Reviving the corporate medical library: using technology to become a cost center

INTRODUCTION

As Americans adjust to the global economy, corporate librarians are beginning to face the service challenges that these changes bring to their own institutions. Not only are they serving staff working in various geographic locations and time zones, corporate librarians are finding that they must do so with fewer staff and smaller budgets [1]. If corporate librarians are unable to meet these new challenges, they might find management questioning the value of their services and the need for the organization to support a library or information center.

The literature reports cost-effective evaluation of library services to assist librarians in proving their value to administration [2–4]. However, while this approach is a useful one, librarians may want to begin exploring ways, not just to prove that they are “worth the money,” but to prove that they can actually contribute to their institution's revenue base. Library staff at Qualidigm, a quality improvement organization (QIO), did just that and are becoming a self-sustaining department in their organization.

REACHING OUT TO OTHER COMPANIES

The Medical Library at Qualidigm supports the company's vision of “better health through better health care information.” Qualidigm is a nationally recognized, nonprofit QIO with more than two decades of experience in improving health care. Under the direction of the Centers for Medicare and Medicaid Services (CMS), the QIO program consists of a national network of fifty-three QIOs responsible for each US state, territory, and the District of Columbia. Medicare QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among underserved populations [5].

Several changes, primarily technological, to library services and workflow positioned the Qualidigm library to begin considering an expansion of services. Using grant funds, the library implemented Ariel for document delivery operations [6], allowing staff to streamline ordering and delivery of DOCLINE requests. In addition, library staff created a library Website with links to PubMed, full-text journals, online request forms, and other pertinent resources. Lastly, the medical librarian created a database to track interlibrary loan (ILL) requests and statistics.

These infrastructure and workflow changes freed library staff time and allowed them to initiate new projects, including investigating offering contractual library services. To do so, library staff created an email survey to determine if other QIOs had librarians or library services. The survey was sent to the most appropriate staff member, typically a communications officer, of all fifty-three national QIOs. Thirty QIOs (representing 34 states) responded to the survey (63% response rate).

Although three QIOs indicated that they were considering developing a formal library, only two (7%) reported professional library services available to national QIO staff, and only three (10%) had a staff member responsible for the administration of an in-house library. Other QIOs contracted with outside organizations, primarily for access to articles (Figures 1 and 2). Document delivery services, at the very least, were obviously needed among many of the QIOs. With this in mind, Qualidigm library staff felt that they could offer needed and important resources to other QIOs.

Figure 1.

Survey questions

• Was there a library at the quality improvement organization (QIO)?
• If so, who managed it?
• How did staff obtain articles they were interested in?
• Contact information

Figure 2.

Survey results: type of library services QIOs use: 2002

PILOT

To evaluate the library's readiness to assume a larger customer base and to determine appropriate service packages and pricing, staff initiated a three-month pilot of providing full library services (i.e., in-person or teleconference orientation, basic literature searches, reference queries, and ILL requests delivered electronically) to one carefully selected QIO (QIO A) at no cost to the QIO, other than providing timely feedback. The assessment of the pilot would include tracking use and cost (i.e., service costs had the QIO been paying a reasonable, customary, hourly fee). Based on the results of the pilot, library staff could determine whether the concept of offering services to other QIOs was viable. Before beginning the pilot, library staff calculated internal statistics to monitor customer service to internal users during the pilot phase. In addition, staff calculated the cost of time spent providing various services to develop profit figures for each of the pilot services based on the actual cost to Qualidigm.

PILOT RESULTS

Within the three months that Qualidigm offered the pilot, QIO A staff requested 12 literature searches and 199 documents. Staff calculated turnaround time and fill rate statistics for document delivery to both QIO A and Qualidigm personnel during the pilot and compared them to their original, pre-pilot statistics (Tables 1 and 2). Staff also tracked the time spent on each request to determine the average weekly time spent on QIO A requests and the cost to Qualidigm of offering services to another QIO. Turnaround time for both user categories decreased compared to pre-pilot statistics, and the cost for offering services (based on an hourly rate for each service with salary, indirect, fringe, and leave rates included) proved within a viable range for offering contractual services.

Table 1 Quality improvement organization (QIO) A pilot statistics: as of January 9, 2004: averages of turnaround time and fill rate for document delivery requests during the three-month pilot

Table 2 QIO A pilot statistics: as of January 9, 2004: time spent during the three-month pilot

Based on this successful pilot, the librarian began assessing service packages to offer QIO A to continue library services, deciding that a subscription fee, with a built-in 20% profit fee, would allow for the greatest use of library services and the least administrative work for Qualidigm staff. The result was a proposal that consisted of a 6-month contract with a monthly payment for library services.

During this first pilot, the library also began a second pilot with another QIO (QIO B). Staff tracked the same statistics (Tables 3 and 4) and found that, once again, internal customer service did not suffer, even though they completed fourteen literature and reference queries for QIO B and seventy-six document delivery requests.

Table 3 QIO B pilot statistics: as of March 5, 2004: averages of turnaround time and fill rate for document delivery requests during the three-month pilot

Table 4 QIO B pilot statistics: as of March 5, 2004: time spent

Ultimately, both QIO A and B have agreed to subscribe to Qualidigm library services. Qualidigm is using much of the revenue from these contracts to cover the company's overhead costs for the library. However, this revenue also allows library staff to offer new services to patrons, both internal and external, much of which staff can do using new technologies.

MOVING FORWARD

With the success of both pilots, library staff have begun investigating the best strategies to market their service to other QIOs. One of the librarian's immediate concerns was how to expand the library's infrastructure to accommodate more patrons. As a result, the library purchased Clio's basic ILL management system, which is now compatible with DOCLINE and affordable for small libraries. In addition, the library has subscribed to EBSCO'S Corporate Biomedical Reference Collection to provide the new patron base with electronic access to more materials.

To improve customer service, the library is also purchasing its own uniform resource locator (URL) for a new Qualidigm Medical Library Website, accessible to external customers through authentication. Qualidigm hopes that the purchase of additional technology will eliminate the need to increase staff time, which is ultimately more costly to the company than most of the electronic resources the library staff use. Lastly, the staff have created a pamphlet to market the new library services. This pamphlet is being mailed to all QIO chief executive officers along with a cover letter from the Qualidigm chief executive officer, extolling the worthiness of this endeavor.

CONCLUSION

Like most libraries, corporate libraries are currently faced with reductions in their budgets and staffs and increases in the number and cost of journals and amount of vendor-provided information. Maintaining or improving services despite such challenges is a constant concern. The Qualidigm experience shows that niche libraries can market their ability to find and deliver requested literature in a timely and efficient manner to other institutions and promote the value of information services to companies that may not traditionally understand the need for a library. Corporate or hospital libraries can also use extra revenue to provide services they might not otherwise have been able to offer, such as access to aggregated databases and full-text journals.

All libraries can benefit from collecting compelling return-on-investment data that can help secure their places in their institutions. By using their professional skills to their advantage, librarians can create a “win-win” situation for their own library and the organizations they serve.