Hospital Hospital Administrator Administrator

Perceptions of the Perceptions of the LibraryLibraryElaine R. Martin, DAElaine R. Martin, DANN/LM, NERNN/LM, NER

University of Massachusetts University of Massachusetts Medical SchoolMedical School

BackgroundBackground Value Study conducted in NN/LM, Value Study conducted in NN/LM,

MAR (Fall/Winter 2007)MAR (Fall/Winter 2007) NER RAC Hospital Library NER RAC Hospital Library

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

Call for participation (Spring 2008)Call for participation (Spring 2008) NER study conducted (Fall 2008)NER study conducted (Fall 2008)

Participant Participant CharacteristicsCharacteristics

DistributionDistribution StateState

44 CTCT

55 MAMA

33 MEME

44 NHNH

33 RIRI

22 VTVT

Hospital Bed SizeHospital Bed SizeRangeRange CountCount

<100<100 55

100-199100-199 66

200-299200-299 66

300-399300-399 00

>400>400 44

Study PurposeStudy Purpose The purpose of this study is two-fold: 1) The purpose of this study is two-fold: 1)

to investigate the views of hospital to investigate the views of hospital administrators about librarians and administrators about librarians and library services in their institutions and library services in their institutions and how they make decisions around what how they make decisions around what services are provided and funded in their services are provided and funded in their hospital; and 2) to explore the views of hospital; and 2) to explore the views of health sciences librarians, informed by health sciences librarians, informed by interviews with hospital administrators interviews with hospital administrators on the value of the hospital library. on the value of the hospital library.

MethodologyMethodology Qualitative studyQualitative study Librarian interviews of hospital Librarian interviews of hospital

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

SubcommitteeSubcommittee MAHSLIN presentation and next steps MAHSLIN presentation and next steps

discussiondiscussion

Interview QuestionsInterview Questions How are competing budgetary needs How are competing budgetary needs

ranked and prioritized? Do key ranked and prioritized? Do key individuals have a louder voice?individuals have a louder voice?

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

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

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

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

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

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

Questions (continued)Questions (continued) What would convince you that the What would convince you that the

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

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

Focus Group QuestionsFocus Group Questions The script was divided into two sections. The The script was divided into two sections. The

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

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

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

Data CollectionData Collection Transcribed textual data were reviewed Transcribed textual data were reviewed

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

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

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

Focus Group 1: ThemesFocus Group 1: Themes Theme 1: Demonstration of Theme 1: Demonstration of

value, worthy of fundingvalue, worthy of funding

Quantitative statisticsQuantitative statisticsOutcomesOutcomesMedical staff verbal supportMedical staff verbal support

Focus Group 1Focus Group 1 Theme 2: Why library is valuableTheme 2: Why library is valuable

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

Library support of EBM and Library support of EBM and researchresearch

Focus Group 1Focus Group 1 Theme 3: How library could show Theme 3: How library could show

value & doesn’t presentlyvalue & doesn’t presently

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

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

which equals moneywhich equals money

Focus Group 1Focus Group 1 Theme 4: How administrators Theme 4: How administrators

measure valuemeasure value

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

Focus Group 1Focus Group 1 Theme 5: What administrators value Theme 5: What administrators value

about libraryabout library Literature searchesLiterature searches Online resourcesOnline resources Committee workCommittee work BenchmarkingBenchmarking Helping employees going back to Helping employees going back to

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

Focus Group 1Focus Group 1 Theme 6: Tone of interviewTheme 6: Tone of interview

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

interviewinterview For the most part, librarians new For the most part, librarians new

intervieweesinterviewees

Focus Group 1Focus Group 1 Theme 7: Key pointsTheme 7: Key points

Library is valuableLibrary is valuable Go outside the library (committees, Go outside the library (committees,

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

Focus Group 1Focus Group 1 Theme 8: SurprisesTheme 8: Surprises

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

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

EMR and offered suggestionsEMR and offered suggestions

Focus Group 1Focus Group 1 Theme 9: Follow-upTheme 9: Follow-up

Administrator appointed librarian to Administrator appointed librarian to committeecommittee

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

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

Focus Group 1Focus Group 1 Theme 10: Librarian value of Theme 10: Librarian value of

experienceexperience

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

Focus Group 2Focus Group 2 Theme 1: Demonstration of value, Theme 1: Demonstration of value,

worthy of fundingworthy of funding Regulations, compliance, safety, and Regulations, compliance, safety, and

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

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

Statistics; dataStatistics; data

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

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

Supports education and community Supports education and community outreachoutreach

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

Focus Group 2Focus Group 2 Theme 3: How library could show Theme 3: How library could show

value and doesn’tvalue and doesn’t

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

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

Focus Group 2Focus Group 2 Theme 4: How administrators Theme 4: How administrators

measure valuemeasure value

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

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

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

Focus Group 2Focus Group 2 Theme 5: What administrators valueTheme 5: What administrators value

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

Administrators did not mention specific Administrators did not mention specific resourcesresources

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

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

Focus Group 2Focus Group 2 Theme 6: Tone of interviewTheme 6: Tone of interview

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

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

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

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

Focus Group 2Focus Group 2 Theme 7: Key pointsTheme 7: Key points

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

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

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

Focus Group 2Focus Group 2 Theme 8: SurprisesTheme 8: Surprises

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

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

Focus Group 2Focus Group 2 Theme 9: Follow-upTheme 9: Follow-up

Administrators wanted to hear results of Administrators wanted to hear results of studystudy

One wanted to attend librarian focus One wanted to attend librarian focus groupgroup

Administrator came to library open houseAdministrator came to library open house Librarian was asked to provide info for Librarian was asked to provide info for

monthly reportmonthly report

Focus Group 2Focus Group 2 Theme 9: Follow-up continuedTheme 9: Follow-up continued

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

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

Focus Group 2Focus Group 2 Theme 10: Librarian value of Theme 10: Librarian value of

experienceexperience

Opportunity to educate administrator Opportunity to educate administrator about libraryabout library

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

DiscussionDiscussion Tone of focus groups somewhat Tone of focus groups somewhat

differentdifferent First group participants knew each First group participants knew each

other; did that insert bias or effect other; did that insert bias or effect more positive comments about the more positive comments about the library?library?

Both groups of librarians saw value Both groups of librarians saw value in participating in the studyin participating in the study

Common ThemesCommon Themes What people say about the library influences What people say about the library influences

administrator funding decisions and perceptions of the administrator funding decisions and perceptions of the librarylibrary

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

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

education, they could not see library helping them in education, they could not see library helping them in their decision makingtheir decision making

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

Lack of specific examples by administrators regarding Lack of specific examples by administrators regarding library value roles in education and patient care except library value roles in education and patient care except for helping nurses with magnet statusfor helping nurses with magnet status

SummarySummary ““I just think that hospital I just think that hospital

administrators don’t realize all the administrators don’t realize all the skills that librarians have…”skills that librarians have…”

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

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

Next StepsNext Steps MAR Follow-up study to be piloted MAR Follow-up study to be piloted

this summer; development of “toolkit” this summer; development of “toolkit” for replicating the study for replicating the study

How do MAHSLIN/NER hospital How do MAHSLIN/NER hospital librarians want to follow-up?librarians want to follow-up?

Other issues for discussion—impact of Other issues for discussion—impact of economy on this study—influence on economy on this study—influence on future of hospital libraries in the future of hospital libraries in the regionregion