The Medical Libraries and Future Demands

What does it mean to work in a medical library in a reality offering information overload, anarchy and more search options than the users can handle

Abstract for 9th European Conference of Medical and Health Libraries, Santander, September 20-25, 2004 by Inger Vibeke Nielsen, Chief Librarian, Psychiatric Research Library and Information Centre, Psychiatric Hospital in Aarhus, Denmark

The quantity of information is tremendous, the anarchy on the Internet has never been bigger, and the options for getting and searching for information accelerate like never before. And there is no indication that the development will change into any other direction than the one followed so far. As a matter of fact, we have been saying this for the past 10 years, but this is still the fact. Things have become more complicated, but the clearness has not grown.

More than ever before is it necessary to design the information to the users of the libraries according to each users specific needs. If the doctors, the nurses and the other staff members within the health sector should not feel overthrown by these conditions, we have to be very specific in our initiatives towards them. How can we do that?

How do we communicate to meet the users needs, and which PR to choose in order to reach the many staff groups working within the health sector today. Out of consideration for the patients, it is necessary that we make it easy and interesting to obtain the necessary information.

How do we prepare the staff for this task, developing the right qualifications and which methods can we use for this. It is very important that the staff have working conditions, which besides giving them options for acquiring special expertise, prepare them for changes, provide them with innovation, job satisfaction, commitment and enthusiasm, making it possible for them to meet the needs presented by todays users.

Which organizational structure is needed for affording to provide the right service to the users and the right working conditions for the employees.

The article will form the basis of the discussion of the different possibilities making it possible for the library to become a better co-operation partner for the staff within the health sector at the hospitals, the centres, the research units, etc.

Outline
A bit about myself
Preface
How to consider the users’ needs –  here and now
How to communicate the possibilities to the users. 
How to educate the staff to meet these demands
How to organize ourselves in order to be able to afford this

A bit about myself
My name is Inger Vibeke Nielsen.  I work at Psychiatric Information Centre at Psychiatric Hospital, Aarhus, Denmark. 
I am the chief librarian and the Psychiatric Information Centre has 3 departments. They are:
- A research library which is a public library with a special responsibility for all employees working within psychiatry in Denmark – no matter where they work – as to lending of material, interlibrary loan and literature search. Besides this, the library gives courses on search for medical literature to health staff from both somatic and psychiatric hospitals.

- An information centre for patients and relatives where these groups (and other interested in psychiatric diseases) can turn up and find literature on the subject in Danish. Our collections comprise booklets, articles and videos. The centre is obligated to inform the citizens of Aarhus County about psychiatric diseases. This is done through our homepages where you can find information about psychiatric diseases and their treatments. We also organize lecture nights about the subjects. The Information Centre has also a patient library. This library visits all wards once a month with new books.

- And, finally, we have a non-profit publishing company which publishes small leaflets on psychiatric diseases. 

The entire staffs consist of 5 librarians, 3 assistants, 2 student assistants, and at the moment 4 volunteers.

Preface
It is true that the quantity of information is immense, and that access to and quantity of information increase with unreduced speed. We have spent the last 10 years gaining control ourselves of the new technological tools and this immense quantity of information. The technological development has been big and occupied many of our resources both concerning money and staff compared to the development of competences. I believe we have now reached a point where we are so well educated and have so much control of both the information technology and the scientific part that we now have to spend more time on meeting the single user’s needs. Many of our users want to be able do things themselves, but in many situations they lack the tools to achieve this ability to do the things themselves. They find it more difficult to find their way in the wilderness and do not have the time to check the possibilities thoroughly. The result is that they do as they are used to, but this is not necessarily the best way to do things. You can here compare medical practice and evidence based medicine. Also here many doctors and nurses do as they used to instead of finding out what is the best knowledge within this area.

It is in specific this situation which should be improved, and it is here I believe that the libraries can and must play a big role. We have the knowledge and the tools needed for helping the users. What we lack is focus on communication of the exact information needed by the single person at a given time. As we do not know it exactly, we have to work close together with the users. 
We have been working on this for the past 18 months, and I will tell you about our initiatives:

How to consider the users’ needs – here and now
For several years, we have been giving courses on search for medical literature and the use of Reference Manager. We offer these courses to the entire health sector in most of Jutland. But as the layout of the databases has changed, making the accessibility bigger and the selection multiple, the users want to learn other things. In many cases, there is no need for long courses, but instead short introductions. Therefore, we have launched the new initiative called ‘Book a librarian’. We have not any fixed time for when and how long the introduction should be, but aim at ½ - 1 hour.
We say: Call the library and make an appointment for an introduction of the subject/subjects you need to know more about. We tell the users that this is not courses where you gain competence, but it is a help to get started with what has been difficult for you.

You can ‘Book a librarian’ for:

•	How to search in Luna – the online catalogue of the Research Library?
•	How to search in the database bibliotek.dk?
•	How to order full text articles through Medline/PubMed?
•	How to find electronic versions of journals?
•	How to get table of contents from various journals by e-mail?
•	What are the databases Retsinformation and Karnov and how to start using them?
•	What is Cochrane Library and how to start using the database?
•	How to search evidence based in medical databases?
•	What is Web of Science and how to start using the database?
•	What is MicroMedex and how to start using the database?
•	How to start information search in connection with a research or development project? How to elaborate a search protocol and how to read the literature found critically?
•	What are the rules for publication, copyright and copyright deposit?
•	What can you use Reference Manager for?
•	What is impact factor and where to find it?

Like this, we have many different subjects to give introductions on, and we expect that some of the subjects will be more in demand than other. In this way, we hope to meet the users’ needs for help to be able to manage them selves, and that they, when they can set the time themselves, also will use it for the patients’ benefit. We started just before the summer holidays, but until now it has been a success.

In this connection, like in many other at the library, it is important to know who you are dealing with. Doctors, nurses, psychotherapist and so on do not need the same kind of introduction. If you make it too difficult, or to easy, you fail and you do not achieve the effect wanted.

The very arrangement of the library is also important. At our place we experienced that the nurses would like to do research or participate in development projects, but found it difficult to get started. Among other things, they did not have a place where they could meet and concentrate without being disturbed. We heard that whereupon we furnished 2 rooms – one with dictionaries, computer, white board and projector, and one with a new computer, notice board for posters presented at congresses, press cuttings, new books and journals and so on. Now it is a natural meeting point and the plan is, when the nursing council has finished its preliminary work, that once a week or a couple of times each month there will be a nurse experienced in doing research present at the library. She will make it possible for nurses, who want to do research, to get help concerning research method, study design from the nurse, and help in elaboration of research protocol and literature research by the library staff. Even though it was the nurses’ needs which made us change the arrangement of the library, the doctors have also realized the importance of the rooms, so we know for a fact that we did the right thing when we changed our 2 old reading rooms to rooms for study and learning. We have learned that the more targeted the information is, the more differentiated it is communicated, the better you get your message through.

How to communicate the possibilities to the users. 

Still, we felt that the number of users in the library was decreasing – especially from the clinical wards. We do know that their duty rosters are so tight that it can be difficult to go to the library and that much information is available through the internet, but we did feel that something was missing. For several years, we have constructed homepages with access to electronic versions of journals and databases, information on psychiatric diseases, and published a newsletter for the last 5 years. But did our users use this information and the accesses on the internet? Did all potential users get our newsletter? Were we offering the right services? When offering courses was it then the right ones, and did they have the right form? What did the users think they would need in 2 – 3 years?
Like this, we had a number of unanswered questions which we would like to have answers to.

We decided to do an advertising round for our library. We started with the top management – I myself am a member of this management level. I told them about our worries, services and wishes for the future and asked them to help me to reach as many members of the staff as possible – to find out how the management area was organized and which various staff groups was employed.
According to agreements with the managements – and our own wish – we divided our advertising round into visits for doctors, nursing staff in the wards, staff in the community psychiatry, and staff and users in the social psychiatric centres.

In this way we had the chance for targeting our mentioning of the service offers, and were able to control the discussion during the visits. We started all the meetings with the following questions:

•	What is your need for information?
•	How do you fulfil this today?

The participants found it difficult to answer the questions, but this made the staff we visited realize that we would like to listen to them and enter into a dialog with them.
The visits were very different but a couple of things were common: An astonishment in realizing that there were so many possibilities which they did not have had the time to find out.
A desire to use these possibilities.
A pleasure in seeing us and learning that we would like to hear their opinion.
Every visit resulted in new users and a subsequent good communication.

As to the doctors, these meetings have furthermore resulted in that one from the research library participates in parts of the monthly literature conferences. This makes it possible for us to know the future subjects and by this getting the time to find the relevant literature before the next meeting. It also resulted in a close collaboration with the doctors responsible for education through which we achieve the same and get a closer collaboration with the doctors who are in the training for becoming a specialist, as we become their sparring partner in connection with the course assignments. Prior to these visits this process was a doctor turning up 1 – 2 days before deadline not always being able to get the best material, either because it was out, or because the doctor did not have the time to wait for a proper search on the subject. Another function for us in the wards is that a librarian participates in the staff or staff/patient meetings once a month, some places once every quarter. Here we introduce the newest books on psychiatric diseases, and if patients participate the newest books bought by the patient library. Each visit results subsequently in visit to the information centre.

The advertising visits have been a success; we have not quite completed them yet, but when we have, we start all over again as we always meet new staff members. We plan to visit the departments/wards every 18 months as minimum – in fact the first two re-visit has already taken place after just 6 months according the ward’s wish. It is a really good idea to have fixed target groups. This has made it easier for us and given the potential users better information.

The question is then, how to get resources for it?

How to educate the staff to meet these demands

First, the entire staff has to work up the competences necessary. This does not happen over night. It is a question of a calculated choice. Plans have to be made for each employee; you have to fix time for meetings in the staff groups who have to work within the same area, and the competences have to be worked up through courses, coaching on the workplace, participation in conferences and so on. We spend 3% of our budget for courses, meetings outside the hospital and participation in conferences. It is the amount recommended by Danish trade and industry if you want to have a company which can live up to today’s quality demands. I think this is a reasonable technical starting point. We have been working very determinedly with competence development for several years, and one of the things from which we have benefited the most is what in Danish is called GRUS – group development talks. Here we discuss and work through professional topics. We have fixed rules for the talks. It always has to be agreed upon who do what within which period, and who the employee can use as sparring partner. It is a very fine way to work in details with a subject, and it sends the signal that it is okay to become deeply absorbed in a subject. It is also a fine way to develop competences as you during such a period learn from each others.

By making demands to the staff about development of competences, giving them tasks which require more than what they learned during their education you give the persons the possibility for development both as a human being and professionally. Most like this; they become more engaged and happier about their work. It is also important to create a milieu where it is possible to test new things and where it is okay to make a wrong estimate, where you work close together and feel comfortable about each other.
All experience shows that happy and content employees perform the most.

How to organize ourselves to be able to afford this

Of course, all this costs money. We earn some through our courses as we charge payment for all our courses. The price is not high, and the request for payment does not stop the staff from attending courses. We give about 40 courses a year with some 400 participants. The money earned through courses goes to the library and we dispose it ourselves.

Another way to get more for your money is to co-finance with other libraries. We cannot do it all ourselves, there is not enough money. By entering into binding agreements – typically with a larger library – you can liberate some means. We have established co-financing with the big university library in Aarhus concerning journals. The University Library buys all licenses for electronic access to journals. We share more hard copy subscriptions where you cannot cancel it all, and we get the hard copies of the journals dealing with psychiatry here at our library. Lately, the University Library has taken over all our subscriptions. This was not a big task for them, but a considerable relief for us. Each year we pay the University Library a sum according to the agreement. We have gained access to much more than we could afford ourselves; we have been able to make it cheaper through bulk purchases, and we have reduced the costs for administration of subscriptions. 

We also have a binding collaboration with another university library and most medical libraries in Denmark as we share the same library system. The university library owns the library system, holding control and adjustment of it. We pay a very reasonable annual fee for this. We are pleased that we do not hold the responsibility for the technical side of our library system, as it took many more resources than the present agreement costs. 

We have a mixture of co-financing and outsourcing, but I believe that co-financing is one of the most important elements in the future running of a library.

As closing remarks, I should say that today we do a lot to help our users. We teach them, guide them, try to create a structure in the great quantity of information, but are we doing the right thing?

We have a great task in front of us by entering into close dialogue with the users: To find out how they would like things to be if the situation was perfect! Are the database searches okay; should it be possible to search by means of other criteria; should the possibilities for weighting be possible; are the sorting possibilities okay; would it be desirable to ask questions like: Who is expert within a specific area and so on.
Do the users want to have their own personal librarian?

Only the users can tell us what their needs are; so we must enter into a close and qualified dialogue with them.