collections.” 

Budget pressures are hitting academic medical libraries as well has hospital libraries.  Yet as the statement says, these libraries are “pivotal to the success of all health care organizations.” The libraries’ collections and services support the institutions information needs including providing information to medical professionals for patient care.  However the economy and budget pressures have forced many libraries to make substantial cutbacks resulting in smaller collections of regular and online resources and fewer library staff to provide services.  According to a recent AAHSL survey “many academic libraries had mid-year budget reductions in the current fiscal year, and nearly 70% are expecting budget cuts for the coming year, some of which could be 10% or higher. In many cases these are permanent cuts to libraries budgets.” 

If large academic medical libraries are feeling the pinch, you better believe the smaller hospital library is in a vice grip.  I almost wonder if they were our canary in the tunnel.  And in some instances I can say yes.  Yet at other times I often wonder why a hospital hasn’t already cut their library.  As a medical librarian and one whose previous job was working in a community hospital this may come across as a pretty odd statement. 

Every day I encounter different librarians and libraries at all different levels and I am amazed and saddened by the ones who provided wonderful services with limited budgets and resources yet all of a sudden found their job reduced or eliminated.  But for each of those super librarians I unfortunately run into, I also run into librarians who seem to be stuck in a time warp and are running a 1980 library in 2009 and wondering why their budget is cut every year.  I am not saying these librarians have to be on Twitter or doing the latest and greatest things with technology.  But these librarians have got to be looking at future and seeing and evaluating whether their resources and services they have in today’s environment are relevant to their institution.

While I was at MLA I sat in on several committees, meetings, and section programs.  There were heated debates on the state of the hospital library.  One very heated debate centered around the hospitals without librarians ordering on DOCLINE.  This even spilled out on to Medlib-l email list.  Yet can you blame a hospital for eliminating its library when the librarian has not activated one online journal title?  Can you blame the hospital library for outsourcing its document delivery (or trying to use DOCLINE on the sly) when their librarian did not have an online document delivery program in process and received their articles through the mail and then turned around and sent them to the doctor via inter-office mail?  Can you blame the hospital administrator for believing everything is online through Google when the librarian didn’t even have an online catalog or bother to add the URLs to the 856 field of the catalog? 

Some of you may think I exaggerate the state of some hospital libraries, I can assure you I have been to these type of libraries through my travels.   Each time I see them I silently shake my head and wonder how long they will be at their job or if the library will survive when they retire.  What makes me frustrated is that these librarians either don’t realize that they are slowing killing their library or they are so close to retirement they don’t care.   I have seen enough hospital libraries close once the librarian retires and the hospital either outsources their needs from companies or another hospital library picks up the pieces. 

Now days academic medical libraries are feeling the pinch of the economy and they are being asked to do more with less.  How they respond will predict their outcome.  If they become complacent or ignore the future issues, they will encounter many of the same problems as hospital libraries and librarians have been dealing with for quite a while.  Time to stop thinking about your users coming to you, but how you can come to your users.   That may not prevent all closures and cutbacks like those hospital librarians who were cut despite the wonderful services they provided.  But to do otherwise will almost assuredly land your library in the same spot as the hospital library that  still relies on card catalogs and has no links to their electronic collection.

24 thoughts on “Why is the Hospital Library Disappearing?”

  1. Part of the issue is that librarians become as attached their services as they do their cars.

    People put so many of their limited resources into their cars that when they break down they invest even more. The cost of repairs to keep in running has the added impact of siphoning off resources which could be used to buy a new one.

    Similarly, librarians put so many of their limited resources into developing services and put even more into maintaining them. This siphons away resources which could be used to develop new ones.

    I haven’t worked out the other half of the analogy yet. But it strikes me that librarians need to treat their services more like they do their cell phones. They need to invest just enough so they are willing to toss them aside for a new model every two years.

  2. I’m also a former hospital librarian, and I’d like to take issue with a part of what you’ve said, while agreeing with other of your statements. I too have observed shoddy practices, or libraries and librarians which are little more than collections and their caretakers – not just a 1980s perspective, but something far older that goes back to the earliest years of medical librarianship, when hospital libraries were merely in-house repositories of physicians’ own private collections, and the clerical staff hired to take care of them, dragons at the gates.

    However, it seems a bit simplistic to dismiss this latest loss of funding as the fault of victims who have failed to grow and change with the times. After all, the same can be said of libraries in any other setting. Hospital libraries and librarians are widely diverse, and many have done some very fancy footwork in the past several decades – integrating themselves with resident and medical student objectives; with quality assurance initiatives as Six Sigma consultants; taking the lead on new technologies (like the PDA). Yet you may reflect the sentiment of others in the profession, in saying

    “Now days academic medical libraries are feeling the pinch of the economy and they are being asked to do more with less. How they respond will predict their outcome. If they become complacent or ignore the future issues, they will encounter many of the same problems as hospital libraries and librarians have been dealing with for quite a while.”

    The outcome – loss of funding, failure, closing of libraries – is most certainly not a result only of failure to plan or to respond on the part of hospital librarian. There is so much more to be said and done here. I do not feel that we can walk away from colleagues (even in print, even for a moment) without taking the time to acknowledge, even to explore and speak out about, their contributions, their tremendous importance – and to ask how we as researchers, faculty, associations – can understand this crisis. Because it is certainly that, and unless we do take the time to understand in more depth, we may inadvertently do injury to the entire profession. Otherwise, it sounds like we’ve begun to prepare an eulogy Alas poor Yorrick – I knew him well! when in fact, we knew nothing well at all – certainly not whether the actions of a shoddy few have rung the knell for those many who serve so excellently well, and who still are worth our attention and support.

  3. Nice of you to be so judgmental about us idiot backwoods community hospital librarians. How about the fact that requesting articles or lit searches takes time because the librarians are only allowed to work part time. How about the fact that having an OPAC costs $$ that is simply not available. How about the fact that I’m so far from retirement age, you’ll beat me to it by a wide margin.

    I hear what you’re saying about librarians who do not want to look into positive change. But those of us who are struggling to figure out ways to better library services (and yes, keep getting paid to do our work), need help and suggestions that are geared to our minuscule budgets, not just coverage about all the cool new stuff for the major research libraries. But hey, maybe I’m just out of the loop because I’ll never be able to afford to go to a conference like the MLA. Helpful ideas and suggestions would go a heck of a lot further to help keep the community hospital libraries alive, not snotty remarks from those who’ve moved up the food chain and feel they’re in position to judge.

  4. The philosopher Heinz von Forster once remarked “If you pick up a library and shake it information doesn’t drop out the bottom”. It would be an interesting experiment for management to padlock the door of a hospital library one day and leave an I-Mac and I-Phone outside for each member of staff with a note saying “Your library is officially closed. Take these toys and go off and interact with your clients.” Some of us might go home and cry. Others might set up our new library in the cafeteria, become ubiquitous informationists and clinical librarians providing a 24/7 service. Librarianship is not a job – it’s an informed state of mind.

  5. I tried saying as much at a meeting the other day but it couldn’t be better put here:

    Every day I encounter different librarians and libraries at all different levels and I am amazed and saddened by the ones who provided wonderful services with limited budgets and resources yet all of a sudden found their job reduced or eliminated. But for each of those super librarians I unfortunately run into, I also run into librarians who seem to be stuck in a time warp and are running a 1980 library in 2009 and wondering why their budget is cut every year.

  6. Henny Penny,
    I was a community hospital librarian and I am working with several community hospital librarians right now. I think am completely in a position to make my statements.
    When I came to my community hospital library there were 2 online journals, a card catalog, and no web pressence. To not work to improve that situation would be inexcusable for any hospital librarian, plain and simple.

    Unfortunately you haven’t been reading my blog for a long time because if you had then you would realize that in the five years that I have been writing it that I have come up with many examples on funding, staffing, services, etc. for small hospital libraries. Granted some of my focus this last year has been on larger hospital libraries but that still doesn’t mean I haven’t passed along good ideas and examples of what is available and what others are doing.

    Some of these ideas and examples are from what I learned on the job working at my library and some are from other librarians’ experiences.

    Here is just a sample of the things I have previously written about on my blog regarding how to get new or different resources with little or no increase in budget:

    -There are inexpensive good catalog systems out there, CyberTools is one & it specializes in small medical libraries. I paid for it by cutting one little used journal title subscription.
    -There are free open source catalogs. But if you don’t have the programming skills or time many small libraries have used LibraryThing to get their colleciton out there.
    -Having an online system allows you to collect all sorts of usage data that may have been to cumbersome to collect manually.
    -Getting an online catalog does require some time selecting the right system for you library and your budget.
    -Implentation can take time but it goes much faster if you have volunteers. My entire collection had to be added into the system one by one. I got it all done in 3 months with the help of 3 volunteers (2 library school students and one regular volunteer).

    -Activate all of the online journal titles that come free with your print subscriptions. I did this and it took no extra money. It is simple to do and requires very little time.
    -Online journal access provides another method for easily collection of usage data.
    -Link to open access medical title collections. Again they are free and it is quick and easy to do. However they usually don’t give usage statistics.
    -Set up LinkOut on PubMed. People want to know what is available online and available through the library, if you don’t set up LinkOut it makes it that much more difficult for them. This is also free and depending on the size of your collection and how up to date your SERHOLD list is it is a quick process.

    -Create a web presence. Every library should have some sort of online web page. IF you don’t have one on at least the Intranet ask IT if you can get one. IT departments aren’t the most flexible of departments but they usually will approve of this type of request and they usually have a specific easy to use WYSIWYG software to do it. IF you for some reason you can’t get a web presence from IT create one online using free web software like a wiki. Wiki’s make it easy to create a web presence.

    -Apply for grants! This is free money!!! Why people don’t apply for relevant grants is beyond me. For example the GMR has Technology Improvement Award. IT is $4900 for the purchase, installation, and/or upgrading of information technologies that enhance access to health information. This kind of money would pay for: CyberTools, off campus access using Athens, A-Z journal product, possibly a link resolver system, web development software, computers, scanners, etc.
    -I applied for a grant (not the GMR one) and I used that money to provide 3 year access to EBSCO’s LinkSource and off campus authentication using Athens. During those three years I collected every possible usage statistic and did user education and outreach on finding journals and online information. I am proud to say that usage double every year during those 3 years and because I was able to show hard usage numbers to my adminstrators the hospital continued the funding after the grant stopped paying.

    -Stay current by being active in the profession. This can be done by going to MLA. MLA has a grant for librarians who would like attend the meeting. This year I listed several other MLA meeting grants and awards that various sections, SIGs, and groups had available for those wishing to attend the meeting and can’t afford to go. But if you don’t qualify for those grants or awards and still can’t afford to go, there are other opportunities to be active.
    -Regional meetings are usually closer to your home than the national meeting and are for fewer days which means they are also cheaper to attend. They also provide the opportunity to meet with and discuss issues with librairans in your region who might provide a fresh perspective unique to your local area librarians.
    -State and local meetings. These are much closer to your home and often you can sleep in your own bed at night. They are rarely longer than long afternoon or work day, meaning you aren’t away from your library too long.
    -Finally there are a lot of low cost or free online meetings that are springing up on the Internet. NNLM often lists a few every so often.
    -There are a lot of ways to get involved and stay up to date and learn from others for little or no money and you don’t have to go to the Annual Meeting each year (or ever) to do it.

    Those are just a few of the many things that I have written about in the past that would be helpful to small hospital librarians. I have other examples like how a librarian got her hospital library more involved as a community health resource by partnering with the local public library. Ohter librarians worked closely with their doctors to start a prescription for information program. I don’t ignore the community hospital librarians on behalf of large institutional hospital or academic libraries. I look at all things of interest to all medical librarians, which means I have a little bit of everything for everyone.

    I have at least 30 more years before I am close to retiring. It is a good long time and libraries and librarians will have changed several times. The real tragedy are the librarians who are layed off or who have their hours reduced despite the fact that they are doing innovative services. I don’t know what can be done about that. But the librarians who are comfortable with status quo and who are unwilling to stay up to date with trends, services, and technology and don’t look at every possible way to change that situation should have their libraries closed because they aren’t serving their population. You can only lead these “poor me” librarians to water so often and if they keep refusing to drink then at some point in time you have to know when to stop and let them deal with the reprocussions.

  7. I feel heart broken by the news of another hospital library closing.
    I lost a valued colleague who was informed when she went to renew her journals that there was no budget for print. She was to only have online journals. Danger bells started ringing in her head, she was not surprised to find out later, since there was no need for checking in and copying the journals, her hours would be reduced, and then surprise – her job was eliminated. “We are following a new model of information services with electronic only delivery.”

    I do have holdings in LinkOut, I did it immediately after getting the training at my state Medical Library Association meeting.I make sure to activate all my free with print online journals and I have gotten a grant to buy a desktop scanner so that I can send my ILLs as email attachments and paid for the full program of Adobe Acrobat so the file size is small enough to work within the restrictions of my email account.

    But everyday, I wonder if I have done enough. I entered my catalog into the OCLC system and can share my holding at the public library, but this system won’t work within my facility, so I will take another look at CYBERTOOLS and LIBRARYTHING so that I can get rid of my card catalog before you come and see me as a “waiting to retire” librarian.

    The economy is really the elephant in the room. It may be that even in the information age, information professionals are not going to be employed in small one person libraries any longer. It may not be economically feasible, even with progressive service and a staff that relies on your help. I am hoping that working in a facility that is trying to become a magnet hospital the value of what I do is seen as cost effective. But everyday I appreciate the fact that I am a member of a small cadre of hospital librarians and there is no promise that my job will be here tomorrow, but while it lasts. I love what I do, I work hard to please the people I serve and I think it shows.

  8. I inherited a hospital library that meets your description – maybe not quite a 1980 library…. I’d call it an early 90s at best. After I was hired I developed a comprehensive library website. I applied and received GMR’s technology grant and started a document delivery service. I use Docline and linked our collection into PubMed using LinkedIn. I’ve purchased electronic book and journal packages and get every title I can afford in an electronic format. I market my services throughout the hospital and muscled my way into patient and employee programs. I pay out of pocket to attend conferences and serve on committees.

    I read this blog often and benefit from many of the ideas offered here, but this left a sour taste in my mouth. You’ve lumped hospital libraries into a single category, painting an image of decrepit stewards of aging collections. My library provides high end information services on a small budget. It is cost efficient and an outstanding value to my institution. I am not ashamed of being a hospital librarian.

  9. Kathy,
    I don’t want you to think that you are another librarian waiting to retire. As you have described your library and what you do, I wouldn’t think you are. But to be honest we have all seen some of those librarians and their libraries.

    Oh yes the elephant is most definitely the economy. But hospital libraries have been closing way before our economy got really crummy.

    I think to a certain extent we (librarians in general) are not associated as online information professionals in the age of everything is free and on Google. They don’t realize that we are the ones who maintain the URLs, do license agreements, subscribe to relevant databases, etc. Admin still thinks of us a books and journals kind of group and sometimes erroneously outsource our jobs to the IT department or outisde information companies. That is why having up to date online resource is important AND providing relevant services that get you out of the library and seen as the online information professional is almost more important.

    The elephant is most definitely the economy. But hospital libraries have been closing way before our economy got really crummy. That is because we are inivisible infrastructure to a certain extend. If we are not relevant or seen as relevant by admin then it is easy for them to think that they can get by without us.

    I think academic medical libraries are now starting to see this more than they used to.

  10. Elizabeth, I don’t mean to lump all hospital libraries and librarians into one single category and my appologies if that is the way it reads or appears.

    My intention was to call attention and pull the veil from the eyes from those people who are in hospital libraries who aren’t active and who aren’t looking at new ways to improve their library who are sitting back and doing things the way they always have for 20-30 years without seriously evaluating their services and their libraries. Just because you have always done it a certain way means that you should or shouldn’t keep doing it. Look at it and think if you can do things better, whether it is TOC services, copy services, document delivery, cataloging, journal check in, book ordering, user eduation, etc.

    I think there is a dirty little secret out there in library world where we all know of those places where the librarian cries poor me but does not or will not look at other options or alternatives. You can only help those people with suggestions on alternative funding, creative strategies, and alternative services so much before it feels like you are talking to a brick wall. Yet despite your help or available help from other groups (MLA, local orgs, or colleagues) they still complain that they don’t have money, time, or support to do anything.

    Not all hospital libraries and librarians are alike, there are very good ones that run on budgets large and small. They are very poor ones that run on budgets large and small. Hospital libraries that did not adapt nor provide relevant services (regardless of their budget or staff) saw themselves on the short end. Academic medical libraries that have been slow to adapt are now starting to see some of that same type of enhanced scrutiny due to the economy. There used be a time in the not so distant past that universities and colleges put great amounts of money into collections and buildings to boast that they had X, Y, Z on this, that, and the other. Not so now. Collections are downsizing and attention is now on services.

    Unfortunately I think there will always be those libraries (hospital, public, academic, special) that despite providing stellar service and innovative programming are downsized or elminated. That is most unfortunate and I can only hope those librarians find jobs elsewhere quickly because there is a library out there who needs and wants them. But there are some libraries out there that quite simply do not meet the needs of their users, what do you do with them? What do you do with the librarian who runs them? Answer that as a librarian and then answer that as administrator who has to deal with 30 other departments and the institutional budget.

  11. hie. interesting comments by all, it seems that even in a third world country like mine, the problems that medical libraries face are the same as those in your developed world. my request is for suggestion on how i can make my library better in an environment where i dont get access to any grants. and i have poor internet and a very torn and tattered collection of ancient medical books..that is my challenge.

  12. As someone who started in a hospital library and detoured to academia before consulting & outreach, I’ve heard far too many stories of librarians doing the right thing and fighting, often losing, battles with administrators and outside consultants – especially the latter. But there ARE many who could do more. Without standards for knowledge-based information services that are more specific than what we have now, there is nothing to prevent the loss of professional librarians. I agree with everything Krafty Librarian writes, and would go further. Health science librarians need to be MORE involved in advocay efforts and calling for higher standards. We need to show (document) the link between effective services and improved outcomes. So get outside the library walls – work with your clients AND your professional organizations. Budget some of your personal income and time for professional development. Be open to new ways, and learn the language of those who make decisions. And be sure you serve them as well as the care providers…

  13. It is true many hospital libraries is closing because of budget/financial constraint. Our view in developing country like Uganda think the issues of the budget constraints only affect libraries in poor countries. there one thing which I need to mention. For example in Gulu we are struggling to open a hospital library despite the budget problem noted — the need for hospital library is very high here and we are going to open among this many problem. We should not stop the services of Hospital Library completely because of budget problem, information is the driver for all economy, including health of a country.

  14. Are there any reports available on the “state of” the non-academic hospital library, and, if they continue to go by the wayside, how clinicians are accessing clinical information in the hospital setting?

  15. Fred, I am not sure about any official reports of the “state of” non-academic hospital libraries. While it is poor “official proof” there is a lot of anecdotal evidence that is seen the email lists, at meetings, etc. I know within my 8 hospital system 4 of the 8 have no librarians or libraries and 2 have part time librarians. In my career two of the hospitals used to have libraries and librarians but one hospital laid a librarian off and the other chose not to replace the librarian when she retired. That happend several years ago and those libraries within those hospitals are pretty much gone. There is nobody acting on behalf of those hospitals for library resources, so while we has the mothership of the large system try to provide system wide resources we have no contact information at those hospitals (despite many years and several attemps) to get them to help pay for their share of costs for medical information products like MDConsult, CINHAL, full text journals like JAMA and NEJM. These are all what we would consider basic core resources but many of those hospitals without librarians don’t realize these are a need and think they only need one product or doctors do just fine Googling it.
    I honestly wonder about the legal liabilities of hospitals that don’t have librarians or library resources, have poor access to resources, and have an administration that thinks doctors can just Google things or “get by” with one product. What happens when a doctor makes a poor patient care decision based on the ineadquate information? What happens when there is unequal access to medical resources within a hospital system? It just takes one multi million dollar lawsuit to make the cost of library resources (ranging from a few hundered dollars to a couple hundred thousand depending on product and size of hospital) look like peanuts. Yet many library budgets are cut to the bone, closed, or disappeared through retirement. Electronic resources such as ebooks, ejournals, and electronic databases are NOT cheaper than the old way printed materials, it is way more expensive. The cost to have a decent library has gone up beyond inflation and hospital libraries are asked to provide these resources on smaller budgets. If they can’t afford to provide these resources they risk beeing seen as becoming behind the times and irrelevant which then administration is loathe to fund. Hospital libraries were the canary in the mine, academic medical libraries are now seeing this downward spiral as well.

    That turned into a long answer to your short question, sorry. If you are looking for a report you might contact the Medical Library Association to see if they know of any recent ones.

  16. I’ve recently aquired the supervision of our Library. All your comments sure hit home and I can see I need some serious help to clean up Grandma’s Attic, which is what this library is often referred to. Not even sure where to start. Is there anyone out there willing to give me some advise?

  17. Diane, I helped move a library into the 21st century (got online catalog, website, ejournals, etc.) I can help. Just a quick question, are you a librarian? I ask because some non-librarians (nursing administration, secretaires, physician administration, etc) have been assigned to “deal” with the library and there is a big learning curve for non-librarians to know about the vendors, procedures, products, skills and knowledge to move a library forward.

  18. I started my job in August. I am dealing with 1980s library. I am hoping to implement a catalog soon, update our Intranet, but the biggest challenge is changing perceptions.

  19. If hospital libraries have been operating on an outdated paradigm it’s management’s fault, not the librarians. If a hospital’s management tolerates–dare I say encourages–low quality performance, outdated collections & technology, that’s what they get, and they attract low performers.

  20. I worked in a hospital library for 30 years and one day I was called into an office and told I was being laid off. I was a Medical Library Assistant in charge of Interlibrary Loan, borrowing and lending. Now what has always bothered me about librarians is that they seem to think they are running libraries without support staff. None of these posts even mention their fellow staff members. I was a very qualified library assistant who had to know medical terminology, computers, PDF email programs and handling the demands of physicians, nurses, and administrators AND other libraries. I used Docline, OCLC etc. I was even past president of COLTS, coalition of library technicians. I had a very demanding job but I did not have a library degree in librarianship. Many of the hospital librarians have support staff working side by side with them. And those support staff have just as much investment, love, and devotion to the library as the librarians have. I was part of the team. But any time I read articles regarding libraries being underfunded or under assault in any way I never read any librarian acknowledging the support staff who do mountains of work and keep the whole operation going.

  21. I agree library technicians are a very important part of the library. I know we wouldn’t be able to do half the stuff we do in my current library without our library techs. I think there might be a few reasons you don’t often hear as much about library support staff when you hear about cuts to medical libraries. One reason is that a large amount of hospital libraries are staffed by solo librarians. These people don’t have another staff person (librarian or tech) to help run the library. The second reason might be a matter of perspective. Sometimes the author and the reader’s perspective is different for the same pieces. I don’t specifically about the library techs but I know the times when I say we provide ILL’s or we work the front desk, I don’t specifically say the librarians and the library techs because both librarians and library techs do those jobs at our library. Every person at our library (including the director) works the front desk answering questions. I know when I talk about cuts, I often don’t even talk about the personnel cuts. I talk more about the resources that are cut. Personnel cuts are much more complicated and usually are the very last resort.
    I am sure there are times where I should have included the term library tech more appropriately in my writings. I will try to think about that a bit more as I write. One way to get more people aware of library techs impact in the libraries is to write about it. Perhaps you or somebody you know would be good at that. It is always good to hear different voices no matter if they are librarians, library techs, patrons, admin, etc.

  22. Thanks for your comment. I think the term non-librarian should be retired as well. I wasn’t a non anything. I was a something and that something was a Medical Library Assistant/Technician.

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