Providing Library Services in a Time of Fiscal Crisis: Alternatives* BY ROBERT G. CHESHIER, Director
The Cleveland Health Sciences Library of Case Western Reserve University and The Cleveland Medical Library Association Cleveland, Ohio ABSTRACT The nature of the fiscal crisis in health science libraries in the United States is in part due to the style of management in these libraries, in part due to the lack of user identification, in part due to the lack of economically valid fees for service, and in part due to the success of the Biomedical Communications Network. These issues are discussed in terms of how they might be approached. A pragmatic stance is advocated for practitioners, the MLA, the NLM, and library schools to jointly address the questions raised.
THE "fiscal crisis" of American health science libraries needs to be seen in perspective. In September 1976 I journeyed to England, to Switzerland, and to Canada, and the library fiscal crisis in each of these countries makes our own look pale by comparison. Further, in some basic and important ways the medical libraries there have done well in optimizing the expenditure of scarce resources to provide library services. This is partly the result of a very long-term fiscal pinch, but it is also partly due to innovation by our colleagues who merit our respect and have some lessons for us. It would be accurate to say that misery loves company and that many library complaints around the world result from shared penury. But one has only to look back a short time to recall the days of one-upmanship and ready funds in the United States, and to realize that libraries operate, as indeed do most human endeavors, on a sine curve, with ups and downs similar to those of a roller coaster. Several years ago, if one library used a computer, another had its own computer. If one library provided documents free, another delivered them. This was not all bad, because from a longer perspective these past ten years or
so may be viewed as one of the more exciting and innovative periods in health science library history. But success creates as many problems as failure does, and it is important that we not point fingers at our traditional financial supporters. One of my favorite cartoons is that showing a cleaning lady sitting across the desk from a tycoon who is saying, "I know, Mother, but what have you done for me lately?"
THE NATURE OF OUR FISCAL CRISIS It is important to know just what our fiscal crisis consists of, because our attitudes toward, and our proposed solutions for, the situation are definitely outgrowths of our perception. First, we are caught in the very difficult position of having costs of library materials and staff rising rapidly, and of having technological innovations of crucial importance to us accelerating both in number and in cost, while we are being asked to keep our total budgets at the same dollar level or to decrease them. No matter how you phrase it, there is a dollar crunch. There is a second factor, however, which further complicates the situation. Many libraries have relied upon tederal funds to enable them to establish service networks without developing mechanisms to replace the federal dollars at the end of the grant period, even though in some cases the federal dollars were provided with the express condition that the services be provided without any sort of fee or other support being imposed upon those served. We are thus left in an awkward position due in part to our outreach and success, and no one can call the current health sciences library network anything but a success. It may need refinement, but its basic structure and the service it provides are excellent.
CRISIS
IN
MANAGEMENT
*Presented at the meeting of the New York Regional Another aspect of our current situation is that Group of the Medical Library Association, Columbia we are facing a managerial crisis. Several years University, New York, Nov. 13, 1976. Bull. Med. Libr. Assoc. 65(4) October 1977
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ago many librarians argued that our larger libraries could not be effectively managed without major shifts in organization, attitude, and support. In recent years this view has been modified somewhat, but now our position is again approaching the unmanageable in our larger libraries. For one thing, we have too small a managerial pool, partly because we have created too small a window through which talented and willing librarians from the profession can enter the managerial ranks; and once they do make it through, we have difficulty keeping them on a personal and professional growth curve. Women in particular have been excluded from management, as Goldstein and Hill have argued [1], and far too many top jobs in libraries and library schools have gone to people from outside the profession. A cursory survey of libraries from the Library of Congress down to small libraries of all types and of the list of library school deans will illustrate the nature of this problem. We have some reckoning coming here, and there is great concern that we are not producing effective library managers through either our educational or our practice efforts. We have also been remiss in not changing the style of management in our libraries so that all levels of staff can assist in solving the problems of service and fund raising in a creative way. Yet the technology we now have by itself requires participatory management and delegation of authority and responsibility, as well as new patterns of intralibrary and interlibrary communication and cooperation. "Technology" here is used in Drucker's sense to mean process as well as equipment. No director, in my view, can speak knowledgeably about OCLC, MEDLINE, the economics of information, network development, marketing techniques, management, and the host of other concepts or systems we must increasingly use. More importantly, no director should try to do so, any more than a single physician should either try to work outside the "team concept" we all hear about so often and see so seldom, or should try alone to provide total health care. Drucker's point is worth stating here: Technology is not about things: tools, processes, and products. It is about work: the specifically human activity by means of which man pushes back the limitations of the iron biological law which condemns all other animals to devote all their time and energy to keeping themselves alive for the next day, if not for the next hour
[2].
All of these factors have combined to create a 420
sort of paralysis or, at the very least, a reluctance to innovate, which Galvin has explored at length [3]. The factors described have also hampered another development which, as a result, has become part of our problem rather than part of the solution. This is the identification and use of alternative funding sources. Libraries are like biological organisms in that their stability increases as the diversity and range of their feeding sources increase, but we have been directed toward and opted to use a very limited number of feeding sources. We have also been misled as to the ability or willingness of some of our clients to help us financially, as typified by the view generally presented of hospitals as nonprofit institutions, or of other librarians as parasites upon us. Hospitals are nonprofit after salaries and a lot of other expenditures of which library service may be a valid component, and our library has had no difficulty in generating payment from other libraries for services rendered. The amounts may be questioned, but the concept is accepted. FEES FOR LIBRARY SERVICES I feel that neither the concept nor the reality of fees for library service has been discussed adequately in terms of service or support. If a librarian assumes that in periods of financial distress he can simply pass costs on to those who use services heretofore "free" or provided in a "have-have not" milieu, he may find himself in the position of destroying his market or even precluding development of it. Many libraries not previously charging for service have now decided to implement fees. Some are overcharging and haven't really prepared the market for this major change in policy or, in some cases, are using the fee to discourage use. Eight dollars for an interlibrary loan is probably an overcharge and $2.00 is probably much more realistic, for the simple reason that fees for use by other than "primary users" should be treated as marginal income to cover marginal costs. If one takes total library costs, and divides them by total use, the result will come closer to $2.00 than to $8.00, and the method seems reasonable to several economists our library has consulted. The point, however, is not $2.00 or $8.00, but rather the "marginal cost" concept of economics. This is particularly relevant because in most libraries the materials and services provided must be there to serve the library's primary population, and increased use of them by others thus reduces the unit use cost. The Bull. Med. Libr. Assoc. 65(4) October 1977
LIBRARY SERVICES IN A TIME OF FISCAL CRISIS
concept of marginal costs is difficult, but here is one useful view of it. Further, this application of the concept has egalitarian appeal in that all users pay the same amount, although the primary users are accounted for by institutional support. Clearly, however, much thinking and research will be needed to address this issue. It is important because lack of understanding of this issue could cause considerable dismantling of the regional library network or an untoward development of local library resources to increase self-sufficiency, both contrary to our goals and activities over the past few years. If large resource libraries have not established rapport with their users, including other libraries, they may find it difficult to charge these users for service rendered without some peril. Another part of the problem is that too few academic health center libraries have established rapport with and provided real service to their hospital library constituencies. I mentioned earlier the one-upmanship we used to see; what we now see is one-upmanship of a different kind. If one library charges $1.00 per loan, another charges $2.00, another charges $8.00, and all are indignant that those they serve must pay their way with precious little statistical or analytical assistance either to help them pay or to preclude their borrowing through resource development. A specific experience can be cited here. The Cleveland Health Sciences Library (CHSL) has 135 institutional members and nearly 2,000 individual members. In 1968 CHSL began to document delivery to that public from the Allen Memorial Medical Library. The data showed that institutional service increased about 22% per year from 1964 to 1971, while individual service was relatively stable. Since then, circulation has increased more sharply and is nearly three times this year what it was in 1971-72. For the year April 1, 1975 through March 31, 1976 the library received 32,121 requests, filled 79% of them, and referred 17% for a total response rate of 96%. Thus, the total number of requests, the rate of increase, and CHSL's share of the total region's activity are all increasing very rapidly. There are some difficulties with these data, and yet CHSL has no wish to decrease its lending. The more library materials and services an institution provides in-house, the more it will use CHSL for interlibrary loan and other services, and the less likely we will be to fill its requests. As efficiency increases, concentration upon the relatively small percentage of requests not filled will increase the emotional aspects of the network. We thus must Bull. Med. Libr. Assoc. 65(4) October 1977
ask ourselves a number of questions, which will require considerable input from our institutional colleagues. Can we continue this growth spiral? If not, how do we check it? What are the economics of this process? CHSL has a problem and this experience may serve as an indicator of its magnitude and seriousness. Clearly, some serious and important research must be done. CHSL has established a system, developed rapport with users, implemented a fee, and increased its lending enormously; in the process it has uncovered a sorcerer's-apprentice phenomenon that is not fully understood. I feel strongly that we cannot and should not stop the growth in interlibrary loan until we know more. SOURCES OF FUNDS
There are, of course, other sources of funding than fees from users, and perhaps we need to establish limits to growth, but few sources of funds are as easy to tap as fees are, are more easily and morally defended, or are more easily raised as service and hence costs climb. There are foundation funds, individuals devoted to libraries, and such organizations as social clubs, unions, and industrial firms which can help. Here again, however, we have a problem because we have not effectively separated the service required to further a professional's activities from those other services which might encourage his support of libraries for their own sake; nor have we addressed the question of who those individuals are who might be users of our libraries given the opportunity. Perhaps a physician should support libraries financially because they are "good," but should not pay for library service he requires as part of his work in an institution. Perhaps the institution should pay. This will raise eyebrows, but we must distinguish between service and social good, and in the process, between individual and institutional responsibility and between individual and institutional costs. New institutional members of CHSL in recent months are the Ohio Carpenters' Pension Plan, the Sagamore Hills Children's Psychiatric Hospital, the Brown Insulating Systems, and Anaconda Company, Wire and Cable Division. Our total institutional membership illustrates the complexity of this issue and further stresses my point. We cannot accept the advice of the Association of Research Libraries and await federal support rather than pursue extension of both our fees and our network.
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ROBERT G. CHESHIER NETWORK COSTS
The final part of our fiscal crisis of import here is probably due to network developments per se. It will probably never be known how much such networks as the RML network may have cost participating libraries. Meetings, travel, allocation of scarce resources to develop relationships with individuals and institutions remote from health science centers, and data collection and analysis have been enormously expensive both for individual libraries and for regions. The federal support provided for these activities, on the other hand, has not been enormous, although this statement is not intended to be anti-NLM. NLM has not handed out money lightly nor without clear indication of conditions attendant upon use of the funds and upon development of continuation capability. Still, the problem is similar to the one at Case Western Reserve University when NLM's policy shifted away from support of the education program for health science librarians, and the program was continued with funds from other sources. Cleveland Health Sciences Library has a very large budget this year, and the amount we will receive for federally determined and funded network activity is about 1.7% of that budget. Even if we accept the philosophy of NLM with regard to provision of library service, and even if we see the benefits of network development, we still must question the cost effectiveness of CHSL's activities in these areas. Let me emphasize again that nobody is at fault here and that NLM has consistently pointed out the "seed money" aspects of its support and has repeatedly stressed that health care practitioners in the American health care system need better library service. However, we still have the problem of operational networks that we may not be able to afford without some different types and amounts of funding. In 1969 CHSL had extensive discussions with the director of its regional medical library and with representatives of NLM. There was serious concern that CHSL was going counter to federal legislation and NLM policy by charging for service. I cite this to indicate the swiftness with which major shifts in basic philosophy have occurred.
agreement that we cannot stand still. For example, the staff at CHSL feels that the library must continue to expand and improve document delivery, even with the potentially enormous growth described earlier. It must increasingly provide reference service. It must continue to serve an archival function, to educate both health professionals and librarians, to place professional librarians in hospitals, to research what collections and services are needed at all levels of the library network, and to assist in the development of a national biomedical network. There is very little any of us can see that we could or should drop without requiring a major shift in our goals and philosophy, although we feel strongly that we must enhance our research and funding capabilities if we are to address these issues. ECONOMIC RESEARCH NEEDED We need to do a great deal more research on the economics of information before we make major changes in our current system. If coupled with a study of available library statistics, such research could help us move toward a more reasonable system. A number of publications on library economics are now available which few of us can easily comprehend, and we have only recently seen that the economics of information is becom-
ing a respected subset of the economics profession. On our campus we have had a student in the economics of information, whose Ph.D. dissertation was on CHSL's fee-for-service, and who has continued to work in the area of library economics [4]. If research in this field is combined with some pragmatic research by all of us, we may be able to implement reasonable fees for service and to clarify and understand better the economics both of our specific organizations and of libraries generally. In CHSL's case, fee-for-service covers both individual and institutional members, and will generate in this fiscal year 17.5% of the total budget. When you compare this with the 1.7% of the budget CHSL will receive from federal funds, you will see why fees for service are important. CHSL started its fee-for-service for institutions in 1968 and its fee for individuals in 1894. We are not certain of the best way for a library to begin an effective fee-for-service operation at this time, but we feel strongly that individual entrepreneurship WHAT SERVICES SHOULD WE PROVIDE? in this area must be carefully handled. Depending upon how much one is involved in In addition to fees as described here, we can networks, one can talk either of adding or of drop- also accommodate increased services and income ping services. There seems to be general through expansion of our markets. Limiting 422
Bull. Med. Libr. Assoc. 65(4) October 1977
LIBRARY SERVICES IN A TIME OF FISCAL CRISIS
services is not a creative way to build for the future, although one can understand libraries limiting some services through sheer inability either to subsidize them, to pay for them, or even to perform them. Still, I believe our future lies in expanding our markets. We have yet to reach most health professionals with quick and meaningful library service; to address the questions and needs identified by the Occupational Safety and Health Act; to rise above "primary user population," "type of library," and a host of other limiting concepts; to maximize the use of our materials and hence minimize their unit use cost while ensuring that they are kept workable and in good repair. There are markets to be tapped that offer potential sources of support of considerable magnitude. These become especially important if continuing growth results in an increase in the order of magnitude of our activity. A subset of the expanded market potential is the expansion of library functions. The library is probably the one major "nonthreatening" component of most academic health science centers, and it can and should serve as the link between the health science practitioner community and its academic counterpart. How does the library assist the foreign medical graduate? How does the library become involved in the medical malpractice area and should it serve lawyers and the public as well as health professionals? How does the library use the questions generated by health practitioners in community hospitals to stimulate an educational response from health professional schools? What does the library do in the areas of medical records, or preventive medicine, or consumer health education? There are, of course, no specific answers to these questions, but in our experience consideration of them improves communications, generates income, and affects library operations without damaging the traditional concept of the role of the library. RESOURCE SHARING The final way in which we can match cost and service is through resource sharing. CHSL is part of a group called the Northeast Ohio Major Academic Libraries. The directors of seven institutions meet regularly, assign responsibilities to committees, and in general share their resources. We use the United Parcel Service delivery system to share our materials, and our common experience has been favorable and cost effective. Last year, for example, we saved over $40,000 in Bull. Med. Libr. Assoc. 65(4) October 1977
our combined serials budgets and we continue to explore ways to increase and speed up access to an increasingly larger set of library materials by an increasingly larger population of users. CHSL also belongs to the Library Council of Greater Cleveland, a group which includes all academic and public libraries in Cuyahoga County, and which has representatives of ASIS and SLA as observers at its meetings. Here, too, the directors meet, committees are assigned specific responsibilities, the United Parcel Service system is used to share materials, publications are generated on collections of strength, and overall access to and sharing of resources are facilitated. Finally, CHSL is a member of the Ohio College Library Center, an activity which costs us only about $8,000 per year, but which has enormous effect upon our operations. A quotation from the minutes of a recent OCLC board meeting may help to demonstrate the potential resource sharing and cost effectiveness of this system: In the first part of September 1976, participating libraries were cataloging at the rate of approximately 20,700 FTU (first time uses) a day, using existing records in the system for 92.1 per cent of books cataloged [5].
IMPLICATIONS FOR OTHER LIBRARY SYSTEMS We need a great deal more library research relative to some of the points above. Many librarians are particularly anxious that NLM support more such research, that practitioners, MLA, and the library schools collaborate in this effort, and that the findings be made widely available. NLM could be very helpful in analyzing the nature and extent of regional medical library activity and in presenting the findings to the profession for discussion. It seems fair to say that NLM's current attitude is that we need to increase service and expand networks, an attitude which may only compound our problems, but NLM has also asked for help in identifying research needs and potentials, so that its overall view is close to that presented here. In the near future, through the increased communication and need assessment possible by NLM-practitioner-library school collaboration, we will probably see major research capability aimed toward the vexing problems of our profession. It seems presumptuous to argue that both NLM and MLA need to take serious steps to ensure the viable continuation of the regional medical libraries, but it also seems necessary. Changes in federal support and the encouragement of fee mechanisms may be one way to do
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this, and both the tactics and the strategy of fees need broader discussion. All of us need to defuse some of the depressing emotionalism we see hampering communication and cooperation between resource and basic unit libraries. CHSL for one cannot and will not handle the "why don't you" questions we are asked. However, we feel positive toward our hospital library colleagues in northeast Ohio because much of the success of our fee-for-service and of our network is due to their interaction with us. In fact, we would argue both that fees can remove the hospital library from the "have not" part of the "have-have not" model, and that the resulting network is more businesslike and less emotional as a result. The CHSL staff spends considerable time and effort on this very issue. Mary Parker Follett wrote the following statements in 1924 which seem pertinent here: If you divest the balance of power theory of the pomp of diplomacy and the sanctity of academic controversy, the doctrine is no more dignified than the behavior of the two men (each having taken a course in "applied psychology" and learned that he must not face the light in a business interview) who dodged each other round the room until they found themselves side by side on the window seat. The questions all leaders, all organizers, should ask is not how we can bring about the acceptance of this idea, but how can we get that into the experience of the people which will mean the construction of new habits? This means a keen and inventive intelligence; good intentions, noble ideas, are not enough. As progress is through the release and integration of the action tendencies of each and every individual in society, ways should be provided for such activity to take place normally. This is perhaps the sentence in this book which I want most to emphasize [6].
If we are successful in some of the ways here discussed, I envision that the traditional pyramid which depicts the biomedical communication network will be turned upside down. The attitude of the resulting network then becomes one in which information queries from health practitioners would flow into the network, stimulating and in
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fact determining the response required from the various network levels as the query works its way down the pyramid. This model is a clear shift from the traditional hierarchical theory illustrated by the upright pyramid. A pinball machine helps to demonstrate some of the management issues raised above. You will recall that a ball enters the pinball field and either drops into a hole or proceeds down to the bottom of the machine. This latter is not desirable, so that one tries to keep it from happening. One can argue, with certain appropriate modifications, that the ball represents an information problem and one seeks to have it drop into the most quickly reached appropriate hole, which can be designated as a level of information response. It is my contention that we have been on the wrong track in building hedges in our profession represented by such concepts as "core libraries," "stop lists," "primary population," and "type of library," around the holes in the pinball machine analogy. Rather, we need to identify the process by which information requests are generated and responded to, and we need to work together to deal with the dynamics of the process. That seems a good beginning to help us cope with both fiscal stress and library service. REFERENCES 1. GOLDSTEIN, RACHAEL K., AND HILL, DOROTHY R. The status of women in the administration of health science libraries. Bull. Med. Libr. Assoc. 63: 386-395, Oct. 1975. 2. DRUCKER, PETER F. Work and tools. In: Drucker, Peter F. Technology, Management and Society. New York, Harper and Row, 1970. p. 45. 3. GALVIN, THOMAS J. Beyond survival: library management for the future. Libr. J. 101: 1833-1835, Sept. 15, 1976. 4. CASPER, CHERYL. Library pricing models and information requirements: a case study. Ph.D. dissertation. (Diss. Abstr. Int. 36A: 3866, 1975.) 5. OHIO COLLEGE LIBRARY CENTER. Minutes of the seventy-fifth meeting of the Board of Trustees, Sept. 21, 1976. p. 3. 6. FOLLETT, MARY PARKER. Creative Experience. New York, Peter Smith, 1951. p. 182, 200, 224.
Bull. Med. Libr. Assoc. 65(4) October 1977
The Cleveland Health Sciences Library of Case Western Reserve University and The Cleveland Medical Library Association Cleveland, Ohio ABSTRACT The nature of the fiscal crisis in health science libraries in the United States is in part due to the style of management in these libraries, in part due to the lack of user identification, in part due to the lack of economically valid fees for service, and in part due to the success of the Biomedical Communications Network. These issues are discussed in terms of how they might be approached. A pragmatic stance is advocated for practitioners, the MLA, the NLM, and library schools to jointly address the questions raised.
THE "fiscal crisis" of American health science libraries needs to be seen in perspective. In September 1976 I journeyed to England, to Switzerland, and to Canada, and the library fiscal crisis in each of these countries makes our own look pale by comparison. Further, in some basic and important ways the medical libraries there have done well in optimizing the expenditure of scarce resources to provide library services. This is partly the result of a very long-term fiscal pinch, but it is also partly due to innovation by our colleagues who merit our respect and have some lessons for us. It would be accurate to say that misery loves company and that many library complaints around the world result from shared penury. But one has only to look back a short time to recall the days of one-upmanship and ready funds in the United States, and to realize that libraries operate, as indeed do most human endeavors, on a sine curve, with ups and downs similar to those of a roller coaster. Several years ago, if one library used a computer, another had its own computer. If one library provided documents free, another delivered them. This was not all bad, because from a longer perspective these past ten years or
so may be viewed as one of the more exciting and innovative periods in health science library history. But success creates as many problems as failure does, and it is important that we not point fingers at our traditional financial supporters. One of my favorite cartoons is that showing a cleaning lady sitting across the desk from a tycoon who is saying, "I know, Mother, but what have you done for me lately?"
THE NATURE OF OUR FISCAL CRISIS It is important to know just what our fiscal crisis consists of, because our attitudes toward, and our proposed solutions for, the situation are definitely outgrowths of our perception. First, we are caught in the very difficult position of having costs of library materials and staff rising rapidly, and of having technological innovations of crucial importance to us accelerating both in number and in cost, while we are being asked to keep our total budgets at the same dollar level or to decrease them. No matter how you phrase it, there is a dollar crunch. There is a second factor, however, which further complicates the situation. Many libraries have relied upon tederal funds to enable them to establish service networks without developing mechanisms to replace the federal dollars at the end of the grant period, even though in some cases the federal dollars were provided with the express condition that the services be provided without any sort of fee or other support being imposed upon those served. We are thus left in an awkward position due in part to our outreach and success, and no one can call the current health sciences library network anything but a success. It may need refinement, but its basic structure and the service it provides are excellent.
CRISIS
IN
MANAGEMENT
*Presented at the meeting of the New York Regional Another aspect of our current situation is that Group of the Medical Library Association, Columbia we are facing a managerial crisis. Several years University, New York, Nov. 13, 1976. Bull. Med. Libr. Assoc. 65(4) October 1977
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ROBERT G. CHESHIER
ago many librarians argued that our larger libraries could not be effectively managed without major shifts in organization, attitude, and support. In recent years this view has been modified somewhat, but now our position is again approaching the unmanageable in our larger libraries. For one thing, we have too small a managerial pool, partly because we have created too small a window through which talented and willing librarians from the profession can enter the managerial ranks; and once they do make it through, we have difficulty keeping them on a personal and professional growth curve. Women in particular have been excluded from management, as Goldstein and Hill have argued [1], and far too many top jobs in libraries and library schools have gone to people from outside the profession. A cursory survey of libraries from the Library of Congress down to small libraries of all types and of the list of library school deans will illustrate the nature of this problem. We have some reckoning coming here, and there is great concern that we are not producing effective library managers through either our educational or our practice efforts. We have also been remiss in not changing the style of management in our libraries so that all levels of staff can assist in solving the problems of service and fund raising in a creative way. Yet the technology we now have by itself requires participatory management and delegation of authority and responsibility, as well as new patterns of intralibrary and interlibrary communication and cooperation. "Technology" here is used in Drucker's sense to mean process as well as equipment. No director, in my view, can speak knowledgeably about OCLC, MEDLINE, the economics of information, network development, marketing techniques, management, and the host of other concepts or systems we must increasingly use. More importantly, no director should try to do so, any more than a single physician should either try to work outside the "team concept" we all hear about so often and see so seldom, or should try alone to provide total health care. Drucker's point is worth stating here: Technology is not about things: tools, processes, and products. It is about work: the specifically human activity by means of which man pushes back the limitations of the iron biological law which condemns all other animals to devote all their time and energy to keeping themselves alive for the next day, if not for the next hour
[2].
All of these factors have combined to create a 420
sort of paralysis or, at the very least, a reluctance to innovate, which Galvin has explored at length [3]. The factors described have also hampered another development which, as a result, has become part of our problem rather than part of the solution. This is the identification and use of alternative funding sources. Libraries are like biological organisms in that their stability increases as the diversity and range of their feeding sources increase, but we have been directed toward and opted to use a very limited number of feeding sources. We have also been misled as to the ability or willingness of some of our clients to help us financially, as typified by the view generally presented of hospitals as nonprofit institutions, or of other librarians as parasites upon us. Hospitals are nonprofit after salaries and a lot of other expenditures of which library service may be a valid component, and our library has had no difficulty in generating payment from other libraries for services rendered. The amounts may be questioned, but the concept is accepted. FEES FOR LIBRARY SERVICES I feel that neither the concept nor the reality of fees for library service has been discussed adequately in terms of service or support. If a librarian assumes that in periods of financial distress he can simply pass costs on to those who use services heretofore "free" or provided in a "have-have not" milieu, he may find himself in the position of destroying his market or even precluding development of it. Many libraries not previously charging for service have now decided to implement fees. Some are overcharging and haven't really prepared the market for this major change in policy or, in some cases, are using the fee to discourage use. Eight dollars for an interlibrary loan is probably an overcharge and $2.00 is probably much more realistic, for the simple reason that fees for use by other than "primary users" should be treated as marginal income to cover marginal costs. If one takes total library costs, and divides them by total use, the result will come closer to $2.00 than to $8.00, and the method seems reasonable to several economists our library has consulted. The point, however, is not $2.00 or $8.00, but rather the "marginal cost" concept of economics. This is particularly relevant because in most libraries the materials and services provided must be there to serve the library's primary population, and increased use of them by others thus reduces the unit use cost. The Bull. Med. Libr. Assoc. 65(4) October 1977
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concept of marginal costs is difficult, but here is one useful view of it. Further, this application of the concept has egalitarian appeal in that all users pay the same amount, although the primary users are accounted for by institutional support. Clearly, however, much thinking and research will be needed to address this issue. It is important because lack of understanding of this issue could cause considerable dismantling of the regional library network or an untoward development of local library resources to increase self-sufficiency, both contrary to our goals and activities over the past few years. If large resource libraries have not established rapport with their users, including other libraries, they may find it difficult to charge these users for service rendered without some peril. Another part of the problem is that too few academic health center libraries have established rapport with and provided real service to their hospital library constituencies. I mentioned earlier the one-upmanship we used to see; what we now see is one-upmanship of a different kind. If one library charges $1.00 per loan, another charges $2.00, another charges $8.00, and all are indignant that those they serve must pay their way with precious little statistical or analytical assistance either to help them pay or to preclude their borrowing through resource development. A specific experience can be cited here. The Cleveland Health Sciences Library (CHSL) has 135 institutional members and nearly 2,000 individual members. In 1968 CHSL began to document delivery to that public from the Allen Memorial Medical Library. The data showed that institutional service increased about 22% per year from 1964 to 1971, while individual service was relatively stable. Since then, circulation has increased more sharply and is nearly three times this year what it was in 1971-72. For the year April 1, 1975 through March 31, 1976 the library received 32,121 requests, filled 79% of them, and referred 17% for a total response rate of 96%. Thus, the total number of requests, the rate of increase, and CHSL's share of the total region's activity are all increasing very rapidly. There are some difficulties with these data, and yet CHSL has no wish to decrease its lending. The more library materials and services an institution provides in-house, the more it will use CHSL for interlibrary loan and other services, and the less likely we will be to fill its requests. As efficiency increases, concentration upon the relatively small percentage of requests not filled will increase the emotional aspects of the network. We thus must Bull. Med. Libr. Assoc. 65(4) October 1977
ask ourselves a number of questions, which will require considerable input from our institutional colleagues. Can we continue this growth spiral? If not, how do we check it? What are the economics of this process? CHSL has a problem and this experience may serve as an indicator of its magnitude and seriousness. Clearly, some serious and important research must be done. CHSL has established a system, developed rapport with users, implemented a fee, and increased its lending enormously; in the process it has uncovered a sorcerer's-apprentice phenomenon that is not fully understood. I feel strongly that we cannot and should not stop the growth in interlibrary loan until we know more. SOURCES OF FUNDS
There are, of course, other sources of funding than fees from users, and perhaps we need to establish limits to growth, but few sources of funds are as easy to tap as fees are, are more easily and morally defended, or are more easily raised as service and hence costs climb. There are foundation funds, individuals devoted to libraries, and such organizations as social clubs, unions, and industrial firms which can help. Here again, however, we have a problem because we have not effectively separated the service required to further a professional's activities from those other services which might encourage his support of libraries for their own sake; nor have we addressed the question of who those individuals are who might be users of our libraries given the opportunity. Perhaps a physician should support libraries financially because they are "good," but should not pay for library service he requires as part of his work in an institution. Perhaps the institution should pay. This will raise eyebrows, but we must distinguish between service and social good, and in the process, between individual and institutional responsibility and between individual and institutional costs. New institutional members of CHSL in recent months are the Ohio Carpenters' Pension Plan, the Sagamore Hills Children's Psychiatric Hospital, the Brown Insulating Systems, and Anaconda Company, Wire and Cable Division. Our total institutional membership illustrates the complexity of this issue and further stresses my point. We cannot accept the advice of the Association of Research Libraries and await federal support rather than pursue extension of both our fees and our network.
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The final part of our fiscal crisis of import here is probably due to network developments per se. It will probably never be known how much such networks as the RML network may have cost participating libraries. Meetings, travel, allocation of scarce resources to develop relationships with individuals and institutions remote from health science centers, and data collection and analysis have been enormously expensive both for individual libraries and for regions. The federal support provided for these activities, on the other hand, has not been enormous, although this statement is not intended to be anti-NLM. NLM has not handed out money lightly nor without clear indication of conditions attendant upon use of the funds and upon development of continuation capability. Still, the problem is similar to the one at Case Western Reserve University when NLM's policy shifted away from support of the education program for health science librarians, and the program was continued with funds from other sources. Cleveland Health Sciences Library has a very large budget this year, and the amount we will receive for federally determined and funded network activity is about 1.7% of that budget. Even if we accept the philosophy of NLM with regard to provision of library service, and even if we see the benefits of network development, we still must question the cost effectiveness of CHSL's activities in these areas. Let me emphasize again that nobody is at fault here and that NLM has consistently pointed out the "seed money" aspects of its support and has repeatedly stressed that health care practitioners in the American health care system need better library service. However, we still have the problem of operational networks that we may not be able to afford without some different types and amounts of funding. In 1969 CHSL had extensive discussions with the director of its regional medical library and with representatives of NLM. There was serious concern that CHSL was going counter to federal legislation and NLM policy by charging for service. I cite this to indicate the swiftness with which major shifts in basic philosophy have occurred.
agreement that we cannot stand still. For example, the staff at CHSL feels that the library must continue to expand and improve document delivery, even with the potentially enormous growth described earlier. It must increasingly provide reference service. It must continue to serve an archival function, to educate both health professionals and librarians, to place professional librarians in hospitals, to research what collections and services are needed at all levels of the library network, and to assist in the development of a national biomedical network. There is very little any of us can see that we could or should drop without requiring a major shift in our goals and philosophy, although we feel strongly that we must enhance our research and funding capabilities if we are to address these issues. ECONOMIC RESEARCH NEEDED We need to do a great deal more research on the economics of information before we make major changes in our current system. If coupled with a study of available library statistics, such research could help us move toward a more reasonable system. A number of publications on library economics are now available which few of us can easily comprehend, and we have only recently seen that the economics of information is becom-
ing a respected subset of the economics profession. On our campus we have had a student in the economics of information, whose Ph.D. dissertation was on CHSL's fee-for-service, and who has continued to work in the area of library economics [4]. If research in this field is combined with some pragmatic research by all of us, we may be able to implement reasonable fees for service and to clarify and understand better the economics both of our specific organizations and of libraries generally. In CHSL's case, fee-for-service covers both individual and institutional members, and will generate in this fiscal year 17.5% of the total budget. When you compare this with the 1.7% of the budget CHSL will receive from federal funds, you will see why fees for service are important. CHSL started its fee-for-service for institutions in 1968 and its fee for individuals in 1894. We are not certain of the best way for a library to begin an effective fee-for-service operation at this time, but we feel strongly that individual entrepreneurship WHAT SERVICES SHOULD WE PROVIDE? in this area must be carefully handled. Depending upon how much one is involved in In addition to fees as described here, we can networks, one can talk either of adding or of drop- also accommodate increased services and income ping services. There seems to be general through expansion of our markets. Limiting 422
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services is not a creative way to build for the future, although one can understand libraries limiting some services through sheer inability either to subsidize them, to pay for them, or even to perform them. Still, I believe our future lies in expanding our markets. We have yet to reach most health professionals with quick and meaningful library service; to address the questions and needs identified by the Occupational Safety and Health Act; to rise above "primary user population," "type of library," and a host of other limiting concepts; to maximize the use of our materials and hence minimize their unit use cost while ensuring that they are kept workable and in good repair. There are markets to be tapped that offer potential sources of support of considerable magnitude. These become especially important if continuing growth results in an increase in the order of magnitude of our activity. A subset of the expanded market potential is the expansion of library functions. The library is probably the one major "nonthreatening" component of most academic health science centers, and it can and should serve as the link between the health science practitioner community and its academic counterpart. How does the library assist the foreign medical graduate? How does the library become involved in the medical malpractice area and should it serve lawyers and the public as well as health professionals? How does the library use the questions generated by health practitioners in community hospitals to stimulate an educational response from health professional schools? What does the library do in the areas of medical records, or preventive medicine, or consumer health education? There are, of course, no specific answers to these questions, but in our experience consideration of them improves communications, generates income, and affects library operations without damaging the traditional concept of the role of the library. RESOURCE SHARING The final way in which we can match cost and service is through resource sharing. CHSL is part of a group called the Northeast Ohio Major Academic Libraries. The directors of seven institutions meet regularly, assign responsibilities to committees, and in general share their resources. We use the United Parcel Service delivery system to share our materials, and our common experience has been favorable and cost effective. Last year, for example, we saved over $40,000 in Bull. Med. Libr. Assoc. 65(4) October 1977
our combined serials budgets and we continue to explore ways to increase and speed up access to an increasingly larger set of library materials by an increasingly larger population of users. CHSL also belongs to the Library Council of Greater Cleveland, a group which includes all academic and public libraries in Cuyahoga County, and which has representatives of ASIS and SLA as observers at its meetings. Here, too, the directors meet, committees are assigned specific responsibilities, the United Parcel Service system is used to share materials, publications are generated on collections of strength, and overall access to and sharing of resources are facilitated. Finally, CHSL is a member of the Ohio College Library Center, an activity which costs us only about $8,000 per year, but which has enormous effect upon our operations. A quotation from the minutes of a recent OCLC board meeting may help to demonstrate the potential resource sharing and cost effectiveness of this system: In the first part of September 1976, participating libraries were cataloging at the rate of approximately 20,700 FTU (first time uses) a day, using existing records in the system for 92.1 per cent of books cataloged [5].
IMPLICATIONS FOR OTHER LIBRARY SYSTEMS We need a great deal more library research relative to some of the points above. Many librarians are particularly anxious that NLM support more such research, that practitioners, MLA, and the library schools collaborate in this effort, and that the findings be made widely available. NLM could be very helpful in analyzing the nature and extent of regional medical library activity and in presenting the findings to the profession for discussion. It seems fair to say that NLM's current attitude is that we need to increase service and expand networks, an attitude which may only compound our problems, but NLM has also asked for help in identifying research needs and potentials, so that its overall view is close to that presented here. In the near future, through the increased communication and need assessment possible by NLM-practitioner-library school collaboration, we will probably see major research capability aimed toward the vexing problems of our profession. It seems presumptuous to argue that both NLM and MLA need to take serious steps to ensure the viable continuation of the regional medical libraries, but it also seems necessary. Changes in federal support and the encouragement of fee mechanisms may be one way to do
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this, and both the tactics and the strategy of fees need broader discussion. All of us need to defuse some of the depressing emotionalism we see hampering communication and cooperation between resource and basic unit libraries. CHSL for one cannot and will not handle the "why don't you" questions we are asked. However, we feel positive toward our hospital library colleagues in northeast Ohio because much of the success of our fee-for-service and of our network is due to their interaction with us. In fact, we would argue both that fees can remove the hospital library from the "have not" part of the "have-have not" model, and that the resulting network is more businesslike and less emotional as a result. The CHSL staff spends considerable time and effort on this very issue. Mary Parker Follett wrote the following statements in 1924 which seem pertinent here: If you divest the balance of power theory of the pomp of diplomacy and the sanctity of academic controversy, the doctrine is no more dignified than the behavior of the two men (each having taken a course in "applied psychology" and learned that he must not face the light in a business interview) who dodged each other round the room until they found themselves side by side on the window seat. The questions all leaders, all organizers, should ask is not how we can bring about the acceptance of this idea, but how can we get that into the experience of the people which will mean the construction of new habits? This means a keen and inventive intelligence; good intentions, noble ideas, are not enough. As progress is through the release and integration of the action tendencies of each and every individual in society, ways should be provided for such activity to take place normally. This is perhaps the sentence in this book which I want most to emphasize [6].
If we are successful in some of the ways here discussed, I envision that the traditional pyramid which depicts the biomedical communication network will be turned upside down. The attitude of the resulting network then becomes one in which information queries from health practitioners would flow into the network, stimulating and in
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fact determining the response required from the various network levels as the query works its way down the pyramid. This model is a clear shift from the traditional hierarchical theory illustrated by the upright pyramid. A pinball machine helps to demonstrate some of the management issues raised above. You will recall that a ball enters the pinball field and either drops into a hole or proceeds down to the bottom of the machine. This latter is not desirable, so that one tries to keep it from happening. One can argue, with certain appropriate modifications, that the ball represents an information problem and one seeks to have it drop into the most quickly reached appropriate hole, which can be designated as a level of information response. It is my contention that we have been on the wrong track in building hedges in our profession represented by such concepts as "core libraries," "stop lists," "primary population," and "type of library," around the holes in the pinball machine analogy. Rather, we need to identify the process by which information requests are generated and responded to, and we need to work together to deal with the dynamics of the process. That seems a good beginning to help us cope with both fiscal stress and library service. REFERENCES 1. GOLDSTEIN, RACHAEL K., AND HILL, DOROTHY R. The status of women in the administration of health science libraries. Bull. Med. Libr. Assoc. 63: 386-395, Oct. 1975. 2. DRUCKER, PETER F. Work and tools. In: Drucker, Peter F. Technology, Management and Society. New York, Harper and Row, 1970. p. 45. 3. GALVIN, THOMAS J. Beyond survival: library management for the future. Libr. J. 101: 1833-1835, Sept. 15, 1976. 4. CASPER, CHERYL. Library pricing models and information requirements: a case study. Ph.D. dissertation. (Diss. Abstr. Int. 36A: 3866, 1975.) 5. OHIO COLLEGE LIBRARY CENTER. Minutes of the seventy-fifth meeting of the Board of Trustees, Sept. 21, 1976. p. 3. 6. FOLLETT, MARY PARKER. Creative Experience. New York, Peter Smith, 1951. p. 182, 200, 224.
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