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Hospital libraries in perspective.

The proliferation of hospital libraries since World War II has created a generation of librarians who take for granted the existence of libraries in hospitals. A literature review for the first half of the twentieth century presents a picture of uncertainty and struggle for identity for the hospital library. Then as now, hospital libraries reflect the institutions within which they operate. A brief history of the development of the American hospital provides a context for describing the various roles that the hospital library has played within its parent institution during the twentieth century. Some personal reflections on working in a hospital library are also presented.

Education, Medical

Total quality management (TQM) in a hospital library: identifying service benchmarks.

Hospitals are turning to total quality management (TQM) to lower costs of providing care. A hospital library in a TQM environment needs to embrace corporate goals while maintaining its accountability as a contributor to quality patient care. Alliant Health System (AHS) Library at Norton Hospital and Kosair Children's Hospital in Louisville, Kentucky, conducted a study to establish TQM benchmarks and to examine the significance of its role in clinical care. Using a methodology designed to allow both library user and nonuser to respond, 2,091 surveys were distributed to physicians and nursing and allied health personnel. Areas surveyed included frequency of library use, impact of information received on clinical judgments, cognitive value of the information, and satisfaction with library products and services. Results confirm that the library has a substantial clinical role. Eighty-eight percent of reporting physicians agreed that information from the library contributed to higher quality care. Nursing and allied health were less convinced of the importance of the library's clinical role. Sixty-nine percent of nursing personnel and 58% of allied health personnel agreed that the library contributed to higher quality care. Nursing and allied health personnel also used the library less frequently than physicians. With these results as benchmarks, improving the clinical role of the library will take commitment to the TQM process and a willingness to change.

Attitude of Health Personnel

The hospital library in transition.

The community hospital library has evolved to a current status of real importance because of advances in medicine and technology, rising expectations from better-informed consumers to be "well," health care specialization, legislation, and malpractice and licensure concerns. Some suggestions are offered to help the hospital library and librarian function in a broad range of roles, from a reservoir of information to public relations resource.

Accreditation

Outreach: the western New York Hospital Library Services Program, 1985-1989.

The Hospital Library Services Program (HLSP) in western New York, during the period covered by its first five-year plan, 1984-1989, is recounted and described. This ongoing program is funded annually by a New York State grant and hospital participation fees. It is designed to support access to biomedical information for health care professionals through a grant program for hospitals with staffed libraries and a circuit program for hospitals without library staffing or without libraries. Hospitals participating in the grant program contribute funds and receive grants for collection development. Hospitals participating in the circuit program pay a participation fee and receive regularly scheduled, documented, circuit librarian visits; a collection development grant; and a grant for contract library services. The program contracts with the State University of New York at Buffalo's (UB) Health Sciences Library to provide computerized literature searches; interlibrary loan (ILL) of journal articles, books, and audiovisuals; and ILL referrals.

Fees and Charges

Conversion of the periodical collection in a teaching hospital library to microfilm format.

The Martland Hospital Library converted many of its periodical backfiles to 16 mm microfilm cartridges. Some details of program implementation, user reactions, costs, and problems are discussed. In a teaching hospital library microfilm in cartridge format has been well accepted by patrons, in part because the need to read from a projection screen has been minimized by granting liberal printing privileges.

Costs and Cost Analysis

Hospital libraries' consortium blunts impact of budget cuts.

Hospital libraries frequently are faced with increasing costs for journals and other educational resources, increasing demand for continuing education materials by health care professionals, and decreasing budgets to meet these needs. Several medical and hospital libraries in Illinois are providing continued, and possibly improved, services under budgetary constraints through a consortium that emphasizes sharing of resources, interlibrary loans, librarian consultation services, and cost-saving projects.

Budgets

The changing status of hospital libraries 1984 to 1989: characteristics and services in Region 7 of the National Network of Libraries of Medicine.

Economic and political factors have had far-reaching effects on hospital libraries in the last decade, but quantitative evidence of these changes is not readily available. Through periodic evaluation surveys within its multistate region, the Pacific Southwest Regional Medical Library Service, the Regional Medical Library for Region 7 of the National Network of Libraries of Medicine (formerly the Regional Medical Library Network) has monitored hospital library changes over the years. This paper compares data from a 1989 survey with similar information gathered in 1984. Longitudinal analysis was performed on responses from 188 hospitals that responded to both the 1984 and the 1989 survey, as was cross-sectional analysis of all responses from both surveys. Results showed a small decrease in the number of hospitals with separate library collections. Staffing patterns had changed considerably, with a drop of approximately one entire full-time salaried equivalent per library and a decrease in libraries managed by a librarian with an M.L.S. The libraries that provide all of a set of predefined core services and resources decreased from 61% in 1984 to 44% in 1989. Libraries with M.L.S. staff were more likely to have core services than those without professional staff.

Cross-Sectional Studies

Cooperation strengthens small hospital libraries in a rural area of New England: a five-year experience.

Before 1970, library facilities and services at the small hospitals in rural Vermont were essentially nonexistent. Similar findings were later encountered along the Connecticut River in New Hampshire and in a small area of upstate New York. The Hospital Library Development Services program was established at the University of Vermont's Dana Medical Library to improve these conditions. Financial assistance was received from the National Library of Medicine, and by the end of 1974, thirty-three hospitals had staffed libraries. Earlier that year it has been decided to begin emphasing cooperation among the developing libraries, including the production of union lists and regular meetings of staff members from geographically proximate hospital libaries to plan and implement various activities. An additional one-year award from NLM was received in 1975. Results achieved during and after the period of grant support are reported. Cooperation among hospital libraries is seen as a feasible and beneficial undertaking provided that the participating libraries are internally supported and developing.

Financing, Government

Health information for patients: The hospital library's role.

Libraries today, including most hospital-based patients' libraries, are involved only peripherally in providing patient health science information. Hospital libraries should collaborate with health professionals in getting health information to patients--along with the library's more traditional roles of providing recreational reading for patients and serving the informational needs of the physician and medical staff. The library should act as the center for educational materials and programs within the hospital. Many health agencies, health educators, physicians, and librarians have been discussing the need for patient health education, but there are few effectively organized or established education centers. This paper discusses an overview of patient health education and intellectural freedom, proposes a new role for the existing hospital library in patient health education, and suggests guidelines for establishing a patient education center.

Health Education

Toward hospital library standards in Canada.

A report is given on Canadian hospital library standards as recently developed and incorporated in a new Guide to Hospital Accreditation, 1977. The new Canadian standards are compared with MLA recommendations to the Joint Commission on Accreditation of Hospitals. Their development is sketched and the contribution from Quebec of a model of hospital classification is examined. This model provides differential minimal library standards based on the function of the hospital rather than on its size alone. Use of these minimal standards as a practical means of developing hospital libraries is discussed and their implications for accreditation visits are underlined.

Accreditation