The Medical Library Association brought together a panel of hospital-based health librarians to discuss these issues in the webinar, “Raising and communicating your strategic value to clinicians: A panel discussion with and for Hospital Librarians.” Sponsored by Wolters Kluwer Health, the panel was moderated by Joe Van De Graaff, Vice President of Digital Health for KLAS research group, and featured three medical librarians representing a variety of healthcare institutions:
- Michelle Kraft, Director for Alumni Library for the Cleveland Clinic, serving 18 locations in Ohio, throughout the U.S., and internationally.
- CeCe Railey, System Medical Librarian for Norton Healthcare, serving seven locations in and around Louisville, Ky.
- Jessica Callaway, Library Director and Archives Director for the Shepherd Center for traumatic brain and spinal cord injuries in Atlanta.
How is the role of the health librarian changing?
With more research resources and CDS tools available and updated online, Railey points to “a more intense, diversified focus on IT” in the medical library.
Kraft agrees, adding that the shift to electronic access has been exacerbated by the COVID-19 pandemic and people working from home. “Whereas people used to come to the hospital, now you have a larger group of people whom you serve who don’t step foot on the hospital grounds,” she explains. “Librarians and vendors have not found the magic bullet to get online access to correct authorized users and make it simple.”
That broadening of access and scope of responsibilities in the medical library reflects a broader transformation in library sciences as a field, says Callaway. “We’ve switched from a more localized level to a more global level.” With that shift comes an increase in the cost of resources and access subscriptions, she says, as well as an increase in the complexity of the technology needed to support your network of global users.
Relating to hospital administration and stakeholders
Part of the modern medical librarian’s remit is defending the library’s importance in the hospital ecosystem and protecting its budget. That becomes more complicated in an era of mergers and acquisitions, says Kraft, when multiple healthcare entities are combined and absorbed and the decisions are made at such a high administrative level, the library’s needs often aren’t considered until after the ink on the deal has dried. “Then they’re often surprised by the costs associated with [the library], and they don’t bake that into the merger system,” she says.
Getting creative with limited staffing
It is also difficult in a merger situation for the acquiring library to take on the acquired organization’s library staff, particularly if ample funding and resources haven’t been allocated.
For Kraft, who serves clinicians, trainees, allied health professionals, and other staff at more than 15 locations, an important part of her job is outreach and education to her stakeholders. “Some of our hospitals don’t have librarians or library staff [on site], and that’s where it becomes challenging, because educating the people [at those satellite locations] to know what they have access to is difficult when you don’t have feet on the ground. Sometimes we don’t know what they don’t know, and they don’t know what they don’t know.”
Callaway is a one-person library, supporting a research department, clinical staff, allied health, residents, philanthropic activities, and administration at her traumatic injury center. “You have to be creative when you have so many different types of patrons,” she says. She increases her visibility and outreach by joining rounds, attending regular meetings with administration, and maintaining research times with residents. But she needed to be proactive to get herself established in these meeting spaces.
Ultimately, it comes down to the day-to-day questions clinicians and other stakeholders have and need researched, which can come in by email, in person, by chat, or by phone. Kraft says she looks at the ideal librarian-clinician relationship as collaborative.
Railey agrees, noting her relationship with clinicians needs to function as a “partnership” in order to meet the goals of patient care. A big part of that is transparency and clear communication of clarifying information to save time for both librarian and clinician.
Training can assist with this, adds Callaway. By adding library orientation to the new clinician onboarding process at her organization, she has found a significant decrease in the amount extraneous requests, plus she believes it has helped clinicians feel more familiar and comfortable with her as a colleague and resource.
How else do medical librarians reach their stakeholders?
- Staff in-services – Offering research training has been helpful for Kraft, who has the advantage of an internal marketing department to help promote these opportunities. Her organization’s Education Institute also requires internal medicine residents to go through an in-person research exercise with a medical librarian.
- Reporting ROI – Railey helps communicate the library’s value by sending a notation of how many dollars were saved in purchase or subscription fees with each article she sends to users.
- Engage advocates – Professionals who are already supporters of the library are great resources for spreading the word. They can be engaged as speakers at library events. But sometimes, Kraft notes, just their support within the administration is enough. “By helping them achieve their goals, that makes your value go up higher to them, and they become your advocates later on.”
Where will the health librarian be in five years?
Looking forward to how their roles will continue to evolve, the panel agrees, it’s hard to see past the immediate financial concerns brought on by COVID-19.
“The economic fallout with COVID has hit our hospitals the worst,” observes Railey. “Our budget is flat for 2023, and I’m glad we at least get the same money, but it doesn’t give us room to do anything new. It’s going to take at least five years for hospitals to even begin to level out.”
In addition to the budget crunch, the health librarians are concerned about:
- Higher prices for CDS subscriptions.
- What U.S. government-mandated open access policy will bring in terms of response from publishers?
- More security around electronic resources makes access and sharing more complicated.
- Difficulty of achieving resource equity – making sure all satellite locations have at least the same baseline of resources.
“Everybody thinks of COVID as being done or that we’re living with it,” Kraft says. But with health systems reporting record losses, nursing shortages still at crisis levels, and potential revenue boosters like surgeries still not back to their pre-COVID levels, “it’s going to take us a long time to get out. That’s one of the reasons a third of the hospitals in the U.S. are in financial jeopardy. It’s the perfect storm.”