Positive image and high profile gets results in a hospital library

INTRODUCTION

The film, It's a Wonderful Life, [1] depicts Jimmy Stewart (as George Bailey) contemplating suicide after a series of financial reverses. His guardian angel shows him what may have happened had he never been born. In a dramatic scene, George clutches at the angel and begs over and over:

“Where's Mary?” (his wife played by Donna Reed) Finally, the angel relents and tells him:

“You're not going to like it, George! She's an old maid! She never married! She's just about to close up the library!”

The scene shifts to a frumpily dressed Donna Reed, just closing the door to the Pottersville Library. When George approaches her, she screams and runs away. Mary Bailey, sans husband, is doomed to an unhappy life of lonely toil in the library. She is unattractive, unstylish, timid, and given to hysteria—the perfect librarian!

This movie reflects the culture of 1940s America, yet its image of librarians lives on. An invalid and dated image affects medical librarians, too. Studies have shown that many physicians, nurses, and allied health personnel view hospital librarians as book handlers and book curators who provide technical and clerical services and have a static set of responsibilities [2–4]. Other traits that have been attributed to librarians include orderliness, meticulousness, acquisitiveness, conformity, conservatism, passivity, submissiveness, introspection, anxiousness, and lack of self-confidence [5]. The real work of librarians as organizational innovators and managers of information is not well publicized in the mass media. Image—humorous or not-so-humorous—is important because it affects how library users and potential users judge the value and validity of librarians' work. An outdated, ineffectual image may even threaten a small medical library's existence or the librarian's job. A conscious and focused effort is needed to dispel stereotypes and to replace them with new images suggesting strength, innovation, and self-confidence. With this in mind, the librarian in one hospital has developed a plan of action to promote a positive image, visibility, and respect.

BACKGROUND

Aveni Medical Library served the staff and patients of PHS Mount Sinai Medical Center East, a 100-bed community hospital. The hospital (formerly named Richmond Heights General Hospital) had been recently sold to Primary Health Systems of Pennsylvania and was trying to maintain economic viability by marketing its services to physicians and the community. The author was hired by the medical director of the hospital to serve as a solo librarian, with responsibility for managing the medical library and providing information services to staff. Soon after, the medical director was replaced and the necessity for a full-time librarian was questioned. Budgets were cut in many hospital departments; morale among employees was low; and a feeling of uncertainty was high. At the same time, a brand new administration was trying to quell rumors and motivate the staff. If the library was to survive, it was imperative that library be seen as a vital part of the hospital organization.

PLAN OF ACTION

As a first step in developing a new image, a library logo was developed. This logo was then included on all materials that emanated from the library (e.g., search results, interlibrary loans, faxes, current awareness materials, etc.). Most materials also included the librarian's name and degrees as well as the Academy of Health Information Professionals (AHIP) credential.

A second step was to establish open communication between the librarian and potential users or key departmental personnel in the hospital. A newsletter and annual report were instituted to document library accomplishments and provide library-to-user communication. A survey was sent out to physicians and nurses inviting feedback about acquisitions and library policies. The librarian met and talked with hospital staff at every opportunity. Four groups of users were identified for development and marketing:

▪ physicians

▪ nursing and allied health staff

▪ hospital administration

▪ patients, families, visitors, hospital community

Physicians

Past mediated searches and interlibrary loans (ILLs) made clear that physicians were the heaviest users of the library. In this institution, the library was traditionally viewed as the physicians' library, and it was not fully used by the other staff. A major concern was that physicians would view any changes in library operations as a decline in services available to them. Several steps were taken to assure physicians that the level of services they had enjoyed in the past would be met and exceeded. The quarterly library newsletter provided information about computer updates, acquisitions, and new library services and helped to showcase the library. Literature searches were now provided with a one-day turnaround time. New signage was provided based on information obtained from the user survey.

What physicians needed most was information that related to patient care, and they often had difficulty locating relevant information [6, 7]. A clinical librarian service was initiated for residents who presented and attended daily morning report in the hospital. Follow-up materials based on that day's patient presentations were provided to all residents and students. A copy was sent to the medical director as well. The librarian was asked to participate as a member of the Medical Education Committee and to attend meetings as part of the job. Library involvement in clinical areas, such as the clinical librarian service, was promoted at these meetings.

Nursing and allied health staff

Only a small proportion of nursing and allied health staff used hospital library services. They were generally unfamiliar with available services, yet they needed information for patient care and patient teaching [8–10]. The following activities were developed to increase nurses' use and awareness of library services.

A meeting was held with nursing department coordinators to discuss how use of the library could be made more attractive to nurses. Staffing requirements often made it difficult for nurses to leave their units and come to the library. To address this problem, a small core nursing collection was moved to a bookcase in the nursing lounge, where staff could sign out books and return them. Some crucial materials, such as the most recent editions of nursing texts, were kept in the library so that they could always be available. Also, at the suggestion of the nurses, diabetes education materials, which were scattered throughout several units of the hospital, were centralized in the library, and the librarian assumed maintenance of this collection.

The concept of the librarian as a member of the interdisciplinary team has been discussed in the literature [11]. The librarian began to attend weekly nursing rounds. These meetings discussed the care of each patient in the hospital and included nurse coordinators as well as physical therapists, occupational therapists, home care nurses, speech therapists, social workers, and transitional care managers. Information was provided as needed to caregivers. Patient information needs were also noted, and appropriate information was provided via caregivers. The librarian's attendance at nursing rounds increased library use by both nursing and allied health staff. Providing material directly to patients or their families increased the value of library services to these important groups of hospital customers.

The nursing and allied health collection was strengthened and enlarged to meet current and future needs. Input and suggestions were solicited from nurses and allied health staff. Also, the library newsletter was routed to nursing coordinators and to all patient care units.

Hospital administration

Support for library services from hospital administration was crucial to success in the organization. When the new position of chief operating officer (COO) was created, the librarian requested that she report to the COO rather than the medical director. This request was granted, and the move positioned the library in the center of the institution. Requests from administrative staff on topics such as development of new services and neighborhood demographics were actively sought. When key administrators called or came to the library with information needs, processing was rapid and comprehensive.

Patients, families, visitors, community

The medical library can be a valuable source for patient and community information. A patient collection is a good way to increase the value and visibility of the library to the hospital and surrounding community. It is also helpful in marketing hospital services when new business is much needed. The following measures have been introduced to engage patients and the rest of the community.

The librarian was asked to evaluate patient-education materials in the emergency room for usefulness and accuracy. Many outdated or inappropriate materials were weeded. The resulting gap provided a good opportunity to develop a hospital-wide collection, which would meet the patient-education needs of the entire hospital. The library served as a clearinghouse for patient-information materials and housed the collection. Because ordering up-to-date materials was time consuming and costly, the permanent collection was limited to a few core references. Reproducible materials from the vast array of authoritative Internet patient sources were collected at the time of need. A small catalog of materials was produced and sent to all patient care areas and to attending physicians in their offices. An introductory letter, invitation to review materials in the collection, and information on contacting the library were included with the catalog. Volunteer services and hospital marketing were contacted and offered consumer-oriented materials for their community outreach programs.

Local public libraries were contacted; meetings were held with librarians; and information sharing was suggested. As a result of these meetings, requests for disease-specific information were received. A cover sheet with this information included the hospital library's name and logo. The librarian was invited to do a presentation on Internet health information for the regional library reference group. The hospital librarian was able to provide lists of selected materials that were available in the local public library for hospital patients.

As a result of the exposure the library received from involvement with patient-education materials, the nursing director requested that the librarian chair the Patient/Family Education Advisory Committee. This committee had responsibility for developing a policy for interdisciplinary documentation of patient education in preparation for a Joint Commission on Accreditation of Healthcare Organizations visit in 1999. Ultimately, it would select and develop patient-education materials specific to the needs of the hospital.

CONCLUSIONS

Focused efforts to change the image and role of the library, aimed at specific hospital user groups, paid off in increased visibility. This visibility was evidenced by requests for the librarian to join committees and participate in hospital functions and by the ready acceptance of the clinical librarian program and patient-education collection. During a three-year period, an increase in the number of librarian-mediated searches and the number of requests for interlibrary loans demonstrated how much use of the library had expanded (Table 1, Figure 1). As a result of these activities, the library has been a busier and livelier place where all levels of staff come for information or ideas. Support for the library has increased among all four targeted groups, and many positive comments have been received. Despite administrative changes, job cutbacks, and budget slashes during the same three-year period, the library thrived and a full-time librarian stayed on staff. This plan for marketing and promoting the library and librarian was adopted in a crisis situation in this hospital. The same techniques could be appropriate for any hospital library and might be even more successful if used before library services were threatened.

Table 1.

Library use

Figure 1.

Library use