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Hospital Administrator Perceptions of the Library. Elaine R. Martin, DA NN/LM, NER University of Massachusetts Medical School. Background. Value Study conducted in NN/LM, MAR (Fall/Winter 2007)

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Hospital Administrator Perceptions of the Library

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Hospital administrator perceptions of the library l.jpg

Hospital Administrator Perceptions of the Library

Elaine R. Martin, DA

NN/LM, NER

University of Massachusetts Medical School


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Background

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

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

  • Call for participation for NER members (Spring 2008)

  • NER study conducted (Fall 2008)


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NER Participant Characteristics


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NER Hospital Bed Size


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MAR Participant Characteristics

Representation from New York, New Jersey and Pennsylvania


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Study Purpose

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


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Methodology

  • Qualitative study

  • Librarian interviews of hospital administrators

  • Focus groups with librarian interviewers

  • Analysis of common themes

  • Initial report to RAC in MAR

  • Initial report to RAC Hospital Library Subcommittee

  • MAR is using data to frame larger value study


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Interview Questions

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

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

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


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Questions (continued)

  • Are there one or two specific services or resources that are especially useful to you personally at work? When you need information for your work, what is your usual approach to finding answers?

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

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


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Questions (continued)

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

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


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Focus Group Process

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

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

  • There were 9 questions in all.


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Data Collection

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

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

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


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NER Focus Group 1

  • Theme 1: Demonstration of value, worthy of funding

    • Quantitative statistics

    • Outcomes

    • Medical staff verbal support


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NER Focus Group 1

  • Theme 2: Why library is valuable

    • Library supports education

    • Library supports nurses (magnet status)

    • Library support of EBM and research


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NER Focus Group 1

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

    • Press-Ganey (assist with best practices)

    • Show information effects patient outcomes or improve processes

    • Show library saves administrator time which equals money


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NER Focus Group 1

  • Theme 4: How administrators measure value

    • Reporting structure

    • Juxtaposition of library space

    • Quantitative numbers

    • Involvement in community

    • Respond to administrator questions


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NER Focus Group 1

  • Theme 5: What administrators value about library

    • Literature searches

    • Online resources

    • Committee work

    • Benchmarking

    • Helping employees going back to school/students

    • Library as place

    • ILL service


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NER Focus Group 1

  • Theme 6: Tone of interview

    • Positive

    • Upbeat

    • Quick; not a lot of thought

    • Disappointing in lack of depth of the interview

    • For the most part, librarians knew interviewees


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Focus Group 1

  • Theme 7: Key points

    • Library is valuable

    • Go outside the library (committees, community)

    • Target administrators

    • Library as physical place important

    • Statistics (numbers) important

    • Library support for education important


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Focus Group 1

  • Theme 8: Surprises

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

    • Administrator asked for lit search

    • Administrator saw role of library in EMR and offered suggestions


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Focus Group 1

  • Theme 9: Follow-up

    • Administrator appointed librarian to committee

    • Administrator requested information (lit search)

    • Administrator suggested other contacts

    • More recognition in the hall


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NER Focus Group 1

  • Theme 10: Librarian value of experience

    • Confidence building

    • Opened lines of communication

    • Teachable moment

    • Cache of being in NLM study


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NER Focus Group 2

  • Theme 1: Demonstration of value, worthy of funding

    • Regulations, compliance, safety, and direct patient care drive funding

    • IS is valued and library is part of IS

    • Listen to what people say about the library (anecdotes); library as “dissatisfier”

    • Statistics; data


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NER Focus Group 2

  • Theme 2: Why library is valuable

    • Library saves people time; time equals money

    • Supports education and community outreach

    • Library doesn’t consume a lot of resources


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Focus Group 2

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

  • Most administrators in this group could not offer suggestions

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


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NER Focus Group 2

  • Theme 4: How administrators measure value

    • Revenue generating services are looked at more favorably

    • Library didn’t consume many resources and was bargain

    • They measure value in “dollars and cents”


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NER Focus Group 2

  • Theme 5: What administrators value

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

    • Administrators did not mention specific resources

    • One administrator goes to the library to read the newspaper

    • Statistics--usage

    • Serving the public


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NER Focus Group 2

  • Theme 6: Tone of interview

    • Disappointing

    • “…she valued the library despite what the future may hold.”

    • For the most part, librarians did not know interviewees; some were rescheduled more than once

    • Not as positive as Focus Group 1


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NER Focus Group 2

  • Theme 7: Key points

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

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

    • Go out of the library; Sell yourself

    • Regulations drive funding decisions


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NER Focus Group 2

  • Theme 8: Surprises

    • Administrator could not see value of library in strategic planning

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


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NER Focus Group 2

  • Theme 9: Follow-up continued

    • RI library regulation challenged

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


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NER Focus Group 2

  • Theme 10: Librarian value of experience

    • Opportunity to educate administrator about library

    • Opportunity to change perceptions about library


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MAR Focus Group 1

  • Theme 1: Demonstration of value

    • Medical staff financial and verbal support of the library


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MAR Focus Group 1

  • Theme 2: Why library is valuable

    • Library supports educational mission

    • Library supports clinical care mission

    • Library supports administrative decision making

    • Offers online access to resources


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MAR Focus Group 1

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

    • Link to EMR

    • Become a resource for executive leadership

    • Support the bottom line


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MAR Focus Group 1

  • Theme 4: How administrators measure value

    • Who you report to in the organization

    • Administrators want numbers

    • If the librarian earns respect

    • Importance of voices; medical staff


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MAR Focus Group 1

  • Theme 5: What hospital administrators value

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

    • Library as place

    • Being able to use a surrogate

    • Help with administrative issues


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MAR Focus Group 1

  • Theme 6: Tone of interview

    • Positive experience

    • Opportunity for librarian to sell/educate about the library

    • Opportunity to talk to administration

    • Only one negative experience in this group


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MAR Focus Group 1

  • Theme 7: Key Points

    • Library is valuable if relevant to mission

    • Important to hear what administrators need not what we think they need

    • Administrators value physical place as well as resources

    • Administrators lack awareness of expanded roles of librarians

    • Administrators listen to medical staff


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MAR Focus Group 1

  • Theme 8: Surprises

    • Physicians see library as a recruitment tool

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

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


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MAR Focus Group 1

  • Theme 9: Follow-up

    • Interview was an opportunity to establish relationship

    • Follow up meeting with administrator interviewed for budget purposes and led to administrator having better understanding of the library

    • Administrator offered opportunity for library presentation to senior staff

    • Administrator offered opportunity for new initiatives


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MAR Focus Group 1

  • Theme 10: Nurses

    • Nurses value the library

    • Libraries play important role in achieving magnet status


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MAR Focus Group 1

  • Theme 11: What would help librarians from this study

    • Share results


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MAR Focus Group 2

  • Theme 1: Demonstration of value

    • What others (medical staff) say about the library and to whom you say it matters

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


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MAR Focus Group 2

  • Theme 2: Why library is valuable

    • Resources (Ovid, Up-to-Date, MD Consult, internet, e-journals, literature searches

    • Library plays a role in evidence-based, data decision making

    • Working with nursing staff

    • Supports patient care, education and research missions

    • Consumer health

    • Place for online education of staff


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MAR Focus Group 2

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

    • Need to show ROI but not sure how

    • Help researchers get more funding

    • Demonstrate link to patient satisfaction

    • Link evidence to the bedside through EMR


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MAR Focus Group 2

  • Theme 4: How administrators measure value

    • Foot traffic

    • Quantitative measures (# of documents requested, use, statistics, etc)

    • Measure results of Ask a Librarian to length of stay

    • Patient satisfaction documented in the chart

    • Press Ganey Patient Satisfaction Survey

    • Recognition by JCAHO

    • Positive comments about the library

    • Involvement in important projects


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MAR Focus Group 2

  • Theme 5: What administrators value about the library

    • Library as place

    • Quiet place and print journals

    • Access to resources such as electronic journals, up-to-Date and MD Consult


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MAR Focus Group 2

  • Theme 6: Tone of interview

    • Positive Experience for the most part

    • Negative experience for some where administrator struggled to provide answers and didn’t want to spend the time


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MAR Focus Group 2

  • Theme 7: Key Points

    • Those who use the library value it most

    • Interview led administrator to think of new committees/roles for librarian

    • Usage effects funding; statistics matter

    • Budgetary decisions are driven by compliance and regulation

    • Improved patient satisfaction could be linked to consumer health services


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MAR Focus Group 2

  • Theme 8: Surprises

    • Administrator suggested librarian be appointed to IRB

    • Library viewed as recruitment tool

    • Expected to hear more about value of library for patient care and traditional services but heard more about consumer health

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


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MAR Focus Group 2

  • Theme 9: Follow up

    • Administrator offered budget help in funding Ovid

    • Library will accept invitation to Magnet conference

    • Librarian will have regular meeting with administrator

    • Librarian will promote library to other departments

    • Librarian will promote other library services beyond consumer health


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MAR Focus Group 2

  • Theme 10: Nurses

    • Librarians are working with nursing staff successfully

    • Library support of evidence based nursing practice

    • Library support of magnet status


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MAR Focus Group 2

  • Theme 11: What would help librarians

    • Importance of whom you report to

    • Regulatory requirements

    • Visibility

    • New evaluation models beyond statistics

    • Share results of the study


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Discussion

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

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

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


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Common Themes (Both MAR and NER)

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

  • Statistics matter

  • Administrators saw value of librarians serving on committees

  • Although administrators could see value of library in patient care, consumer health and education, they could not see library helping them in their decision making or with their own work

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

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


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Summary

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

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

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


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Summary (Continued)

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

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


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Next Steps

  • MAR Expanded Value Study Announced and Participants Being Solicited

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

  • KM Pilot Projects will be funded in 2011-2012


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