hospital administrator perceptions of the library elaine r. martin, da nn/lm, ner university of...

Hospital Hospital Administrator Administrator

Perceptions of the Perceptions of the LibraryLibraryElaine R. Martin, DAElaine R. Martin, DA

NN/LM, NERNN/LM, NER

University of Massachusetts University of Massachusetts Medical SchoolMedical School

BackgroundBackground

Value Study conducted in NN/LM, Value Study conducted in NN/LM, MAR (Fall/Winter 2007)MAR (Fall/Winter 2007)

NER RAC Hospital Library NER RAC Hospital Library Subcommittee meeting with decision Subcommittee meeting with decision to repeat the study in NER (Spring to repeat the study in NER (Spring 2008)2008)

Call for participation for NER Call for participation for NER members (Spring 2008)members (Spring 2008)

NER study conducted (Fall 2008)NER study conducted (Fall 2008)

NER Participant NER Participant CharacteristicsCharacteristics

DistributionDistribution StateState

44 CTCT

55 MAMA

33 MEME

44 NHNH

33 RIRI

22 VTVT

NER Hospital Bed SizeNER Hospital Bed Size

RangeRange CountCount

<100<100 55

100-199100-199 66

200-299200-299 66

300-399300-399 00

>400>400 44

MAR MAR Participant Participant

CharacteristicsCharacteristicsRepresentation from New York, Representation from New York, New Jersey and PennsylvaniaNew Jersey and Pennsylvania

Focus Group 1 5 librarians

Focus Group 2 6 librarians

Study PurposeStudy Purpose

The purpose of this study is two-fold: 1) The purpose of this study is two-fold: 1) to investigate the views of hospital to investigate the views of hospital administrators about librarians and administrators about librarians and library services in their institutions and library services in their institutions and how they make decisions around what how they make decisions around what services are provided and funded in their services are provided and funded in their hospital; and 2) to explore the views of hospital; and 2) to explore the views of health sciences librarians, informed by health sciences librarians, informed by interviews with hospital administrators interviews with hospital administrators on the value of the hospital library. on the value of the hospital library.

MethodologyMethodology

Qualitative studyQualitative study Librarian interviews of hospital Librarian interviews of hospital

administratorsadministrators Focus groups with librarian interviewersFocus groups with librarian interviewers Analysis of common themesAnalysis of common themes Initial report to RAC in MARInitial report to RAC in MAR Initial report to RAC Hospital Library Initial report to RAC Hospital Library

SubcommitteeSubcommittee MAR is using data to frame larger value MAR is using data to frame larger value

studystudy

Interview QuestionsInterview Questions

How are competing budgetary needs How are competing budgetary needs ranked and prioritized? Do key ranked and prioritized? Do key individuals have a louder voice?individuals have a louder voice?

How much budgetary decision-How much budgetary decision-making is driven by making is driven by compliance/regulation? Can you compliance/regulation? Can you provide an example?provide an example?

Are there one or two specific things Are there one or two specific things the library offers that are especially the library offers that are especially useful to this organization?useful to this organization?

Questions (continued)Questions (continued) Are there one or two specific services or Are there one or two specific services or

resources that are especially useful to you resources that are especially useful to you personally at work? When you need information personally at work? When you need information for your work, what is your usual approach to for your work, what is your usual approach to finding answers?finding answers?

Is there a challenge or opportunity for our Is there a challenge or opportunity for our organization where the library could be involved? organization where the library could be involved? (Examples: performance improvement initiatives, (Examples: performance improvement initiatives, or length of stay, or patient satisfaction)or length of stay, or patient satisfaction)

Does your organization involve your librarians in Does your organization involve your librarians in strategic planning and/or hospital-wide, mission-strategic planning and/or hospital-wide, mission-critical committees? If not, why not? What might critical committees? If not, why not? What might make the librarian more central? What would make the librarian more central? What would enhance the librarian’s value to such committees?enhance the librarian’s value to such committees?

Questions (continued)Questions (continued)

What would convince you that the What would convince you that the library is an essential resource, worthy library is an essential resource, worthy of appropriate funding? Can you think of appropriate funding? Can you think of specific measures of library value of specific measures of library value that would be convincing to you?that would be convincing to you?

Is there anything else you would want Is there anything else you would want to say about libraries and librarians to say about libraries and librarians that would help assess the value of that would help assess the value of these resourcesthese resources

Focus Group ProcessFocus Group Process The script was divided into two sections. The script was divided into two sections.

The first section included questions to be The first section included questions to be answered from the point of view of the answered from the point of view of the hospital administrator interviewed. hospital administrator interviewed. Questions focused on their perceptions of Questions focused on their perceptions of the library and how to measure its value. the library and how to measure its value.

The second section included questions to be The second section included questions to be answered from the point of view of the answered from the point of view of the librarian/interviewer. These questions librarian/interviewer. These questions focused on the librarian’s perception of the focused on the librarian’s perception of the interview and the reaction to it. interview and the reaction to it.

There were 9 questions in all. There were 9 questions in all.

Data CollectionData Collection

Transcribed textual data were reviewed Transcribed textual data were reviewed through a continuous process of through a continuous process of comparing data segments to other data comparing data segments to other data segments, looking for similarities, segments, looking for similarities, differences, and themes. differences, and themes.

A list of common themes and subthemes A list of common themes and subthemes for each focus group was constructed. for each focus group was constructed.

Then, a list of common themes across all Then, a list of common themes across all focus groups was constructed. focus groups was constructed.

NER Focus Group 1NER Focus Group 1

Theme 1: Demonstration of Theme 1: Demonstration of value, worthy of fundingvalue, worthy of funding

Quantitative statisticsQuantitative statisticsOutcomesOutcomesMedical staff verbal supportMedical staff verbal support


Theme 2: Why library is valuableTheme 2: Why library is valuable

Library supports educationLibrary supports educationLibrary supports nurses Library supports nurses (magnet status)(magnet status)

Library support of EBM and Library support of EBM and researchresearch


Theme 3: How library could show Theme 3: How library could show value & doesn’t presentlyvalue & doesn’t presently

Press-Ganey (assist with best practices)Press-Ganey (assist with best practices) Show information effects patient Show information effects patient

outcomes or improve processesoutcomes or improve processes Show library saves administrator time Show library saves administrator time

which equals moneywhich equals money


Theme 4: How administrators Theme 4: How administrators measure valuemeasure value

Reporting structureReporting structure Juxtaposition of library spaceJuxtaposition of library space Quantitative numbersQuantitative numbers Involvement in communityInvolvement in community Respond to administrator questionsRespond to administrator questions


Theme 5: What administrators value Theme 5: What administrators value about libraryabout library Literature searchesLiterature searches Online resourcesOnline resources Committee workCommittee work BenchmarkingBenchmarking Helping employees going back to Helping employees going back to

school/studentsschool/students Library as placeLibrary as place ILL serviceILL service


Theme 6: Tone of interviewTheme 6: Tone of interview

PositivePositive UpbeatUpbeat Quick; not a lot of thoughtQuick; not a lot of thought Disappointing in lack of depth of the Disappointing in lack of depth of the

interviewinterview For the most part, librarians knew For the most part, librarians knew

intervieweesinterviewees

Focus Group 1Focus Group 1

Theme 7: Key pointsTheme 7: Key points Library is valuableLibrary is valuable Go outside the library (committees, Go outside the library (committees,

community)community) Target administratorsTarget administrators Library as physical place importantLibrary as physical place important Statistics (numbers) importantStatistics (numbers) important Library support for education importantLibrary support for education important


Theme 8: SurprisesTheme 8: Surprises

Administrator knew my role on Administrator knew my role on committees and/or suggested I be on committees and/or suggested I be on oneone

Administrator asked for lit searchAdministrator asked for lit search Administrator saw role of library in Administrator saw role of library in

EMR and offered suggestionsEMR and offered suggestions


Theme 9: Follow-upTheme 9: Follow-up

Administrator appointed librarian to Administrator appointed librarian to committeecommittee

Administrator requested information (lit Administrator requested information (lit search)search)

Administrator suggested other contactsAdministrator suggested other contacts More recognition in the hallMore recognition in the hall


Theme 10: Librarian value of Theme 10: Librarian value of experienceexperience

Confidence buildingConfidence building Opened lines of communicationOpened lines of communication Teachable momentTeachable moment Cache of being in NLM studyCache of being in NLM study


Theme 1: Demonstration of value, Theme 1: Demonstration of value, worthy of fundingworthy of funding Regulations, compliance, safety, and Regulations, compliance, safety, and

direct patient care drive fundingdirect patient care drive funding IS is valued and library is part of ISIS is valued and library is part of IS Listen to what people say about the Listen to what people say about the

library (anecdotes); library as library (anecdotes); library as “dissatisfier”“dissatisfier”

Statistics; dataStatistics; data



Library saves people time; time equals Library saves people time; time equals moneymoney

Supports education and community Supports education and community outreachoutreach

Library doesn’t consume a lot of Library doesn’t consume a lot of resourcesresources


Theme 3: How library could show Theme 3: How library could show value and doesn’tvalue and doesn’t

Most administrators in this group Most administrators in this group could not offer suggestionscould not offer suggestions

One administrator suggested One administrator suggested librarian serve on Patient Safety or librarian serve on Patient Safety or Patient Satisfaction CommitteesPatient Satisfaction Committees



Revenue generating services are looked Revenue generating services are looked at more favorablyat more favorably

Library didn’t consume many resources Library didn’t consume many resources and was bargainand was bargain

They measure value in “dollars and They measure value in “dollars and cents”cents”


Theme 5: What administrators valueTheme 5: What administrators value

Administrators did not talk about the value Administrators did not talk about the value of the library in education or patient careof the library in education or patient care

Administrators did not mention specific Administrators did not mention specific resourcesresources

One administrator goes to the library to One administrator goes to the library to read the newspaperread the newspaper

Statistics--usageStatistics--usage Serving the publicServing the public



DisappointingDisappointing “…“…she valued the library despite what she valued the library despite what

the future may hold.”the future may hold.” For the most part, librarians did not For the most part, librarians did not

know interviewees; some were know interviewees; some were rescheduled more than oncerescheduled more than once

Not as positive as Focus Group 1Not as positive as Focus Group 1


Theme 7: Key pointsTheme 7: Key points

Keep a log of anecdotes (showing how Keep a log of anecdotes (showing how information affected patient outcomes)information affected patient outcomes)

Numbers matter (“I’m not going to give Numbers matter (“I’m not going to give up counting things.”)up counting things.”)

Go out of the library; Sell yourselfGo out of the library; Sell yourself Regulations drive funding decisionsRegulations drive funding decisions



Administrator could not see value of Administrator could not see value of library in strategic planninglibrary in strategic planning

Despite support for library, Despite support for library, administrator could not see how library administrator could not see how library could help him/hercould help him/her


Theme 9: Follow-up continuedTheme 9: Follow-up continued

RI library regulation challengedRI library regulation challenged Librarians expressed concern about Librarians expressed concern about

additional roles (i.e. going outside the additional roles (i.e. going outside the library and not having the resources to library and not having the resources to deliver); but one was going to follow-up deliver); but one was going to follow-up about serving on a Patient Safety about serving on a Patient Safety committeecommittee


Theme 10: Librarian value of Theme 10: Librarian value of experienceexperience

Opportunity to educate administrator Opportunity to educate administrator about libraryabout library

Opportunity to change perceptions Opportunity to change perceptions about library about library

MAR Focus Group 1MAR Focus Group 1

Theme 1: Demonstration of valueTheme 1: Demonstration of value

Medical staff financial and verbal Medical staff financial and verbal support of the librarysupport of the library



Library supports educational missionLibrary supports educational mission Library supports clinical care missionLibrary supports clinical care mission Library supports administrative Library supports administrative

decision makingdecision making Offers online access to resourcesOffers online access to resources


Theme 3: How library could show Theme 3: How library could show value and doesn’tvalue and doesn’t

Link to EMRLink to EMR Become a resource for executive Become a resource for executive

leadershipleadership Support the bottom lineSupport the bottom line



Who you report to in the organizationWho you report to in the organization Administrators want numbersAdministrators want numbers If the librarian earns respectIf the librarian earns respect Importance of voices; medical staffImportance of voices; medical staff


Theme 5: What hospital Theme 5: What hospital administrators valueadministrators value

Resources such as online access to Resources such as online access to journals; Up-to-Date; remote accessjournals; Up-to-Date; remote access

Library as placeLibrary as place Being able to use a surrogateBeing able to use a surrogate Help with administrative issuesHelp with administrative issues



Positive experiencePositive experience Opportunity for librarian to sell/educate Opportunity for librarian to sell/educate

about the libraryabout the library Opportunity to talk to administrationOpportunity to talk to administration Only one negative experience in this Only one negative experience in this

groupgroup


Theme 7: Key PointsTheme 7: Key Points Library is valuable if relevant to missionLibrary is valuable if relevant to mission Important to hear what administrators Important to hear what administrators

need not what we think they needneed not what we think they need Administrators value physical place as Administrators value physical place as

well as resourceswell as resources Administrators lack awareness of Administrators lack awareness of

expanded roles of librariansexpanded roles of librarians Administrators listen to medical staffAdministrators listen to medical staff



Physicians see library as a recruitment Physicians see library as a recruitment tooltool

Surprised at the amount of recognition Surprised at the amount of recognition and support for the library by some and support for the library by some interviewedinterviewed

Did not hear more about what the Did not hear more about what the library should be doing and is notlibrary should be doing and is not


Theme 9: Follow-upTheme 9: Follow-up Interview was an opportunity to establish Interview was an opportunity to establish

relationshiprelationship Follow up meeting with administrator Follow up meeting with administrator

interviewed for budget purposes and led to interviewed for budget purposes and led to administrator having better understanding administrator having better understanding of the libraryof the library

Administrator offered opportunity for library Administrator offered opportunity for library presentation to senior staffpresentation to senior staff

Administrator offered opportunity for new Administrator offered opportunity for new initiativesinitiatives


Theme 10: NursesTheme 10: Nurses Nurses value the libraryNurses value the library Libraries play important role in Libraries play important role in

achieving magnet statusachieving magnet status


Theme 11: What would help Theme 11: What would help librarians from this studylibrarians from this study Share resultsShare results


Theme 1: Demonstration of valueTheme 1: Demonstration of value What others (medical staff) say about What others (medical staff) say about

the library and to whom you say it the library and to whom you say it mattersmatters

If the library saves medical staff and If the library saves medical staff and administrators time, then it is valuedadministrators time, then it is valued


Theme 2: Why library is valuableTheme 2: Why library is valuable Resources (Ovid, Up-to-Date, MD Consult, Resources (Ovid, Up-to-Date, MD Consult,

internet, e-journals, literature searchesinternet, e-journals, literature searches Library plays a role in evidence-based, data Library plays a role in evidence-based, data

decision makingdecision making Working with nursing staffWorking with nursing staff Supports patient care, education and Supports patient care, education and

research missionsresearch missions Consumer healthConsumer health Place for online education of staffPlace for online education of staff


Theme 3: How library could show Theme 3: How library could show value and doesn’tvalue and doesn’t Need to show ROI but not sure howNeed to show ROI but not sure how Help researchers get more fundingHelp researchers get more funding Demonstrate link to patient satisfactionDemonstrate link to patient satisfaction Link evidence to the bedside through Link evidence to the bedside through

EMREMR


Theme 4: How administrators measure valueTheme 4: How administrators measure value Foot trafficFoot traffic Quantitative measures (# of documents requested, Quantitative measures (# of documents requested,

use, statistics, etc)use, statistics, etc) Measure results of Ask a Librarian to length of stayMeasure results of Ask a Librarian to length of stay Patient satisfaction documented in the chartPatient satisfaction documented in the chart Press Ganey Patient Satisfaction SurveyPress Ganey Patient Satisfaction Survey Recognition by JCAHORecognition by JCAHO Positive comments about the libraryPositive comments about the library Involvement in important projectsInvolvement in important projects


Theme 5: What administrators value Theme 5: What administrators value about the libraryabout the library Library as placeLibrary as place Quiet place and print journalsQuiet place and print journals Access to resources such as electronic Access to resources such as electronic

journals, up-to-Date and MD Consultjournals, up-to-Date and MD Consult


Theme 6: Tone of interviewTheme 6: Tone of interview Positive Experience for the most partPositive Experience for the most part Negative experience for some where Negative experience for some where

administrator struggled to provide administrator struggled to provide answers and didn’t want to spend the answers and didn’t want to spend the timetime


Theme 7: Key PointsTheme 7: Key Points Those who use the library value it mostThose who use the library value it most Interview led administrator to think of Interview led administrator to think of

new committees/roles for librariannew committees/roles for librarian Usage effects funding; statistics matterUsage effects funding; statistics matter Budgetary decisions are driven by Budgetary decisions are driven by

compliance and regulationcompliance and regulation Improved patient satisfaction could be Improved patient satisfaction could be

linked to consumer health serviceslinked to consumer health services


Theme 8: SurprisesTheme 8: Surprises Administrator suggested librarian be Administrator suggested librarian be

appointed to IRBappointed to IRB Library viewed as recruitment toolLibrary viewed as recruitment tool Expected to hear more about value of library Expected to hear more about value of library

for patient care and traditional services but for patient care and traditional services but heard more about consumer healthheard more about consumer health

Administrators did not see library role for Administrators did not see library role for helping them make decisions or help them in helping them make decisions or help them in their worktheir work


Theme 9: Follow upTheme 9: Follow up Administrator offered budget help in funding Administrator offered budget help in funding

OvidOvid Library will accept invitation to Magnet Library will accept invitation to Magnet

conferenceconference Librarian will have regular meeting with Librarian will have regular meeting with

administratoradministrator Librarian will promote library to other Librarian will promote library to other

departmentsdepartments Librarian will promote other library services Librarian will promote other library services

beyond consumer healthbeyond consumer health


Theme 10: NursesTheme 10: Nurses Librarians are working with nursing Librarians are working with nursing

staff successfullystaff successfully Library support of evidence based Library support of evidence based

nursing practicenursing practice Library support of magnet statusLibrary support of magnet status


Theme 11: What would help Theme 11: What would help librarianslibrarians Importance of whom you report toImportance of whom you report to Regulatory requirementsRegulatory requirements VisibilityVisibility New evaluation models beyond New evaluation models beyond

statisticsstatistics Share results of the studyShare results of the study

DiscussionDiscussion

Tone of focus groups not different with Tone of focus groups not different with respect to regional differencesrespect to regional differences

Focus group librarians who knew or had Focus group librarians who knew or had met administrator before the interview met administrator before the interview generally had a more positive generally had a more positive experience; did that insert bias or effect experience; did that insert bias or effect more positive comments about the more positive comments about the library?library?

Both MAR and NER groups of librarians Both MAR and NER groups of librarians saw value in participating in the studysaw value in participating in the study

Common Themes (Both Common Themes (Both MAR and NER)MAR and NER)

What people say about the library influences administrator What people say about the library influences administrator funding decisions and perceptions of the libraryfunding decisions and perceptions of the library

Statistics matterStatistics matter Administrators saw value of librarians serving on Administrators saw value of librarians serving on

committeescommittees Although administrators could see value of library in Although administrators could see value of library in

patient care, consumer health and education, they could patient care, consumer health and education, they could not see library helping them in their decision making or not see library helping them in their decision making or with their own workwith their own work

Administrators had difficulty in measuring value of library Administrators had difficulty in measuring value of library beyond the numbersbeyond the numbers

Lack of specific examples by administrators regarding Lack of specific examples by administrators regarding library value roles in education and patient care except for library value roles in education and patient care except for helping nurses with magnet status; “I couldn’t pull it out of helping nurses with magnet status; “I couldn’t pull it out of him.”him.”

SummarySummary

““I just think that hospital I just think that hospital administrators don’t realize all the administrators don’t realize all the skills that librarians have…”skills that librarians have…”

““I’m pleased this opportunity came I’m pleased this opportunity came about because I probably wouldn’t have about because I probably wouldn’t have tried to get a half hour of her time…”tried to get a half hour of her time…”

““I think this has provided a wonderful I think this has provided a wonderful opportunity to meet with folks we don’t opportunity to meet with folks we don’t ordinarily interact with…good or bad…”ordinarily interact with…good or bad…”

Summary (Continued)Summary (Continued)

““One of the things I heard loud and One of the things I heard loud and clear when I spoke with the executive clear when I spoke with the executive director of the hospital was that how director of the hospital was that how what a strong voice the medical staff what a strong voice the medical staff had in determining whether to keep a had in determining whether to keep a library or physical library on site and library or physical library on site and a program in place.”a program in place.”

““There is still a good bit of education There is still a good bit of education that needs to be done.”that needs to be done.”

Next StepsNext Steps

MAR Expanded Value Study MAR Expanded Value Study Announced and Participants Being Announced and Participants Being SolicitedSolicited

NER Hospital Library Committee -NER Hospital Library Committee -Development of new model for Development of new model for Hospital Library based on Hospital Library based on Knowledge ManagementKnowledge Management

KM Pilot Projects will be funded in KM Pilot Projects will be funded in 2011-20122011-2012

hospital administrator perceptions of the library elaine r. martin, da nn/lm, ner university of...

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