Tradition vs modernisation in hospital libraries
Abstract
This article considers whether hospital libraries should make a clear choice, between providing users with access either to traditional, print-based resources or to modern, digital resources. Or, should hospital libraries seek to provide access to a mixture of both kinds of resources?
Introduction
Libraries in general are undergoing change, by rebranding and reorienting their services. Increasing emphasis is being placed on electronic resources, with rows of PCs being given prominence equal to, if not greater than, that given to traditional stacks of books.
However, should modern e-resources replace print-based sources of information? This is a cause of debate among library professionals, with some believing that librarians must make a choice, between polar extremes of tradition and modernisation. Some libraries have already made this choice: e.g. the former undergraduate library at the University of Texas, which has relocated its 90,000 books.1
Hospital libraries constitute a specialist sector within library services. However, they are subject to the same pressures as other libraries. Consequently, hospital libraries too may need to choose between tradition, and modernisation. Indeed, the Royal Infirmary Library in Edinburgh has already chosen to focus primarily on digital resources: “this means [the library’s] printed collections are smaller than more traditional libraries and the majority of [its] journals are electronic.”2
Or perhaps it is better to compromise, by reconciling traditional approaches to information provision, with a willingness to embrace modern technology.
This article considers the question, of whether an extreme or a reconciliatory approach will work best for hospital libraries.
Methodology: Literature Review, User Needs Analysis, Staff Interviews
A literature review was undertaken, locating references using MEDLINE, CINAHL, as well as searching within librarian journals, to identify existing trends in information provision by hospital libraries.
Next, an information needs analysis was carried out, among users of the Library and eLearning Centre at the Western Infirmary, Glasgow, by means of a questionnaire. Although the main purpose of this analysis was to determine what services users would like to see provided by the new library at Golden Jubilee Hospital, it was also intended to discover whether users have a general preference for e-resources, or for print-based resources, or for a mixture of both.
Finally, interviews were conducted with members of Western Infirmary library staff, to gauge their professional opinions of whether the future belongs to print or to digital resources.
Literature Review
An NHS hospital library needs to cater for the information needs of three main user groups:
(1) Doctors;
(2) Nurses; and
(3) Support staff.
(In future, hospital libraries may also need to cater for the needs of patients, but this is a somewhat controversial issue, beyond the remit of this article.) These groups use the library for a variety of reasons: for example, if they have a query about patient care; if they are engaged in professional development/study/research, which impacts on the kinds of resources that they may wish to access.
Several studies have analysed the information needs of these three groups, and in so doing have explored the issue of whether hospital libraries should offer traditional print-based resources instead of, or in conjunction with, modern e-resources.
Focusing on the information needs of emergency care physicians in a Greek hospital, Lappa found that doctors made little use of their hospital library, “because they are usually under tremendous time pressure.”3 One option might be to increase PC numbers in the library, since online databases—in theory—constitute a less time-consuming way of accessing up-to-date information, than browsing through shelves of books and journals. However, within the user group of physicians, Lappa uncovered significant levels of computer illiteracy, thereby undermining the above argument for more PCs:
“74.2% of the respondents were not competent in getting value of access to … online databases; 71.4% complained that they had not had any training in using electronic information retrieval systems… 51.4% needed additional training when it came to retrieving information from medical sites and 65.7% complained that they have no knowledge of how to use … basic computer applications.”4
In their analysis of computer usage among nursing students, Ragneskog and Gerdner found that “forty-one per cent…felt uncertain or inadequate in their overall competency in operating computers.”5 Ragneskog and Gerdner also cite evidence that many nurses are not making adequate use of online databases:
“Information retrieval systems such as CINAHL and PubMed serve as an infrastructure to evidence-based practice. Yet, in the study reported here, 41% of the nursing students and 31% of staff identified uncertainty or inability to access these online library databases.”6
The implication for a hospital library is clear: the hospital librarian must act as an intermediary, perhaps by conducting research on behalf of clinicians who “did not acquire the skills of literature retrieval during their training,”7 but preferably by providing clinicians with the training that will empower them to carry out their own research, by making them computer and information literate.
Also, this highlights why a hospital library cannot afford solely to provide e-resources. Quite simply, some users lack the skills necessary to avail of modern resources. Therefore, it is important also to provide access to traditional, print-based resources.
This is borne out by Devaney and Outhwaite’s analysis of the information needs of NHS support staff,8 who primarily use their hospital library for vocational/educational reasons (e.g. finding careers information, ECDL training etc), to the extent that, even though they borrow a lot of fiction, it is to “support essential skills development”9 (e.g. literacy). While the majority of support workers want their hospital library to provide “more computers,”10 there are high levels of computer illiteracy, and mistrust, within this user group: “Even those with Internet access at home expressed a preference for print.”11
Again, this indicates that a modern hospital library should retain at least some traditional elements: e.g. shelves of books.
User Information Needs Analysis
All respondents to the information needs analysis questionnaire agreed: the hospital library must provide access both to e-resources, and to books and print journals.
The majority of respondents, while familiar with the NHS Scotland e-Library, considered it to have limitations, in terms of flagging up relevant documents, and of being too dependent on expert keyword use. The professional librarian would see this as an opportunity for providing training in keyword searching. But it seems respondents like to retain control over their own searching, with the reassurance of having the option of going to a librarian for assistance. Since books and journals are accessible simply by browsing library shelves, or by simple searches of the local library management system this allows users to control their own use of library resources. It is important that the library respects, and accommodates, the various, personal preferences of users, recognising that some people like to browse print books and other resources for inspiration, while others may focus on getting one specific article etc.
All respondents insisted that print-based material in the library must be kept up-to-date:
“The library … should only keep the most relevant material on its shelves.”
“Keep a year’s worth of any journal on site, as these will be of most relevance; keep the rest in a central repository somewhere.”
“Library should have 3 or 4 mainstream journals, including old issues dating back 5 years… It shouldn’t really keep anything dating back further than that.”
These comments indicate that the library should provide only the most relevant information, if it is to assist clinicians in providing the best care to patients. Thanks to modern-day online databases, such as MEDLINE and CINAHL, older material may still be accessed virtually, if required (and provided that subscriptions are maintained), without it having to be present in the physical library space. This demonstrates how digital resources have heralded a change in emphasis, by enabling libraries to adopt a ‘just-in-case’ approach: i.e. a shift “from collecting material ‘just in case’ someone might need it, to one of developing partnerships allowing libraries to deliver material from elsewhere ‘just in time’ to answer a user’s needs.”12
Also, the library should perhaps place more emphasis on journals than on books; while one respondent commented that it is “nice actually to be able to pick up a book,” the overall feeling was that the library should concentrate on providing access to journals, since books “go out of date faster.”
Staff Interviews
When asked about the importance of e-resources, staff at the Western Infirmary library were unanimous:
“Electronic resources are better because they can be accessed at any time.”
“Electronic resources are undoubtedly more popular, and will probably win out in future.”
“Most popular [library] service is undoubtedly online resources and eJournals… Users tend to get quite uptight if there is no online access to a given journal… Electronic resources will take over from print.”
“Electronic resources are more popular to many people. They love being able to access eJournals, databases and eBooks from any PC without having to go the library in person.”
However, while the future may belong to e-resources, at present there is still demand for print-based resources, particularly (but by no means exclusively) among older members of hospital staff.
Although eJournals are theoretically accessible at any time, it was conceded that issues of PC availability, of training and of time prevent truly open access. Of course, training is an issue that librarians can address: “Once [staff[ are shown how to use e-resources, they are fine with them,” commented one member of library staff. Unfortunately, if hospital staff find themselves strapped for time, opportunities for such training may prove limited.
eJournals have another limitation:
“If the library has print journals, it can keep old issues even if the current subscription runs out, while old journals might not be available online [if the online subscription expires].”
Also, there is the simple fact that:
“People still like to have something physical and portable to read and write on, and until portable devices are improved, books and print journals will still have a place [in the library].”
Once more, the need for the hospital library to offer a mixture of electronic and print-based resources is reinforced.
Conclusion
The future may well belong to e-resources, and hospital libraries should provide users with access to them. However, there is still room, and significant demand, for print-based resources in the modern hospital library. Coordinating electronic and print resources will enable libraries to develop an effective ‘just-in-time’ strategy for providing information.
In other words, libraries should seek a compromise, rather than choosing between extremes. Ultimately, as long as they are kept up-to-date, traditional information resources will continue to have a positive impact on patient care for years to come.
References
1. Borsato, L. A library without books? Larry Borsato Online 2005. Available: http://larryborsato.com/blog/2005/08/a_library_without_books.html
2. University of Edinburgh. Royal Infirmary Library. Library Online website 2007. Available: http://www.lib.ed.ac.uk/sites/ril.shtml
3. Lappa, E. Undertaking an information-needs analysis of the emergency-care physician to inform the role of the clinical librarian: a Greek perspective. Health Information & Libraries Journal 2005. 22(2): 124.
4. ibid, p.128.
5. Ragneskog H, Gerdner L. Competence in nursing informatics among nursing students and staff at a nursing institute in Sweden. Source Health Information & Libraries Journal 2006. 23(2):130.
6. ibid, p.131.
7. Davidoff F, Florance V. The informationist: a new health profession? Annals of Internal Medicine 2000. 132(12): 996.
8. Devaney A, Outhwaite H. Learning resource needs of UK NHS support staff. Health Information & Libraries Journal 2005. 22(4): 259.
9. ibid.
10. ibid.
11. ibid, p.260.
12. Berry J W. Digital libraries: new initiatives with worldwide implications. Collection Building 1996. 15(4): 24.
Richard Fallis
Student
University of Strathclyde
Tel: 07756785196
Email: rfallis@cis.strath.ac.uk
Or bizarro_jerry@hotmail.com