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
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 user=s 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 exper-
tise, prepare them for changes, provide them with innovation, job satisfaction,
commitment and enthusiasm, making it possible for them to meet the needs
presented by today=s 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.
A bit about myself
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.
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
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
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
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
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
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
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.