This article was downloaded by: [Florida State University] On: 24 December 2014, At: 14:10 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Medical Reference Services Quarterly Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wmrs20
The Road to Virtual: The Sauls Memorial Virtual Library's Journey a
a
Stacie Waddell , Amy Harkness & Mark L. Cohen
b
a
Sauls Memorial Virtual Library , Piedmont Atlanta Hospital , Atlanta , Georgia , USA b
Medical Affairs , Piedmont Atlanta Hospital , Atlanta , Georgia , USA Published online: 14 Feb 2014.
Click for updates To cite this article: Stacie Waddell , Amy Harkness & Mark L. Cohen (2014) The Road to Virtual: The Sauls Memorial Virtual Library's Journey, Medical Reference Services Quarterly, 33:1, 92-101, DOI: 10.1080/02763869.2014.866493 To link to this article: http://dx.doi.org/10.1080/02763869.2014.866493
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [Florida State University] at 14:10 24 December 2014
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Medical Reference Services Quarterly, 33(1):92–101, 2014 Published with license by Taylor & Francis ISSN: 0276-3869 print/1540-9597 online DOI: 10.1080/02763869.2014.866493
HOSPITAL INFORMATION SERVICES
Downloaded by [Florida State University] at 14:10 24 December 2014
Cheryl R. Dee, Kate Daniels, Priscilla L. Stephenson, and Peggy Cruse, Column Editors
The Road to Virtual: The Sauls Memorial Virtual Library’s Journey STACIE WADDELL and AMY HARKNESS Sauls Memorial Virtual Library, Piedmont Atlanta Hospital, Atlanta, Georgia, USA
MARK L. COHEN Medical Affairs, Piedmont Atlanta Hospital, Atlanta, Georgia, USA
The Sauls Memorial Virtual Library closed its physical space in 2012. This article outlines the reasons for this change and how the library staff and hospital leadership planned and executed the enormous undertaking. Outcomes of the change and lessons learned from the process are discussed. KEYWORDS Budget reductions, change management, electronic resources, staff reductions, virtual libraries
INTRODUCTION It was once true that there could be no library without a physical space and materials, such as books, journals, shelves, bricks, and mortar, but not so today. The “library-as-place” model is no longer the only way to conceive
© Stacie Waddell, Amy Harkness, and Mark L. Cohen Comments and suggestions should be sent to the Column Editors: Cheryl R. Dee (crdee@ fsu.edu), Kate Daniels ([email protected]), Priscilla L. Stephenson (priscilla.stephenson@ va.gov), and Peggy Cruse ([email protected]). Address correspondence to Stacie Waddell, Sauls Memorial Virtual Library, Piedmont Atlanta Hospital, 1963 Peachtree Road NW, Atlanta, GA 30309. E-mail: [email protected] 92
Downloaded by [Florida State University] at 14:10 24 December 2014
Hospital Information Services
93
of a library. In fact, today’s libraries should be defined by the services they provide, not by what physical materials they house or if they exist in a physical structure. To think otherwise would limit the possibilities and potential of today’s libraries. On August 1, 2012, the Sauls Memorial Library at Piedmont Atlanta Hospital closed its doors and became a virtual library. There were many reasons behind this change. Clear user preference for desktop delivery of information, a marked decrease in materials circulation and walk-in visits, budget cuts, and a reduction in both library and hospital staff all brought pressures to bear on the library. The library staff needed to make drastic changes to succeed in these new circumstances. In January 2012, the library staff and Vice President of Medical Affairs (VPMA), to whom the librarians report, began to realize that a physical, static presence on the Piedmont Atlanta Campus was not the only way to deliver first-rate library services. The many changes the library had undergone in the course of one year necessitated an honest look at the library and library services. With time and serious discussion, becoming a virtual library was seen as a sound and creative solution. “Going virtual” meant the staff could continue to deliver first-rate information services to staff while accommodating all of the recent changes in library use and in staffing. And so, the Sauls Memorial Virtual Library was born. This column will share the many reasons why a dramatic change in library space was undertaken, as well as describe how the library staff planned and accomplished this change.
LIBRARY BACKGROUND The Sauls Memorial Library opened its doors in 1974 as part of Piedmont Hospital. As the one-campus Atlanta hospital grew into a five-hospital and integrated outpatient system over the years, the Sauls Memorial Library kept pace and served as the library for all five hospital campuses, as well as serving the needs of corporate employees and outlying physician offices. Library services were centralized on the Piedmont Atlanta Campus, but through outreach efforts, such as mobile library services, electronic journals and books, telephone and e-mail requests, and electronic request forms, the library was able to meet the information needs of clinicians and employees regardless of the physical location. Throughout the years, the library has been viewed as a center of hospital life and scholarship and was often spoken of in terms of a “benefit” of working at Piedmont. The library’s physical location encompassed 3,458 square feet, with both a main medical library and a smaller consumer health library. The Business Center comprised eight computers for employee, patient, and family use, as well as a free copier, printer, and fax machine. There were stacks for 4,000 books, videos, and audio books. The library space also had movable journal
94
Hospital Information Services
stacks for 230 bound journal titles, as well as an area for the display of new journal issues. The library housed a small museum of medical history. Seven display cases held medical history items and books, ranging from a Civil War surgeon’s set to a late 1800s apothecary set. The library also had a conference room, which was available to any hospital department by reservation through the library staff.
Downloaded by [Florida State University] at 14:10 24 December 2014
RATIONALE FOR THE CHANGE TO A VIRTUAL LIBRARY Virtual libraries, the diminishment or closing of physical library space, and the changes brought about in library usage patterns by electronic access to resources are not new topics in the professional literature. Silver Cross Hospital in Joliet, Illinois, detailed its experience of becoming a virtual library,1 as did Wisher in her articles about the Touro University Nevada Virtual Library.2,3 The National Library of Medicine and the Association of Academic Health Science Libraries published details of the 2003 symposium, “The Library as Place: Building and Revitalizing Health Sciences Libraries in the Digital Age.”4 This report included talking points that have proven to be prescient, notably: “Library users will have less time, more information needs, and a desire for faster responses from librarians”; “Finally, to succeed, librarians must be open to new opportunities and directions; know when to walk away from traditional library services”; and “doing less with less.” The ways in which electronic resource access has changed user expectations and how users select formats is discussed by Suzetta Burrows.5 Burrows found that, as online journals were introduced in libraries, the use of print journals decreased. Burrows also highlighted user preference for desktop access and delivery of information, a preference which librarians cannot ignore. The rationale for the Sauls Memorial Library to become a virtual library was the result of three major changes in the library: change in use patterns, significant budget cuts, and drastic staff reduction in the library.
Change in Use Patterns The way in which the library’s resources were being used was changing. In 2008, the average circulation of print materials was 600 items per month. By 2010, this number decreased to fewer than 200 items per month. The preference for electronic resources, as well as changes in how physical items in the library were being used prompted the library staff to examine ways to change how services were being delivered. Over the last several years, the library staff observed that those seeking medical information most often called or e-mailed the library for information.
Downloaded by [Florida State University] at 14:10 24 December 2014
Hospital Information Services
95
Actual visits to the library for medical research purposes had been declining over the last few years, as evidenced by gate count statistics. This decrease in library visits was most likely the result of several factors. First, the library had been actively building its electronic journal and book collection over the previous ten years, so users could easily access library resources from anywhere in the hospital or from home. Also, the library staff had implemented electronic request forms a number of years ago. So this manner of making requests was already well established with library patrons, which reduced the need to actually visit the library for assistance. Overall reductions in hospital staff meant that workloads increased for clinical and administrative staff. The need, however, for quality medical information did not change, but busy staff rarely had time to visit the library to seek help or do the research themselves. This meant that easy access to information and the help of a professional librarian had become more important than ever. The library staff had also noted that the computers, printers, and copier were being used more for personal purposes than for research or for hospitalrelated reasons. While the library staff understood employees’ desire for convenient access to such resources, supporting the personal technology needs of employees had never been a core component of the library’s mission or budget.
Budget Cuts Budget reductions have become commonplace in libraries, and the Sauls Memorial Library has not escaped this trend. For fiscal year 2012, the Sauls Memorial Library was asked to cut its budget by 35%. This astonishing decrease in funds meant that business-as-usual in the library was no more, especially since the price of library resources was only increasing. To comply with this drastic budget cut, the library was asked to cancel all print journal subscriptions. Additionally, the library staff could not purchase any additional hard copy books or spend money to update current editions.
Staff Reduction In late 2010, the library staff was reduced from three full-time employees FTEs) to one FTE. This one FTE position was divided between two part-time, professional librarians. This substantial reduction in library staffing meant the staff could no longer maintain all of the services that it once had. Thus the library staff, with help and support from the hospital administration and medical staff, needed to identify the library’s core services in this new environment and find a way to deliver these services in a changed—and changing—hospital environment.
96
Hospital Information Services
Downloaded by [Florida State University] at 14:10 24 December 2014
CORE SERVICES The Sauls Memorial Library had always been a robust hospital department, offering traditional medical library services (e.g., reference services, literature searching, medical journals and books, article delivery, and interlibrary loans). In addition to traditional medical library services, the library also offered recreational audio books, popular magazines, consumer health books and electronic resources, and a Business Center. But with the budget reduction for fiscal year 2012 and the library staff layoffs in 2010, it became clear by January 2012 that a bold, creative solution had to be found that would deliver core library services with the budget and staffing changes that had occurred. First, the staff listed their core services prior to the budget and staff reductions. Next, the staff analyzed how much time was spent on a monthly basis doing each of the library’s functions. Fortunately, the library staff had been keeping usage statistics for over ten years. These numbers were analyzed to help support the changes in the library, as shown in Figure 1. After reviewing the library’s services and how library staff used their time, the library staff and Vice President of Medical Affairs determined what the core library functions were to be going forward. Essentially all physical library services would be eliminated, which included all print materials, computers, Business Center, conference room, historical artifacts, and study space. This would enable the medical librarians to devote their time to the previously determined core functions of the medical library: literature searches and article retrieval, as well as finding new ways to put clinical information at the point of care.
FIGURE 1 Monthly staff activities and time spent (color figure available online).
Hospital Information Services
97
Downloaded by [Florida State University] at 14:10 24 December 2014
BECOMING A VIRTUAL LIBRARY Before taking any steps, the library staff took time to consider what the virtual library would “look like” to users, all the steps involved in the process to become virtual, anticipated costs, how to respond to those who did not support the plan, and how best to decommission the physical items in the library. Early on in the process, the library staff realized that over the years the library had built up a substantial collection of electronic resources encompassing more than 270 electronic medical books, 700 full-text electronic journals, and six different medical databases; thus, a robust virtual library already existed. Maintaining these electronic resources had already been integrated into the workflow of the library staff, and the change to virtual did not require a great overhaul of time or responsibility to keep these resources updated and maintained. Since a virtual library was essentially already in place, the change would actually mean fine-tuning and promoting the virtual resources rather than creating a virtual library “from scratch.” What really had to be planned for then was how to decommission the physical library. After evaluating services and analyzing statistics, the library staff created a proposal for transitioning to a virtual library. This proposal discussed the rationale behind moving to a virtual-only library, as well as library services to be continued and discontinued. The proposal also discussed library staffing and location of staff on campus; the proposal ratification process among hospital leadership; costs involved in the change and upkeep of the virtual library; a transition timeline; an acknowledgment of the disappointment many may feel over the change; and a statement on Philanthropy’s role in informing library donors about the changes. Because the library staff and VPMA understood that this radical change in library services would need upper level support, the VPMA was responsible for putting this proposal into the hands of hospital leadership for review and support. The VPMA had the proposal ratified by senior leadership at the hospital, including the chief executive officer and chief operating officer. The hospital board also gave approval, as did the Medical Executive Committee. Philanthropy’s approval was also sought, as the library is supported in part by Philanthropy funds and was indeed founded upon a donor gift of medical books. Costs associated with the transition to virtual were also addressed in the proposal. The library staff foresaw no new, on-going costs associated with this change. Because the library already had a substantial electronic collection, the library did not need to create a virtual presence and start subscriptions to electronic resources. There would be some cost involved in moving the librarians to their new office space. The proposal included a discussion on costs associated with growing the virtual book and journal collection, and an increase in concurrent
Downloaded by [Florida State University] at 14:10 24 December 2014
98
Hospital Information Services
users of electronic resources. The proposal pointed out that maintaining a relevant, useful virtual library should not be seen as a savings to the hospital. Budget levels would need to be maintained, if not increased, if the library were to continue contributing to patient care and safety. All large projects need a timeline for success, and the proposal included a two-phase timeline that would be spread across three months. In Phase 1, the library staff decommissioned the library materials and made the hospital staff aware of the changes happening in the library. Information about the change was disseminated through hospital-wide e-mails, the library’s intranet page, bookmarks, and signs. The library staff also focused on distributing the library print collection to corresponding medical specialty departments in the hospital. The requirements for a medical department to house the books included a space to keep the books that would make them accessible to everyone in the department (e.g., workroom, conference room), and that the library would no longer be responsible for the books or for procuring updated editions. The library then held a book sale, and after the distribution and the book sale, the remaining library materials were shipped to the non-profit organization Better World Books.6 Proceeds received from the sale of these books went back into purchasing additional electronic books. One month into Phase 1, the library closed its doors to the public. Closing the doors to foot traffic allowed the library staff to address the decommissioning of the library space and materials without having to assist walk-in users. The library staff maintained the newly designated core services throughout Phase 1. The librarians felt it was important that services not lag during the transition. Being responsive to information needs throughout the process would help build confidence in this new iteration of the library. Also, library staff feared a temporary but complete shutdown of services might result in users forgetting about the library’s services or, worse yet, users turning to less credible sources of information. Phase 2 began once the staff moved to their new offices. Phase 2 outlined many on-going projects, including making improvements to the library’s intranet site. The library staff also created a survey asking people to “Help Build the Virtual Library.” The staff attached a link to the survey in their e-mail signatures and various hospital e-publications. Also during Phase 2, the librarians worked with the corporate archivist to remove the historical books and history of medicine artifacts. Finally, the proposal tackled some of the anticipated disappointments about losing the physical library. By including these anticipated disappointments in the proposal, the library staff hoped to convey that they understood this change would not be readily accepted by some and the disappointment felt by many was not being ignored by the library staff or hospital leadership. Finally, appropriate portions of the proposal were mailed to all library donors along with a letter from Philanthropy that outlined the change in library services.
Hospital Information Services
99
Downloaded by [Florida State University] at 14:10 24 December 2014
RESPONSES TO THE VIRTUAL LIBRARY All in all, the majority of the complaints regarding the change to a virtual library revolved around the loss of computer, printer, and copier access. This did not surprise the library staff, as observation and statistics has supported this fact. There were fewer complaints over the loss of physical books and journals or the loss of a quiet space to study or relax. As anticipated, requests for help with literature searches and article retrieval increased after becoming virtual. The librarians saw the literature search requests double for the first half of 2013 compared with the average of the last three years in the same time period. Also, article retrievals increased 13% after going virtual. Of course requests for help on how to use the virtual library increased substantially. In response, library staff created an e-mail template to send to those requesting help on accessing the virtual library. The library staff has been gratified to confirm through statistics that going virtual has in no way diminished the number of people seeking assistance from the library. For all of the library’s marketing attempts, there were people who did not understand the library still existed, even if there was no longer a physical space. Many did not understand what a virtual library meant and so just assumed that the library had ceased to exist in any capacity. Obviously marketing will be an ongoing process, as it always has been, for the library.
LESSONS LEARNED AND NEW ENDEAVORS One unexpected activity undertaken by the library staff during this change was that of “counselor.” Library users and nonusers were vocal in their disappointment about losing the library. The library staff was surprised that, no matter how often or rarely someone used the library, they were displeased that the library was being “taken from them.” The library staff spent a great deal of time counseling these people as to why the change was happening, how it was justifiable based on usage statistics, and giving suggestions for computing and studying needs. One notable consequence of the change to a virtual library is that requests for medical information from patients and family members have dropped 67%. They often came to the physical library to use the computers, printer, or copier. Often during one of these “personal business” visits, they would ask the librarians for help in finding medical information. While the library still advertises its services to patients and family members, much more needs to be done to promote library services to this population. As with all libraries, services need to be marketed. The librarians at Sauls Memorial Virtual Library have had to work harder than ever to make sure people do not “forget” about all of the unique services that are provided to hospital staff, patients, their family members, and the community at large.
Downloaded by [Florida State University] at 14:10 24 December 2014
100
Hospital Information Services
A benefit of no longer having to maintain the physical library space is that the librarians have greater flexibility in how they manage their time. In an effort to position the library resources as close to the bedside as possible, the library staff has started participating in multidisciplinary rounding on five hospital units. This activity, suggested by the VPMA, has been an exciting and challenging endeavor for the library staff. It has generated a good deal of “business” for the library by way of literature search requests, requests for articles, and the need for a quick answer to an “of-the-minute” patient care question. This endeavor is especially valuable, as it puts the librarian and the library resources in the center of patient care activities. Transitioning to a virtual library has shown that the library is a forwardthinking department, and one that is open to change. Completion of this project has been positively acknowledged by hospital leadership and has positioned the library to be an example of making difficult, but ultimately necessary, changes. In the ever-changing landscape of health care, being viewed in such a light has been good for the library.
CONCLUSION Becoming a virtual library has been a rewarding challenge. The library’s users have adjusted to the change, as has the library staff. The change has not led to a decreased use of the library’s resources, nor has it led to a decrease in people seeking librarian assistance. The change has allowed the staff to explore new ways to deliver information and prove value to departments that had not been active users in the past. In this new configuration, librarians at Sauls Memorial Virtual Library continue to meet the needs of the users though responsive collection development, good time management, and unique, professional skills. The staff created a slogan during the transition process, and other libraries considering this change may want to keep it handy as they consider transitioning: “Though We No Longer Fill a Space, We Can Still Fill Your Needs!”
REFERENCES 1. Hu, E. “The Virtual Library Experience: Going Online at Silver Cross Hospital.” Journal of Hospital Librarianship 10, no. 3 ( July–September 2010): 298–304. 2. Wisher, D. “The Touro University-Nevada Virtual Library Experience.” Journal of Electronic Resources in Medical Libraries 2, no. 3 (2005): 1–11. 3. Wisher, D. “The Touro University-Nevada Virtual Library Experience Revisited.” Journal of Electronic Resources in Medical Libraries 4, no. 3 (2007): 17–38. 4. Lynn, V.A., M. FitzSimmons, and C.K. Robinson. “Special Report: Symposium on Transformational Change in Health Sciences Libraries: Space, Collections, and Roles.” Journal of the Medical Library Association 99, no. 1 ( January 2011): 82–87.
Hospital Information Services
101
5. Burrows, S. “A Review of Electronic Journal Acquisition, Management, and Use in Health Sciences Libraries.” Journal of the Medical Library Association 94, no. 1 (2006): 67–74. 6. Better World Books. “Our Library Program.” Accessed September 11, 2013. http://www.betterworldbooks.com/go/donation-library.
Downloaded by [Florida State University] at 14:10 24 December 2014
ABOUT THE AUTHORS Stacie Waddell, MLIS ([email protected]) is Librarian; and Amy Harkness, MLIS, MPH ([email protected]) is Librarian; both at Sauls Memorial Virtual Library, Piedmont Atlanta Hospital, 1963 Peachtree Road NW, Atlanta, GA 30309. Mark L. Cohen, MD, PhD (mark.cohen@ piedmont.org) is Vice President of Medical Affairs and Chief Quality Officer, Piedmont Atlanta Hospital, 1963 Peachtree Road NW, Atlanta, GA 30309.
Medical Reference Services Quarterly Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wmrs20
The Road to Virtual: The Sauls Memorial Virtual Library's Journey a
a
Stacie Waddell , Amy Harkness & Mark L. Cohen
b
a
Sauls Memorial Virtual Library , Piedmont Atlanta Hospital , Atlanta , Georgia , USA b
Medical Affairs , Piedmont Atlanta Hospital , Atlanta , Georgia , USA Published online: 14 Feb 2014.
Click for updates To cite this article: Stacie Waddell , Amy Harkness & Mark L. Cohen (2014) The Road to Virtual: The Sauls Memorial Virtual Library's Journey, Medical Reference Services Quarterly, 33:1, 92-101, DOI: 10.1080/02763869.2014.866493 To link to this article: http://dx.doi.org/10.1080/02763869.2014.866493
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [Florida State University] at 14:10 24 December 2014
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Medical Reference Services Quarterly, 33(1):92–101, 2014 Published with license by Taylor & Francis ISSN: 0276-3869 print/1540-9597 online DOI: 10.1080/02763869.2014.866493
HOSPITAL INFORMATION SERVICES
Downloaded by [Florida State University] at 14:10 24 December 2014
Cheryl R. Dee, Kate Daniels, Priscilla L. Stephenson, and Peggy Cruse, Column Editors
The Road to Virtual: The Sauls Memorial Virtual Library’s Journey STACIE WADDELL and AMY HARKNESS Sauls Memorial Virtual Library, Piedmont Atlanta Hospital, Atlanta, Georgia, USA
MARK L. COHEN Medical Affairs, Piedmont Atlanta Hospital, Atlanta, Georgia, USA
The Sauls Memorial Virtual Library closed its physical space in 2012. This article outlines the reasons for this change and how the library staff and hospital leadership planned and executed the enormous undertaking. Outcomes of the change and lessons learned from the process are discussed. KEYWORDS Budget reductions, change management, electronic resources, staff reductions, virtual libraries
INTRODUCTION It was once true that there could be no library without a physical space and materials, such as books, journals, shelves, bricks, and mortar, but not so today. The “library-as-place” model is no longer the only way to conceive
© Stacie Waddell, Amy Harkness, and Mark L. Cohen Comments and suggestions should be sent to the Column Editors: Cheryl R. Dee (crdee@ fsu.edu), Kate Daniels ([email protected]), Priscilla L. Stephenson (priscilla.stephenson@ va.gov), and Peggy Cruse ([email protected]). Address correspondence to Stacie Waddell, Sauls Memorial Virtual Library, Piedmont Atlanta Hospital, 1963 Peachtree Road NW, Atlanta, GA 30309. E-mail: [email protected] 92
Downloaded by [Florida State University] at 14:10 24 December 2014
Hospital Information Services
93
of a library. In fact, today’s libraries should be defined by the services they provide, not by what physical materials they house or if they exist in a physical structure. To think otherwise would limit the possibilities and potential of today’s libraries. On August 1, 2012, the Sauls Memorial Library at Piedmont Atlanta Hospital closed its doors and became a virtual library. There were many reasons behind this change. Clear user preference for desktop delivery of information, a marked decrease in materials circulation and walk-in visits, budget cuts, and a reduction in both library and hospital staff all brought pressures to bear on the library. The library staff needed to make drastic changes to succeed in these new circumstances. In January 2012, the library staff and Vice President of Medical Affairs (VPMA), to whom the librarians report, began to realize that a physical, static presence on the Piedmont Atlanta Campus was not the only way to deliver first-rate library services. The many changes the library had undergone in the course of one year necessitated an honest look at the library and library services. With time and serious discussion, becoming a virtual library was seen as a sound and creative solution. “Going virtual” meant the staff could continue to deliver first-rate information services to staff while accommodating all of the recent changes in library use and in staffing. And so, the Sauls Memorial Virtual Library was born. This column will share the many reasons why a dramatic change in library space was undertaken, as well as describe how the library staff planned and accomplished this change.
LIBRARY BACKGROUND The Sauls Memorial Library opened its doors in 1974 as part of Piedmont Hospital. As the one-campus Atlanta hospital grew into a five-hospital and integrated outpatient system over the years, the Sauls Memorial Library kept pace and served as the library for all five hospital campuses, as well as serving the needs of corporate employees and outlying physician offices. Library services were centralized on the Piedmont Atlanta Campus, but through outreach efforts, such as mobile library services, electronic journals and books, telephone and e-mail requests, and electronic request forms, the library was able to meet the information needs of clinicians and employees regardless of the physical location. Throughout the years, the library has been viewed as a center of hospital life and scholarship and was often spoken of in terms of a “benefit” of working at Piedmont. The library’s physical location encompassed 3,458 square feet, with both a main medical library and a smaller consumer health library. The Business Center comprised eight computers for employee, patient, and family use, as well as a free copier, printer, and fax machine. There were stacks for 4,000 books, videos, and audio books. The library space also had movable journal
94
Hospital Information Services
stacks for 230 bound journal titles, as well as an area for the display of new journal issues. The library housed a small museum of medical history. Seven display cases held medical history items and books, ranging from a Civil War surgeon’s set to a late 1800s apothecary set. The library also had a conference room, which was available to any hospital department by reservation through the library staff.
Downloaded by [Florida State University] at 14:10 24 December 2014
RATIONALE FOR THE CHANGE TO A VIRTUAL LIBRARY Virtual libraries, the diminishment or closing of physical library space, and the changes brought about in library usage patterns by electronic access to resources are not new topics in the professional literature. Silver Cross Hospital in Joliet, Illinois, detailed its experience of becoming a virtual library,1 as did Wisher in her articles about the Touro University Nevada Virtual Library.2,3 The National Library of Medicine and the Association of Academic Health Science Libraries published details of the 2003 symposium, “The Library as Place: Building and Revitalizing Health Sciences Libraries in the Digital Age.”4 This report included talking points that have proven to be prescient, notably: “Library users will have less time, more information needs, and a desire for faster responses from librarians”; “Finally, to succeed, librarians must be open to new opportunities and directions; know when to walk away from traditional library services”; and “doing less with less.” The ways in which electronic resource access has changed user expectations and how users select formats is discussed by Suzetta Burrows.5 Burrows found that, as online journals were introduced in libraries, the use of print journals decreased. Burrows also highlighted user preference for desktop access and delivery of information, a preference which librarians cannot ignore. The rationale for the Sauls Memorial Library to become a virtual library was the result of three major changes in the library: change in use patterns, significant budget cuts, and drastic staff reduction in the library.
Change in Use Patterns The way in which the library’s resources were being used was changing. In 2008, the average circulation of print materials was 600 items per month. By 2010, this number decreased to fewer than 200 items per month. The preference for electronic resources, as well as changes in how physical items in the library were being used prompted the library staff to examine ways to change how services were being delivered. Over the last several years, the library staff observed that those seeking medical information most often called or e-mailed the library for information.
Downloaded by [Florida State University] at 14:10 24 December 2014
Hospital Information Services
95
Actual visits to the library for medical research purposes had been declining over the last few years, as evidenced by gate count statistics. This decrease in library visits was most likely the result of several factors. First, the library had been actively building its electronic journal and book collection over the previous ten years, so users could easily access library resources from anywhere in the hospital or from home. Also, the library staff had implemented electronic request forms a number of years ago. So this manner of making requests was already well established with library patrons, which reduced the need to actually visit the library for assistance. Overall reductions in hospital staff meant that workloads increased for clinical and administrative staff. The need, however, for quality medical information did not change, but busy staff rarely had time to visit the library to seek help or do the research themselves. This meant that easy access to information and the help of a professional librarian had become more important than ever. The library staff had also noted that the computers, printers, and copier were being used more for personal purposes than for research or for hospitalrelated reasons. While the library staff understood employees’ desire for convenient access to such resources, supporting the personal technology needs of employees had never been a core component of the library’s mission or budget.
Budget Cuts Budget reductions have become commonplace in libraries, and the Sauls Memorial Library has not escaped this trend. For fiscal year 2012, the Sauls Memorial Library was asked to cut its budget by 35%. This astonishing decrease in funds meant that business-as-usual in the library was no more, especially since the price of library resources was only increasing. To comply with this drastic budget cut, the library was asked to cancel all print journal subscriptions. Additionally, the library staff could not purchase any additional hard copy books or spend money to update current editions.
Staff Reduction In late 2010, the library staff was reduced from three full-time employees FTEs) to one FTE. This one FTE position was divided between two part-time, professional librarians. This substantial reduction in library staffing meant the staff could no longer maintain all of the services that it once had. Thus the library staff, with help and support from the hospital administration and medical staff, needed to identify the library’s core services in this new environment and find a way to deliver these services in a changed—and changing—hospital environment.
96
Hospital Information Services
Downloaded by [Florida State University] at 14:10 24 December 2014
CORE SERVICES The Sauls Memorial Library had always been a robust hospital department, offering traditional medical library services (e.g., reference services, literature searching, medical journals and books, article delivery, and interlibrary loans). In addition to traditional medical library services, the library also offered recreational audio books, popular magazines, consumer health books and electronic resources, and a Business Center. But with the budget reduction for fiscal year 2012 and the library staff layoffs in 2010, it became clear by January 2012 that a bold, creative solution had to be found that would deliver core library services with the budget and staffing changes that had occurred. First, the staff listed their core services prior to the budget and staff reductions. Next, the staff analyzed how much time was spent on a monthly basis doing each of the library’s functions. Fortunately, the library staff had been keeping usage statistics for over ten years. These numbers were analyzed to help support the changes in the library, as shown in Figure 1. After reviewing the library’s services and how library staff used their time, the library staff and Vice President of Medical Affairs determined what the core library functions were to be going forward. Essentially all physical library services would be eliminated, which included all print materials, computers, Business Center, conference room, historical artifacts, and study space. This would enable the medical librarians to devote their time to the previously determined core functions of the medical library: literature searches and article retrieval, as well as finding new ways to put clinical information at the point of care.
FIGURE 1 Monthly staff activities and time spent (color figure available online).
Hospital Information Services
97
Downloaded by [Florida State University] at 14:10 24 December 2014
BECOMING A VIRTUAL LIBRARY Before taking any steps, the library staff took time to consider what the virtual library would “look like” to users, all the steps involved in the process to become virtual, anticipated costs, how to respond to those who did not support the plan, and how best to decommission the physical items in the library. Early on in the process, the library staff realized that over the years the library had built up a substantial collection of electronic resources encompassing more than 270 electronic medical books, 700 full-text electronic journals, and six different medical databases; thus, a robust virtual library already existed. Maintaining these electronic resources had already been integrated into the workflow of the library staff, and the change to virtual did not require a great overhaul of time or responsibility to keep these resources updated and maintained. Since a virtual library was essentially already in place, the change would actually mean fine-tuning and promoting the virtual resources rather than creating a virtual library “from scratch.” What really had to be planned for then was how to decommission the physical library. After evaluating services and analyzing statistics, the library staff created a proposal for transitioning to a virtual library. This proposal discussed the rationale behind moving to a virtual-only library, as well as library services to be continued and discontinued. The proposal also discussed library staffing and location of staff on campus; the proposal ratification process among hospital leadership; costs involved in the change and upkeep of the virtual library; a transition timeline; an acknowledgment of the disappointment many may feel over the change; and a statement on Philanthropy’s role in informing library donors about the changes. Because the library staff and VPMA understood that this radical change in library services would need upper level support, the VPMA was responsible for putting this proposal into the hands of hospital leadership for review and support. The VPMA had the proposal ratified by senior leadership at the hospital, including the chief executive officer and chief operating officer. The hospital board also gave approval, as did the Medical Executive Committee. Philanthropy’s approval was also sought, as the library is supported in part by Philanthropy funds and was indeed founded upon a donor gift of medical books. Costs associated with the transition to virtual were also addressed in the proposal. The library staff foresaw no new, on-going costs associated with this change. Because the library already had a substantial electronic collection, the library did not need to create a virtual presence and start subscriptions to electronic resources. There would be some cost involved in moving the librarians to their new office space. The proposal included a discussion on costs associated with growing the virtual book and journal collection, and an increase in concurrent
Downloaded by [Florida State University] at 14:10 24 December 2014
98
Hospital Information Services
users of electronic resources. The proposal pointed out that maintaining a relevant, useful virtual library should not be seen as a savings to the hospital. Budget levels would need to be maintained, if not increased, if the library were to continue contributing to patient care and safety. All large projects need a timeline for success, and the proposal included a two-phase timeline that would be spread across three months. In Phase 1, the library staff decommissioned the library materials and made the hospital staff aware of the changes happening in the library. Information about the change was disseminated through hospital-wide e-mails, the library’s intranet page, bookmarks, and signs. The library staff also focused on distributing the library print collection to corresponding medical specialty departments in the hospital. The requirements for a medical department to house the books included a space to keep the books that would make them accessible to everyone in the department (e.g., workroom, conference room), and that the library would no longer be responsible for the books or for procuring updated editions. The library then held a book sale, and after the distribution and the book sale, the remaining library materials were shipped to the non-profit organization Better World Books.6 Proceeds received from the sale of these books went back into purchasing additional electronic books. One month into Phase 1, the library closed its doors to the public. Closing the doors to foot traffic allowed the library staff to address the decommissioning of the library space and materials without having to assist walk-in users. The library staff maintained the newly designated core services throughout Phase 1. The librarians felt it was important that services not lag during the transition. Being responsive to information needs throughout the process would help build confidence in this new iteration of the library. Also, library staff feared a temporary but complete shutdown of services might result in users forgetting about the library’s services or, worse yet, users turning to less credible sources of information. Phase 2 began once the staff moved to their new offices. Phase 2 outlined many on-going projects, including making improvements to the library’s intranet site. The library staff also created a survey asking people to “Help Build the Virtual Library.” The staff attached a link to the survey in their e-mail signatures and various hospital e-publications. Also during Phase 2, the librarians worked with the corporate archivist to remove the historical books and history of medicine artifacts. Finally, the proposal tackled some of the anticipated disappointments about losing the physical library. By including these anticipated disappointments in the proposal, the library staff hoped to convey that they understood this change would not be readily accepted by some and the disappointment felt by many was not being ignored by the library staff or hospital leadership. Finally, appropriate portions of the proposal were mailed to all library donors along with a letter from Philanthropy that outlined the change in library services.
Hospital Information Services
99
Downloaded by [Florida State University] at 14:10 24 December 2014
RESPONSES TO THE VIRTUAL LIBRARY All in all, the majority of the complaints regarding the change to a virtual library revolved around the loss of computer, printer, and copier access. This did not surprise the library staff, as observation and statistics has supported this fact. There were fewer complaints over the loss of physical books and journals or the loss of a quiet space to study or relax. As anticipated, requests for help with literature searches and article retrieval increased after becoming virtual. The librarians saw the literature search requests double for the first half of 2013 compared with the average of the last three years in the same time period. Also, article retrievals increased 13% after going virtual. Of course requests for help on how to use the virtual library increased substantially. In response, library staff created an e-mail template to send to those requesting help on accessing the virtual library. The library staff has been gratified to confirm through statistics that going virtual has in no way diminished the number of people seeking assistance from the library. For all of the library’s marketing attempts, there were people who did not understand the library still existed, even if there was no longer a physical space. Many did not understand what a virtual library meant and so just assumed that the library had ceased to exist in any capacity. Obviously marketing will be an ongoing process, as it always has been, for the library.
LESSONS LEARNED AND NEW ENDEAVORS One unexpected activity undertaken by the library staff during this change was that of “counselor.” Library users and nonusers were vocal in their disappointment about losing the library. The library staff was surprised that, no matter how often or rarely someone used the library, they were displeased that the library was being “taken from them.” The library staff spent a great deal of time counseling these people as to why the change was happening, how it was justifiable based on usage statistics, and giving suggestions for computing and studying needs. One notable consequence of the change to a virtual library is that requests for medical information from patients and family members have dropped 67%. They often came to the physical library to use the computers, printer, or copier. Often during one of these “personal business” visits, they would ask the librarians for help in finding medical information. While the library still advertises its services to patients and family members, much more needs to be done to promote library services to this population. As with all libraries, services need to be marketed. The librarians at Sauls Memorial Virtual Library have had to work harder than ever to make sure people do not “forget” about all of the unique services that are provided to hospital staff, patients, their family members, and the community at large.
Downloaded by [Florida State University] at 14:10 24 December 2014
100
Hospital Information Services
A benefit of no longer having to maintain the physical library space is that the librarians have greater flexibility in how they manage their time. In an effort to position the library resources as close to the bedside as possible, the library staff has started participating in multidisciplinary rounding on five hospital units. This activity, suggested by the VPMA, has been an exciting and challenging endeavor for the library staff. It has generated a good deal of “business” for the library by way of literature search requests, requests for articles, and the need for a quick answer to an “of-the-minute” patient care question. This endeavor is especially valuable, as it puts the librarian and the library resources in the center of patient care activities. Transitioning to a virtual library has shown that the library is a forwardthinking department, and one that is open to change. Completion of this project has been positively acknowledged by hospital leadership and has positioned the library to be an example of making difficult, but ultimately necessary, changes. In the ever-changing landscape of health care, being viewed in such a light has been good for the library.
CONCLUSION Becoming a virtual library has been a rewarding challenge. The library’s users have adjusted to the change, as has the library staff. The change has not led to a decreased use of the library’s resources, nor has it led to a decrease in people seeking librarian assistance. The change has allowed the staff to explore new ways to deliver information and prove value to departments that had not been active users in the past. In this new configuration, librarians at Sauls Memorial Virtual Library continue to meet the needs of the users though responsive collection development, good time management, and unique, professional skills. The staff created a slogan during the transition process, and other libraries considering this change may want to keep it handy as they consider transitioning: “Though We No Longer Fill a Space, We Can Still Fill Your Needs!”
REFERENCES 1. Hu, E. “The Virtual Library Experience: Going Online at Silver Cross Hospital.” Journal of Hospital Librarianship 10, no. 3 ( July–September 2010): 298–304. 2. Wisher, D. “The Touro University-Nevada Virtual Library Experience.” Journal of Electronic Resources in Medical Libraries 2, no. 3 (2005): 1–11. 3. Wisher, D. “The Touro University-Nevada Virtual Library Experience Revisited.” Journal of Electronic Resources in Medical Libraries 4, no. 3 (2007): 17–38. 4. Lynn, V.A., M. FitzSimmons, and C.K. Robinson. “Special Report: Symposium on Transformational Change in Health Sciences Libraries: Space, Collections, and Roles.” Journal of the Medical Library Association 99, no. 1 ( January 2011): 82–87.
Hospital Information Services
101
5. Burrows, S. “A Review of Electronic Journal Acquisition, Management, and Use in Health Sciences Libraries.” Journal of the Medical Library Association 94, no. 1 (2006): 67–74. 6. Better World Books. “Our Library Program.” Accessed September 11, 2013. http://www.betterworldbooks.com/go/donation-library.
Downloaded by [Florida State University] at 14:10 24 December 2014
ABOUT THE AUTHORS Stacie Waddell, MLIS ([email protected]) is Librarian; and Amy Harkness, MLIS, MPH ([email protected]) is Librarian; both at Sauls Memorial Virtual Library, Piedmont Atlanta Hospital, 1963 Peachtree Road NW, Atlanta, GA 30309. Mark L. Cohen, MD, PhD (mark.cohen@ piedmont.org) is Vice President of Medical Affairs and Chief Quality Officer, Piedmont Atlanta Hospital, 1963 Peachtree Road NW, Atlanta, GA 30309.
