Assignment 3 Needs Assessment of Moses Cone Health System Libraries

Group 2: Kyle Butler Mark Coltrain Mimi Smith-DeCoster Ashanti White Anthony Chow LIS 650 May 27, 2011

Table of Contents
EXECUTIVE SUMMARY 3 INTRODUCTION 3 METHODS 6 RESULTS 9 CONCLUSIONS & RECOMMENDATIONS 23

STRENGTHS AND WEAKNESSES OF THE NEEDS ASSESSMENT EXPERIENCE 24 WORKS CITED APPENDICES 26

I. Executive Summary
Group 2 performed a needs assessment of Moses Cone Health System (MCHS) Libraries located in Greensboro, North Carolina. This included libraries at three hospitals: Moses Cone, Wesley Long and the Womens Hospital of Greensboro. According to their website, Moses Cone is the major health care system in Guilford, Randolph, Rockingham and Alamance counties in the Triad of North Carolina. Leslie Mackler, MLIS, is Director of the Moses Cone Medical Libraries and was our main contact and source of information regarding the MCHS Libraries. She has worked for MCHS in various capacities for over thirty years and is currently based at the Moses Cone Library. Her staff includes two full-time librarians: Peggy Wynn, MLIS, at Wesley Long Hospital and Laura Enyon, MLIS, at the Womens Hospital. We decided a combination of interviews with the librarians and a survey of the patrons at all locations would be the most prudent approach to this assessment. Kyle Butler and Mimi Smith-DeCoster interviewed Mackler in-person at Moses Cone and we also emailed an abbreviated version of the questions we asked Mackler to Enyon and Wynn. The interviews were a success with 100% participation and thoughtful answers to our questions. The surveys were a slightly different story. According to Mackler in one of our initial email exchanges, Walk-in traffic in Cone Library averages 100-150 a day, Womens averages 25 a day, less for Wesley. The number of patrons accessing the librarys resources online is undetermined. Patrons range from physicians and nurses to non-clinical staff, EMTs, patients and patients families. All three libraries had a combined gate count number of 40,000 in 2010 (Mackler, Personal Interview). We received a total of nineteen responses to our survey: ten completed the online version and nine completed the paper version. Nineteen is actually misleading number because, according to Qualtrics, while nineteen surveys were started only seventeen were actually completed. We believe the major reason for the low participation was the fact that the MCHS Libraries were also participating in a National Library of Medicine/UNC-Chapel Hill research project, which included an online survey on the value of hospital libraries, at the same time we were collecting data for our survey (Mackler, library survey). Despite the potential confusion, Mackler agreed to post a link to our survey on the MCHS Librarys website and all three librarians posted flyers at their libraries promoting our survey along with making paper copies of the survey available for patrons. Results of the survey were mixed. The handful of responses we received gave us the smallest of snapshots of the pace of life at the MCHS Libraries. While not enough to determine if they are raving fans (we speculate that they are), the patrons who answered certainly represented a relatively wide swath as far as demographics go. Either way, it is apparent that Mackler, Wynn and Enyon are doing something right in each of their respective hospital libraries.

II. Introduction
Moses Cone Health System, or MCHS, was founded in 1911 by a trust established by Berth Lindau Cone (mosescone.com, History). Since that time, the system has become a multihospital system that consists of LeBauer HealthCare, Penn Nursing Center, Moses Cone

MedCenter-High Point, and Moses Cone MedCenter-Kernersville among other facilities (mosescone.com, History). Moses Cone is a not-for-profit system but remains a premier North Carolina healthcare institution. In fiscal year 2007, it was the fourth busiest hospital in North Carolina when it comes to heart catheterizations (mosescone.com, History). According to their website, MCHS supports patients in Guilford County, Randolph County, and other areas in the Piedmont. With more than 7,400 employees, the system provides in- and outpatient services that range from neonatal care to bypass surgery and cancer treatment (mosescone.com, About Us). As a part of the Greensboro Area Health Education Center, Moses Cone Health System provides students and doctors access to the latest developments in medical care. Moses Cone Health System Library is designed to the educational and informational needs of the medical staff, employees, patients and families of the Moses Cone Health System, the community, and the health care providers in the Greensboro AHEC region. Like the healthcare system it supports, the library actually has three locationsin the Moses H. Cone Memorial Hospital, Wesley Long Community Hospital, and Womens Hospital of Greensboro (gahec.org, Library Services). An amalgamation of a special and academic library, the MHCS Library System provides services designed to aid in the research process. Reference questions can be conducted in-person or online through email and chat (gahec.org, Library Services). The library subscribes to numerous databases, such as DermIs: Atlas of Dermatology and Health Services/Technology Assessment Text (HSTAT), which are available free of charge through the librarys website (gahec.org, Journals). Other databases are available, and MCHS Library professionals can assist or perform literature searches for MCHS and AHEC affiliated staff and to agencies located within the Greensboro AHEC region (gahec.org, Library Services). Search services are free for staff, residents, interns and North Carolina Libraries. Literature services for businesses, special libraries, and students at other institutions will be charged a minimum fee of $75 (gahec.org, Outreach). Affiliated individuals can request books. MCHS managers can also request the table of contents of each issue of selected journals (gahec.org, Outreach). Additionally, the library provides interlibrary loans, personal book orders, and instruction for end-user searching.

III. Methods
Design The methods of data collection were tailored to suit the time limitations of various library constituencies and the level of information that was deemed appropriate to collect from them. A face-to-face meeting of approximately 45 minutes was conducted with Leslie Mackler, the director of the Moses Cone/AHEC library system. Given the work schedules of the two hospital branch librarians, Peggy Wynn and Laura Eynon, their input was solicited by way of an email-based interview, consisting of open-ended questions of a qualitative nature. Patrons were invited to participate in an online survey conducted through Qualtrics, and paper surveys were also made available. The online survey was made available through a link on the librarys website and by way of flyers placed in the library. Exploratory research employed the resources provided on the Moses Cone Librarys website. Based on communication with Leslie Mackler, it was decided that a needs assessment should include not only the Moses Cone Hospital Library, but also the libraries of the Womens

Hospital and Wesley Long Hospital, as the three hospitals actually operate as a unified system rather than autonomous entities. The patron-directed survey was designed to address library services and resources, while the questions for the librarians focused more on institutional missions and goals, administrative interactions, but also on patron needs. Subjects Given the limited time available, Team 2 elected not to seek approval from the University of Greensboros Institutional Review Board. Instead, it was made clear to librarians at the AHEC libraries and any patrons electing to participate in the patron survey that all data collected was to be used solely for the purposes of a class project and not for publication or further research. This was deemed satisfactory by the director of the AHEC libraries. In addition, all patron survey responses are entirely anonymous. Due to time overlap with an unrelated survey, this survey was not distributed by email. As a result, an accurate count of potential responses compared to actual responses cannot be made. Demographics The Greensboro AHEC system employs approximately 7,400 medical professionals. Other patron groups for the AHEC libraries include medical students, patients and families of patients, and the general community. Patron participants in the survey were asked to indicate their relationship with the library and/or role in relation to the hospital system. See the results section for a statistical breakdown of participant roles. Instrumentation Data collection began with email communication with Leslie Mackler, defining the scope and depth of the needs assessment and arranging logistics. Data was ultimately collected via 1) an in-person meeting with Leslie Mackler; 2) email-based surveys with the Laura Eynon and Peggy Wynn, the librarians of the Womens Hospital and Wesley Long Hospital libraries, respectively; and 3) Email and paper surveys of patrons (content of the email and paper surveys was identical). Data Analysis and Presentation Given the largely qualitative nature of the survey, responses were evaluated with relation to services used, services desired, frequency of use, and demographic within the user base. Qualtrics reports were used to represent and interpret the data. Design Limitation In the real world, there is always room for improvement. In an ideal world, this needs assessment would have been timed to not conflict with another survey related to the

Greensboro AHEC libraries, thus allowing for email contact to hospital employees. A longer period of survey availability would have also aided in soliciting more responses. While some paper surveys were provided, making them more available and advertised would have further increased their effectiveness. Conversely, it is evident that the concise survey format and simplified questions were convenient for respondents as only two surveys were started but not completed. The medical librarians were of great help in publicizing the survey but given a more generous data collection time period, both investigators and librarians could have been more successful in informing patrons of the needs assessment process and survey.

IV. Results
Our results paint a fascinating portrait of the types of challenges the MCHCS Libraries overcome or attempt to overcome daily in addition to the many goals and missions that they already get right. According to Mackler, the Moses Cone libraries have challenges common to many libraries: budget challengesthere are challenges getting people to use information. Theres using the information we provide, I should say, the information resources we provide, because, you know, everythings on Google. There are challenges approving ROI [Return on Investment] (Mackler, Personal Interview). And some not as common to other libraries, Theres just challenges in a big corporation when youre in a not for profit department in a for profit organization, getting some of the things done that you need to get done (Mackler). Mackler also says that so far, despite the sluggish economy, budget has not been as much of an issue for the Moses Cone Libraries, but adds that she has been doing more group purchasing with consortiumgetting more bang for our buck. She also adds experience to her arsenal of dealing with challenges: In terms of running through politics here, because Ive been here so long, I just try to navigate the system. Always have a plan A, B, and C. As far as Moses Cones primary goals or functions, Mackler says that, Our mission is to support the organization and the organizations goals. She goes on to say that she and her staff fulfill it by, providing what people need and hopefully pushing information out until they realize its there. This measured not only by regular stats but also by satisfaction surveys available to patrons. Mackler says of these, weve had some really good satisfaction surveys in terms of results so I think were meeting a lot of those needs. In addition to the satisfaction surveys and day-to-day statistics, Mackler says the libraries participate in another biennial survey called a P & P survey, its what people would prefer to see and how we carry it out. The Moses Cone Libraries also participate in national benchmarking which, according to Mackler, is currently very popular in healthcare. The libraries also participate in the Medical Library Associations benchmarking process. Even when the libraries are not participating in assessments, Mackler stays hard at work analyzing the data she collects for the libraries internal quality indicators. The trends she extracts from this data go into quarterly reports. Mackler also discussed how Moses Cones patrons interact with the libraries resources has changed in that people do not physically come into the libraries as much as they did at one time. She and her staff handle much more telephone and electronic reference now than ever before. She also added that the rise of search engines like Google has a lot to do with how many patrons they see these days. She also added that a consequence of Google is that while

patrons can find simple information on their own more and more, the difficulty of the libraries reference questions has increased, so the librarians spend as much time doing research now than ever before. Still, no matter what, patron feedback is important to Mackler and her staff and she says, depending on the nature of the feedback, they try to be as responsive as possible to requests for materials and fixes to problems. As far as the ideal library, Mackler says she would invest in more electronic resources (databases, software and hardware), replace old books and pay the staff more. She also says she would like to redesign the website to make it more functional and hire a librarian to do outreach. Despite not being as close to its ideal state as it could be, Mackler is very positive about the MCHCS Libraries within the context of the hospital: This librarys in a good place. And I think the value, particularly in the past few years that weve been able to bring to our services, and the institution, and the people that work here, is recognized. We get invited to committees, we get invited to MISUs, and we get invited to put things on the intranet. So I feel pretty good about that. Still, Mackler does not take the libraries position for granted, adding, But, you know, all it takes is one new administrator saying I dont want it and thats the end of it. Its what happened to a friend of mine, and its what happened to one of our new librarians. Peggy Wynn and Laura Enyon also discussed challenges for their particular libraries, Wesley Long and the Womens Hospital, respectively. Both libraries are smaller in size and cater to a smaller population than Moses Cone but demographics are largely the same as Moses Cone. Wynn and Enyon said their biggest challenge to overcome is marketing and outreach, or, letting staff and patients know the library is there to helpbased on this sentiment, it appears creating raving fans is often in the forefront of their minds (Wynn and Enyon, E-mail interviews). Wynn participates in new employee orientation classes and gets out and makes rounds to promote the library by word of mouth. Enyon gets out and interacts with staff as well but both are limited in this type of outreach by time constraints for themselves and their patrons. Wynn said the best measure of success for her was her regular collection and use of statistics, which Enyon echoed. Both discussed adhering to their mission by assisting their particular patrons as best they can by staying up-to-date on information, technology trends and other related subjects. Wynns statement from her interview on how Wesley Longs patrons interact with the librarys resources bears repeating as it is extremely well put and indicative of a larger trend across all three libraries: Many of the services and resources are accessed online or through email. Because there is limited face to face contact, it is still important to do a good reference interview and often I have several email exchanges prior to a literature search. Patrons often just ignore information they do not think is useful rather than letting you know more specifically what they need. Patrons appreciate prompt service and response to their needs. The same goes for Enyons statement: I feel like my experience with how my patrons use and interact is a very personal one. Because we are such a small hospital, I know my patrons. So, I can tweak

searches in ways I know they will appreciate. Which just makes them look upon the library that much more favorably.

Patron Survey Our ten-question survey was available for ten days, March 23 through April 1, 2011. Mackler had a link posted on the Moses Cone Libraries web page for patrons to access the online survey. We used the web-based Qualtrics survey program. We also printed paper surveys and made them available at each library. As was explained in the Executive Summary, we had a total of seventeen responses to our survey: eight online and nine in-person. 1. How would you classify your position?

# 1 2 3 4 5

Answer Physician Nurse Paraprofessional Patient Other (please specify) Total

Response 2 5 1 0 7 15

% 13% 33% 7% 0% 47% 100%

Other (please specify) Service radiology technologist EMT EMT

Statistic Min Value Max Value Mean Variance Standard Deviation Total Responses

Value 1 5 3.33 2.81 1.68 15

2. Which of these libraries do you use most frequently?

# 1 2 3 4

Answer Moses Cone Wesley Long Women's Hospital I Use Only The Library's Online Resources Total

Response 5 6 0 4 15 Value 1 4 2.20 1.46 1.21

% 33% 40% 0% 27% 100%

Statistic Min Value Max Value Mean Variance Standard Deviation

Total Responses

15

3. Which of these library services do you use? (Check all that apply)

# 1 2 3 4 5 6 7

Answer Live Chat/Ask a Librarian Online Databases In-person help Computer Workstations Print Journals Books None of these (please list the ones you do use)

Response 0 6 4 6 4 4 2

% 0% 43% 29% 43% 29% 29% 14%

None of these (please list the ones you do use) Statistic Min Value Max Value Total Responses Value 2 7 14

4. How often do you use in-person library services or resources? (check all that apply and

please list resources accordingly, such as: in-person help, computers, journals, or books)

# 1 2 3 4 5 6 9

Answer Daily 2-3 Times a Week Once a Week 2-3 Times a Month Once a Month Less than Once a Month Never 2-3 Times a Week Value 2 9 15

Response 0 5 2 2 1 3 3 Once a Week

% 0% 33% 13% 13% 7% 20% 20%

Daily

2-3 Times a Month

Once a Month

Less than Once a Month

Statistic Min Value Max Value Total Responses

5. How often do you use online library resources? (check all that apply and please list resources accordingly, such as: online chat, online databases, other resources through library

webpage)

# 1 2 3 4 5 6 7

Answer Daily 2-3 Times a Week Once a Week 2-3 Times a Month Once a Month Less than Once a Month Never 2-3 Times a Week Value 1 7 15

Response 1 5 2 1 2 2 4 Once a Week

% 7% 33% 13% 7% 13% 13% 27%

Daily

2-3 Times a Month

Once a Month

Less than Once a Month

Statistic Min Value Max Value Total Responses

6. Have you ever had difficulties using medical library resources? # Answer Response % 1 2 Yes No Total 3 10 13 23% 77% 100%

Statistic Min Value Max Value Mean Variance Standard Deviation Total Responses

Value 1 2 1.77 0.19 0.44 13

7. If you answered yes to the previous question, were your difficulties resolved? # Answer Response % 1 2 Yes (please explain) No (please explain) Total Yes (please explain) Lack of computer knowledge was the reason I need in person assistance. 2 3 5 40% 60% 100% No (please explain) unable to find information on drugs/side effects Links are Clear Just good with computers Statistic Min Value Max Value Mean Variance Standard Deviation Total Responses Value 1 2 1.60 0.30 0.55 5

8. What services would you like to see at your library that are not already provided? Text Response specific for oncology

Statistic Total Responses

Value 1

9. What would you say are your primary reasons for not using medical library services or resources? (Check all that apply) # Answer Response % 1 2 3 4 5 6 7 Do not have the time Not aware of services/ resources in general Not aware of specific services/resources Inconvenient library hours Inconvenient library location Library resources not relevant to my needs No need, resources available elsewhere Value 1 6 6 2 0 1 1 0 3 0 33% 0% 17% 17% 0% 50% 0%

Statistic Min Value Max Value Total Responses

10. How can your library better align existing services or resources to meet your expectations and/or needs? Text Response Connect with other communities for access like UNC Chapel Hill. Statistic Total Responses Value 1

These results are straightforward. User demographics are mixed between physicians, nurses, and support staff. Of those surveyed, few had difficulties, and those problems appear to have been resolved. Equally interesting is the wide range of services rendered, the frequency of use, and the types of access. As Wynn and Enyon note, many of the libraries patrons log on to workstations for personal use: email, online banking, etc. and we think our results definitely have shades of that, as well. While we cannot say for sure, those surveyed could very well be raving fans since there are so few problems reportedthe two that stand out are making

resources more specific to oncology and connecting with other communities for access like UNC Chapel Hill. Mackler appears to be working on the latter with her consortia work. Outreach from all three librarians seems successful; only one person was unaware of specific library resources. However, it would be interesting to conduct the survey again with a longer window of time for patrons to complete it, more advertising of the survey (perhaps with some incentives) and promoting it during a period when no other surveys are being conductedespecially during times of surveys that are much more official than a graduate school class project! The results are revealing but with only fifteen responses, we can only deduce so much. An extensive study indicative of the forty thousand patrons that visited the libraries and the undetermined amount of online users would offer more thorough results.

V. Conclusion & Recommendations

The Moses Cone Health Care System Libraries at Moses Cone Hospital, Wesley Long Hospital and the Womens Hospital of Greensboro all appear to be maintaining as healthy a population of patrons as to be expected in 2011. The librarians are proactive in communicating with patrons in regards to their complaints and meeting patron needs. The librarians appear to be keeping up with current trends in medical librarianship; they collect and analyze statistics on a regular basis in addition to participating in internal and wider-spread benchmarking processes to maintain national standards. Our group recommends that the librarians continue to do what theyre doing: listening and paying attention to their users in thoughtful ways. We also recommend that librarians continue to explore ways to, as Mackler says, get more bang for their buck through various areas like accessing electronic resources through consortia and cultivating other partnerships with medical and research libraries. The fact that the library has such small staff appears to be an asset in the sense that all are so dedicated to hospital patrons, research and current library trends but, as Mackler points out, another potentially tech-savvy librarian dedicated solely to outreach for all three libraries would be ideal. Since the libraries have yet to suffer from major budgetary setbacks, perhaps it would be prudent for Mackler to compose a 1-, 3- and 5-year plan in which she could, based on the wealth of stats she and her staff collect along with anecdotal evidence, prove to hospital administrators that another position is essential to the librarys continued success especially in light of the fact that the move of many patrons to Google-influenced online resources is an obvious and potentially detrimental shift.

VI. Strengths and Weaknesses of the Needs Assessment Experience

Overall, this needs assessment project turned out to be an enjoyable endeavor. However, there were definitely some aspects of the assignment that we could have handled differently. One of the areas that we might have done a better job with involved the distribution of the written surveys. We did get some responses, but unfortunately not as many as we hoped for in order to get a better representation of library users. One idea might have been to take an afternoon or two and hand out some written surveys to the patrons at Moses Cone Library. Its possible this would not have made a great deal of difference, but sometimes people are more willing to fill out surveys when the papers are personally handed to them, rather than just sitting on a table.

Additionally, we were a little more time-constrained than we would have liked, but had we been able to get the surveys out a bit sooner then we might have gotten more responses for our data sample. Despite these minor drawbacks, the pros far outweighed the cons when working on this needs assessment. Despite the fact that our group was not based in one centralized location, we were able to successfully complete the project thanks to frequent and productive correspondence. The assistance we received from the librarians at Moses Cone, Womens Hospital, and Wesley Long was enormously beneficial on this project. Leslie Mackler was particularly helpful, taking time out of her busy schedule to sit down for a recorded interview, plus providing quick responses to the numerous e-mails we sent out over the past several weeks. In addition to Mackler, we also got wonderful responses from Peggy Wynn and Laura Enyon, whose perspectives helped mold our understanding of the critical issues and challenges facing medical libraries today.

Works Cited "About Us." Moses Cone Health System. Moses Cone Health System, 2011. Web. 25 Apr. 2011. "About Us: Library Services." Moses Cone Health System Library. Greensboro Area Health Education Center, n.d. Web. 25 Apr. 2011. "About Us: Outreach Services." Moses Cone Health System Library. Greensboro Area Health Education Center, n.d. Web. 25 Apr. 2011. Enyon, Laura. E-mail interview. 6 Apr. 2011. "History." Moses Cone Health System. Moses Cone Health System, 2011. Web. 25 Apr. 2011. "Journals." Moses Cone Health System Library. Greensboro Area Health Education Center, n.d. Web. 25 Apr. 2011. "Library Services." Moses Cone Health System Library. Greensboro Area Health Education Center, n.d. Web. 25 Apr. 2011. Mackler, Leslie. "library survey." Message to Mark Coltrain. 14 Mar. 2011. E-mail. Mackler, Leslie. "Needs Assessment." Message to Mark Coltrain. 1 Mar. 2011. E-mail. Mackler, Leslie. Personal interview. 23 Mar. 2011. Wynn, Peggy. E-mail interview. 6 Apr. 2011.

VII. Appendices
Leslie Mackler Interview KYLE: Alright, what is your title, and how long have you been a librarian at Moses Cone? LESLIE: My title is Director of Medical Library. I like to think of it more as Director of the Moses Cone Health System Library, but officially its the medical library. And Ive been here over 30 years, in a variety of capacities. KYLE: Ok. Describe some of the major challenges the Moses Cone libraries regularly encounter, and what are some examples of how youve overcome those challenges? MIMI: We can start with what the challenges are LESLIE: Well, there are all sorts of challenges. There are budget challengesthere are challenges getting people to use information. Theres using the information we provide, I should say, the information resources we provide, because, you know, everythings on Google. There are challenges approving ROI. Were lucky here, I dont have space challenges, but I know a lot of people who do. And theres just challenges in a big corporation when youre in a not for profit department in a for profit organization, getting some of the things done that you need to get done. KYLE: OK, how have you been able to overcome some of those challenges, if you can think of any? LESLIE: Well with budget I try to fly under the radar. And so far, everyones getting budget cuts, but we havent had any budget cuts, which has been very good. Weve been working on doing more group purchasing with consortium, so were working on getting more bang for our buck. In terms of running through politics here, because Ive been here so long, I just try to navigate the system. Always have a plan A, B, and C. MIMI: Well that in a way speaks to your experience here. If someone just came in here tomorrow, they would have no way of knowing how to navigate all that. LESLIE: Well you do get some bruised kneecaps, so it plays both ways. KYLE: Were actually gonna skip ahead a little bit because weve already alluded to it, but to what extent are the current economic conditions affecting the library? LESLIE: Well, you know, when journals go up 8% every year, and you have to cut back, and databases expenses are constantly going up, and I know that I cant present a budget thats that high every year, so you have to make tough choices. As I said, we join a consortium so were able to purchase more things by group purchasing. Now some of our expenses have really decreased, in some cases we dont use half the supplies we used to. I dont have to worry about catalog cards and that kind of stuff. And also, when we hire people, they expect to have a living wage. MIMI: I wanted to ask, you said something about flying under the radarhow do you mean? LESLIE: Well what I mean is that Im not going to present a budget every year thats 10% above

what it was so I try to keep it below increase. Sometimes I can even make a decrease in case they need to buy big things, like robots for the OR. KYLE: Just generally, if you could, describe your patrons that you have here. LESLIE: Well physicians, nurses, allied health. Were also open to the public. We do get patient families. Because of the number of people going back to school we get people also, maybe employees going back to school getting their RN or bachelors or masters, so we have a lot of that. MIMI: What about empathizing with patients? LESLIE: Well if someone comes in thats gotten a horrible diagnosis, you take time with them. You dont just give them a medical textbook. And actually for any level of health care professional we try and get them the information they need that they can understand. I guess also in our situation we get a number of physicians who are stressed, they have a patient and they have one who maybe had a bad outcome, and we have to work with that and not take it personally when theyre making certain demands. MIMI: Thats where I was going to go with it next. Because sometimes people have complaints and I guess you just addressed how it is when people have some issue with what services are/arent provided. LESLIE: I guess that could be a piece of it. Also in this particular environment you find a lot of people who are stressed. Some physicians arent getting reimbursed, or are in a time crunch, they cant spend the time with certain patients and so sometimes that plays out with how they treat other people. MIMI: We have addressed this some, but could you talk a little bit about your annual budget and whether its increased or decreased over this past year? LESLIE: Weve been fortunate. Ive been able to get the budget I requested. And, as I said, I dont do major increases. In fact, this year I was able to say Well, were not buying a lot of something, and just shift things out. We have a line-item budget here so everything supplies is on one line. Books and journals are all on one line here. And then e-resources are on another line. And everything has to be justified. Each item is written outwhy do we want a particular item, etc. KYLE: Are there any particular materials that get priority here at the library? LESLIE: Journals. KYLE: Moving forward, what sorts of changes do you foresee at the library in the years to come? LESLIE: Well it wouldnt surprise me if we had a smaller space. Mostly the kinds of things were trying to deliver now are at point of care. So those are the kinds of products were looking atthe kinds of services were trying to provide. And, were trying to do a lot more with embedding librarians into hospital committees so that people get to know us because they dont have to come here. Were also moving outside. Were doing more things with knowledge

management within the organization. Weve got someone who works on the system-wide intranet. Were doing lots of other things, as Im sure every librarian is. MIMI: Ok, so describe what you think is the best part of your job. LESLIE: As a hospital librarian, I get to do a little bit of everything, and I like that. I love doing program planning.thinking of things to do and coming up with new ideas. KYLE: What would you say is your librarys mission, and how does your staff fulfill it? LESLIE: Well our mission is to support the organization and the organizations goals. How do we fulfill it? Hopefully by providing what people need and hopefully pushing information out until they realize that its there. And actually, we get satisfaction surveys and weve had some really good satisfaction surveys in terms of results so I think were meeting a lot of those needs. MIMI: How do you, in particular, and the staff, in general, measure the librarys successes or shortcomings? LESLIE: Thats a good question because I feel like we do a lot of measurements and take a lot of statistics. We do have a satisfaction survey and theres another one called a P & P survey, its what people would prefer to see and how we carry it out. We do that about every other year. And then theres national benchmarking, which is really big in healthcare now. Of course theres the MLA benchmark that we participate in. MIMI: Im also interested to know, internally, when everyone else isnt saying What do you think? is there any way you use those stats to perceive how youre doing? LESLIE: Oh yes, we have quality indicators and I look at thoseactually we all look at those quarterly because I like to look at trends to see whats going on. MIMI: Could you discuss your observations and impressions of how patrons interact with and use the librarys services and resources? LESLIE: Well, its evolved in that we dont see as many people as we used to. They can email us or callpeople used to come in and we just dont see that as much. MIMI: Do you see that as a weakness? LESLIE: Its just different. Previously we had control of the information. We were the only ones who could do in-line searches but now anyone can go to Google so the kind of things were getting from them are much more difficult to find. It takes me a longer time to do a search. Plus, as I said, theres a lot more demand for outcomes and they want literature or data thats outcome based. National guidelines are big with nursing so we have to find national guidelines. Clearly theyre not asking as much, but were taking as much time searching. KYLE: How does patron feedback influence the decision making process? LESLIE: Well it depends on what the feedback is. We always try and be responsive. If somebody has a problem, we try and get that fixed. We try and be responsive if people want certain materials that have a health system wide use, not just one department. So we try to be responsive. Theres a big issue right now that were undergoing with 2 particular products and there is a group that feels very strongly that thats the only product thatthey cant practice

medicine without it. And a lot of that was because of how it was marketed, so weve been going through a big thing with them. On the other hand thisll cost us $100,000, which is a big chunk of my budget. And then with this product for example Ive been surveying others at the top 10 teaching hospitals to see what they do. So Im trying to get my data together to see who else is doing it, where we are in our budget , what the usage is, and other products that we have that are similar and we try to gather a lot of data. KYLE: Obviously youve alluded to keeping statisticshow do you use the statistics? LESLIE: I report them. I use statistics when I talk to the staff. I use statistics when I talk to my boss. Its a very metriccentric institution, and so, when I need them, I have them. MIMI: That leads into the next question, which is, seeing how things really are on the front lines doesnt always translate well to how decisions are being made from above, so do you think thats an issue here? And do you feel that your boss and bosss boss take your input into consideration when making big decisions on budget and that type of thing? LESLIE: Sometimes decisions are just made and you roll with it. We were told to close on Sundays and we just did it. Just roll with it. And sometimes you can have input but theres another political party thats pushing it another way, and you have to kinda work your way around. Its probably not a good answer, but sometimes you roll with it, and sometimes you fight it. There was one decision that was made that I just felt was morally wrong and I just went all the way up the chain of command. I didnt necessarily get what I wanted but I got something that at least was good for everybody. So it really depends. KYLE: Andif things were great and you had an unlimited budget, what changes would you make to the library? LESLIE: If I had an unlimited budget.Well clearly Id get more resources MIMI: What type of resources? LESLIE: I probably would look at more types of electronic resources that we could afford. I wouldnt just go out and buy stuff because its not all being used. Really, weve got a lot of computer stuff now though so we dont really have needs that way. I mean, it would be nice for everyone to have flat screens. Butyeah there would probably be more resources I would get. I might also look at replacing some of these old books. And I would pay the staff. But, I would expect more too. KYLE: I dont suppose you know generally how many patrons come here on a daily basis LESLIE: Well not daily basis, but last year, we had 40,000. We have a counter at the exit. But that includes this library and Womens because I have a counter there. KYLE: So its between Cone and the Womens Hospital? LESLIE: Yes. KYLE: What about Wesley Long? LESLIE: I dont have a counter there. She has about 15-20 a day, I think she said. But were not sure because shes part time.

MIMI: And is it open somehow when shes not there? LESLIE: Theres a combination key. And Womens as well, theres a combination key so you can go in there 24/7. MIMI: Can I ask why, in the future, you perceive having a smaller space? LESLIE: Well you know, real estate is bucks. Actually, were lucky here because they are building a new towerbutI could see that. I think our key is not so muchI mean, interlibrary loan is so cheap now and we can get things so quickly. Before when we had residency programs you had to have backlogs of journals and now you can either get them online or through interlibrary loan. I think the key issue is what are we doing as librarians? And its not just managing resources, so Im not sure we need all that. However, having said that, we do get a lot of people who are working on their degrees and are looking for a quiet place or something like that so people may still come in and use that. KYLE: I was just gonna ask how confident you were in the future of the library, becausewho knows whats gonna happen with the recession? LESLIE: I thinkthis librarys in a good place. And I think the value, particularly in the past few years that weve been able to bring to our services , and the institution, and the people that work here, is recognized. We get invited to committees, we get invited to MISUs, and we get invited to put things on the intranet. So I feel pretty good about that. But, you know, all it takes is one new administrator saying I dont want it and thats the end of it. Its what happened to a friend of mine, and its what happened to one of our new librarians. MIMI: Im just looking back at this idea of the mission being to support the missions of the institution. Do you ever findlike, at UNCG were finding that trying to fit the departments missions with the university missions that sometimes its a good fit, sometimes itswell thats not really something we do How do you find that interaction to be or is it not as imposed upon you? LESLIE: Well it is, because everything we do is supposed to fit within that. Were undergoing a big culture shift here so its a hard question for me to answer. I think I know where were going but the parameters havent been set. We have this triple-A cost quality service and were supposed to be a patient centered culture and were all undergoing training for all of that. So its a very interesting time here. You know, Im thinking back to your question on if I had a bigger budget what would I do, and Im thinking I would hire another person for more outreach, that would be a goal. Im not sure wed have a clinical librarian here but that would be nice to have something with the faculty. Thered have to be some big changes though for that to happen. Looking ahead though that would be a very interesting project. Id bring in somebody to do a websitewe have constraints on our website, but I would bring in somebody to support that. Those are the 2 biggest needs, and were trying to fill it as best we can. KYLE: Since you started here, obviously there have been a lot of changes. What do you think the

best change has been, and what do you think the worst change has been? LESLIE: Thats an excellent question. I think the best changes that weve seen are the tools of the technology. The worst changeI cant start all over again. Its just been a lot of fun. Its just fun. I think the future is just marvelousfabulous. Youre living at a great time. You dont have to type catalog cards. MIMI: Thank you very much. LESLIE: Great. If theres anything else you know where to find me. Thanks. Peggy Wynn Interview Interview Questions: I have answered these questions particular to Wesley Long. The Wesley Long Library is only staffed 20 hours per week. Other times patrons may access the library using a key code. They may check out books, use computers and use the library space to study. Describe some of the major challenges your library regularly encounters. What are some examples of how youve overcome those challenges? At Wesley Long, the primary challenge has been letting people know there is a library and what the services are. It is easy to make regular library users happy but the challenge is in getting nonusers to value the services and use them. I have started making a library presentation at all New Employee Orientation sessions. These are held every 2 weeks and there have been 40-60 new employees at each session. We are also participating in nursing and nurse tech skills fairs. I try to round on the floors from time to time and offer specific services (lit searches, information retrieval, computer instruction) Another challenge is serving patrons when they have needs within a 20 hour work week. It is a bit of a Catch 22- if you are not present, patrons dont come. If patrons dont come in, the library doesnt appear to be busy. Describe your patrons. How does patron feedback influence your decision making process? And how easy is it to empathize with what they want--and subsequently implement any measures to deal with their request(s)? Wesley Long sees high numbers of non clinical hospital employees. Many of these patrons do not have computers or internet service at home and use the computers to check email etc. There are a handful of physicians that use the library space frequently and another group that uses document retrieval and lit search services. Nursing staff often request lit searches and document retrieval. Many of the libraries online services, journals, wikis, and toolboxes are used by clinical staff. System wide, library usage is measured by website hits. The library also sends out a yearly

survey to users and tries to meet requests and needs as much as financially and logistically reasonable. How do you, in particular, measure your librarys successes or shortcomings? How do you fulfill the librarys mission? All three libraries keep monthly statistics on library usage. In addition, we monitor website hits. We are able to track wiki hits also. Success is measured by increases in these numbers. Moses Cone Health System Library supports the educational and informational needs of the medical staff, employees, patients and families of the Moses Cone Health System, the community, and the health care providers in the Greensboro AHEC region. The mission of the library (above) is supported by providing competent, friendly service to all staff and visitors. The librarians strive to stay up to date on current literature and provide proactive services such as monthly alerts and TOC service. We listen to what our patrons want and try to fulfill those needs. Discuss your observations and impressions of how patrons interact with and use the libraries services and resources. Many of the services and resources are accessed online or through email. Because there is limited face-to-face contact, it is still important to do a good reference interview and often I have several email exchanges prior to a literature search. Patrons often just ignore information they do not think is useful rather than letting you know more specifically what they need. Patrons appreciate prompt service and response to their needs. What do you value most about what you do? It is an immense pleasure to serve and be helpful. I am proud to be a part of a profession that values the sharing of information. Laura Enyon Interview I have answered these questions particular to Womens Hospital. My little library is staffed 32 hours per week. I work M-Thurs at Womens, Fridays I work at Cone (I am the cataloger for all the libraries materials, and I do the cataloging from Cone). Other times patrons may access the library using a key code. They may check out books, use computers, watch VHS tapes, and use the library space to study. Describe some of the major challenges your library regularly encounters. What are some examples of how youve overcome those challenges? Like Peggy, I find I am constantly having to market the library. I am lucky because I work in a much smaller hospital (Womens has 134 beds compared to Cone 536 beds and Wesley Long

175 beds + cancer center), so I know most of the employees at Womens Hospital. Once someone has used the library services, they are apt to remember me. I still go up to the different departments once in a while to make sure they remember I am around. Another issue is time. I work mainly with nurses at Womens, and it is becoming increasingly difficult for them to get away to visit the library. Likewise, if I try to go up to the floors, it is not very helpful because they are extremely busy. When our patient census gets below a certain level, they send staff (nurses) home, so time is more and more valuable. I try to respond quickly to emails, as the nurses do have time to shoot me an email from the floor. I also worked on several committees at Womens Hospital it is a great way to meet people and show off skills. Describe your patrons. How does patron feedback influence your decision making process? And how easy is it to empathize with what they wantand subsequently implement any measures to deal with their request(s)? Most of my physical presence patrons are non-clinical staff using computers to access bank information, email, etc. I also have physician assistants visit my library when they are on rotation. It is a place they can sit and chat, check school email, study, etc. I try to keep my library open for small groups to use, etc. I dont want people to think they have to be totally silent. (Since my library is much smaller than Cone, I dont have to worry about a group talking interrupting someone elsewhere in the library.) The patrons I do the most work for are nurses. As I said previously, they are becoming more and more strapped for time. Yet, they are also getting pushed to do research. The libraries system-wide are all still trying to figure out the best way to reach our nurses. I find it very easy to empathize with my nurses. I know they want to do the research, but they just dont have the time. I try to work around their schedules. How do you, in particular, measure your librarys successes or shortcomings? How do you fulfill the librarys mission? (Peggy answered this well!) All three libraries keep monthly statistics on library usage. In addition, we monitor website hits. We are able to track wiki hits also. Success is measured by increases in these numbers. Moses Cone Health System Library supports the educational and informational needs of the medical staff, employees, patients and families of the Moses Cone Health System, the community, and the health care providers in the Greensboro AHEC region. The mission of the library (above) is supported by providing competent, friendly service to all staff and visitors. The librarians strive to stay up to date on current literature and provide proactive services such as monthly alerts and TOC service. We listen to what our patrons want

and try to fulfill those needs. Discuss your observations and impressions of how patrons interact with and use the libraries services and resources. I feel like my experience with how my patrons use and interact is a very personal one. Because we are such a small hospital, I know my patrons. So, I can tweak searches in ways I know they will appreciate. Which just makes them look upon the library that much more favorably. What do you value most about what you do? I love research. And, I really appreciate that I can help the nurses stay up-to-date on the newest information ... in turn giving our patients the best care possible. I deal with lit searches for the NICU, so I like knowing I am helping out the smallest of our patients.