65th IFLA Council and General
August 20 - August 28, 1999
Code Number: 071-86(WS)-E
Division Number: II
Professional Group: Biological and Medical Sciences Libraries: Workshop
Joint Meeting with: -
Meeting Number: 86
Simultaneous Interpretation: No
How to establish a successful health information library in community
Patrons seek health information in order to make informed medical decisions or to learn to how cope with an illness, disability or death. The health information library enables the patron to get reliable up-to-date information in a secure environment facilitated by a knowledgeable and discreet staff. Setting up a consumer health library necessitates a well thought out plan that includes a statement of the goals and vision of the library; procedures and policies; and a staff-training program to ensure customer satisfaction. A health library differs from a public institution in the way patrons are served. This paper examines some options that make a health information library succeed or fail.
Congratulations, you have gotten the funding! Now what do you do? There are so many details that have to be managed, but first you must plan and make crucial decisions before doing the obvious, like ordering furniture and materials for the library. There are decisions about governance and/or maintenance of daily operations. Who has oversight - the librarian, library committee or a manager who does not have daily "hands-on" experience with the operations of the library? Policy decisions need to be made about whom the library serves, computer access issues, fee-for-services, loans, and legal issues like putting disclaimers on materials etc. Practical decisions such as where will the library be located, shelving layout, wiring for computers, storage for supplies and materials, types of furniture, budgeting for the known needs and the unexpected necessities. Most importantly, you have to plan how to get the users to your library, how to give good customer service and how to keep the library funded.
As librarians, it is important to maintain decision-making authority over the daily operation of the library, selection of materials, access to computer information and customer relations. In the beginning, insist that the librarian, who has the training and the professional skills, be the final decision-maker. This will save time, money and mental health of the person who has the most personal contact with the public. Decisions made by committee or perhaps a "clueless" Manager have resulted in some bad results with library patrons and stressful librarians who have to handle the outcomes of bad decisions. This is not to say that the librarian acts without "consultation" with a committee or Manager, or overrules management decisions, but personal experience working with the patrons you are serving, can give you better insight into what is the correct procedure. For example, the committee decides that there should not be any materials on Alternative or Complementary therapy in the collection because they believe that anything not based in traditional Western medicine is misleading. This is not a problem in many public libraries, but is controversial in many hospitals. The experienced librarian, who knows that this is a popular topic with patrons, can argue for a broader material selection policy and also make concessions with the committee by having the materials "reviewed" by experts. This worked well with us, as we actually "selected" the materials to be "reviewed". Once our credibility as reliable selectors of relevant materials was established, the reviewer said that we could go ahead and do our own selection without review and to ask him only if we had questions. The materials are now there for the patron and the committee is satisfied.
In order to protect the library from legal entanglements and misunderstandings regarding the selection of popular or controversial materials, a disclaimer sticker or stamp should also placed on all materials displayed in the library. This sticker or stamp may say something like, "Information found in the Health Information Library may differ from traditional medical opinion, and a health care professional should be consulted if you have any questions or concerns".
[There will be samples of disclaimers at the conference]
The Mission Statement
Once governance issues are negotiated and resolved, important policy and procedures must be established. To do this well, it is helpful to borrow a procedure from the business world and write a Mission Statement. A well thought out and simple one presents the vision and goals that guide the entire operations of the library. It can be as simple as "Our goal is to give great customer service" (from an Ohio bookstore). All the policies and procedures are guided by that simple statement and the employees have embraced it as their own way of doing their job. Customer service is top priority even if it means the store loses money on a transaction. It worked so well that the store's excellent reputation is widespread and the store is very successful.
A health resource library Mission Statement could read "we provide free comprehensive information to help all patrons make informed medical decisions and to promote healthy behavior". From that statement decision about materials selection, fee-for-services, loans, Internet access, who has access to library services (children, adults-only, indigents), can be made. It is important that the mission statement be truly believed and be accepted by all workers in the library. If the library staff and volunteers do not want to practice it, you need to re-educate or relocate them, or else your credibility with the public will be lost and success of the library may be uncertain. We have all had encounters with a surly or lazy employee that give the patron minimal help. If, for example, the patron does not get the comprehensive information he or she needs to make an informed medical decision (including controversial therapies if requested) from an apathetic employee, the meaning of the mission statement is worthless. The patron goes away not fully informed, and in the worst case, the reputation of the library may be damaged by what he or she tells others.
If you have any input on deciding where the library will be housed, remember the three primary needs for successfully selling your home: "Location, Location, and Location". I have always lobbied to have the Health Resource Libraries visibly located near the cafeteria. Visibility and a pleasant appearance are the keys for a successful placement. A welcoming atmosphere will attract the walk-in patron and eating areas are a natural enticement to bring potential patrons nearby. There should be at least one window to the outside corridor so people can see inside the library. There is nothing more forbidding than a solid door and walls, and this can easily deter some patrons. People will give up trying to find the library if it isn't in an easily accessible area. Our Family Library was originally located in the Laboratory Medicine area and rarely visited because no one could find it. Now it is located next to the cafeteria and is always busy. Visible and clearly written signage is also essential. Our experience is that people do not read elaborate signs, so keep them eye-catching and the wording simple.
If the library has the funds, a photocopier and one or two public computers are beneficial. I personally would give the purchase of computers and printers priority over most items for the library. Internet access to resources such as MedlinePlus or support groups is more helpful to the patron than an outdated paper publication. Our patrons are happier getting a printout of an Internet search than a pamphlet because they feel they are getting the most up-to-date and credible information. This may not in fact be true, but that is how they perceive it. You, however, must know the sensibilities of your patrons. If they are suspicious of or intimidated by the computer (and many are) then you need to concentrate on print materials.
Needless to say, comfortable seating and well-lighted reading areas are a must. Shelving and layout of the library must be conducive to storage and ease in finding materials for all, but it is especially important in enabling handicapped patrons to get information. I always feel that a "sense of place" is important. These libraries are often a haven for distressed people, so make it comfortable for them. You may be giving more than just information to patrons; you may also be giving them a place to sit, think and make important decisions, and maybe even give them a sense of harmony and peace of mind.
Procedure and Policy Manual
When writing your procedure and policy manual, remember your Mission Statement and the patrons you will be serving. Here are some things to consider.
- Are you going to be answering homework questions? - A thorny problem for hospital based libraries because it is so time consuming
- Are you going to charge back for services? - We charge for copier use and cost recovery for any interlibrary loans.
- Do you loan books out to patrons? If so, do you have sufficient funds to replace them? - Unless you are part of a library system, you will lose a lot of books.
- Internet access - will you let it be open to all, or have monitored access or will you use filtering software? - Sometimes having the computers next to the librarian's desk solves many problems.
- Are you going to allow people to use your computers for email? - We found this ties up computers that should be used for searching health information.
- How will you handle inappropriate usage of the Internet? - A written policy statement displayed by each computer helps when you want to remove an offender.
- Do you establish time limits on the computer? - 30 minutes works well for us, and if it isn't busy we allow the patrons to stay on longer.
- Do you allow indigents to "loiter"? - Have a written policy covering this if you are allowed to remove homeless patrons from the library. Our hospital has tight security so this is not a problem.
- Do you answer telephone or email requests for information? - This is a very difficult issue because the patron is not there in front of you. Be sure to quote directly from a dictionary or textbook and give the citation. This may seem an innocent problem, but there is such a danger here of giving out the wrong information. Libraries with email addresses are being inundated with requests from patrons outside their geographic area.
You need to think of all contingencies and cover everything in your manual for both consistency in handling problems and also for legal protection. You also have to decide whether you want to be the "Library Police" and have to enforce too many rules. Every librarian must make these decisions based on experience with patrons that the library will serve and the library's mission. The CAPHIS (Consumer and Patient Health Information Service) listserv is an excellent source of information for help answering these questions. Address to subscribe is LISTSERV@SHRSYS.HSLC.ORG
If at all possible, have a separate room where patrons can have some privacy to read sensitive material. Since there are stigmas to certain diseases and the sensitivities of some patrons must be taken into consideration, a private space - a room or even a partitioned area - is desirable to enable them to read or view video materials in private. Staff must be sensitive to personal information they receive from the patron and handle the questions in a professional manner. They should NEVER discuss what they have heard from a patron with anyone, not even with another library staff member, unless it is to solicit help. Think of yourselves and patrons as having the same confidential relationship as doctor and patient
Staff and Volunteer Training
Training, especially with volunteers, is one of the most important aspects of setting up a health information library. Although the steps in helping a patron are similar to a public library, special care must be used with patrons seeking information on severe illnesses, disabilities, or coping with death and dying. Sometimes patrons are emotionally fragile after hearing bad news or are in denial, and they may need special handling. They are sometimes unclear about the diagnosis and this can be a problem because the librarian or volunteer must be especially cautious about giving misinformation. Good reference interview techniques are needed to search out the real diagnosis or, in many cases, to find out what the patron really wants (not always what they first say). The librarian may be the first one to give them information that the physician has not yet divulged and, if it is bad news, must be ready to handle the patron's reaction. Role-playing can help train your staff to deal with unexpected reactions from patrons and give them confidence in handling emotionally charged scenarios. These scenes don't happen very often, but it raises the confidence level of staff and/or volunteers so they can handle them calmly and professionally when they do.
The very first question I ask a patron is "What has your doctor told you?" or "What do you know about this syndrome/disease/disability? Can you explain it to me so I know what it is?" And then: "Is this information for you or someone else?" This lets me know several things: their level of comprehension, how much they know about a devastating illness and/or what their doctor has told them and who wants to know - caregiver, parent, friend, relative etc. I then probe to find out what and how much they really want to know (it may not be what I expected). I usually begin giving them basic information and see if that satisfies their information needs. I then tell them that if they need more advanced materials I will be happy to get it for them. Try not to overwhelm the patron at first, but if you sense that they are already well informed about the condition, immediately give them more complex information.
You should not ever interpret medical information for the patron unless you are a trained health care professional. Even if you think you understand the material, and it is tempting to help out the patron, you are in danger of giving them misinformation. If they are having difficulty with the information presented, we either give them more basic information that they can understand or show them a nursing dictionary so they can look up terms. When I have parents who ask me, "what does this mean?" I suggest they photocopy the information and take it to their doctor or a nurse (who usually explains things more clearly) or some other health care practitioner to give them an explanation. "I do not have medical training and can't explain or interpret this material for you," is a safe thing to tell a patron. Since hospital liability is an important consideration for us, we are very stringent with this rule. You may be able to less rigid about this, but do be careful.
A professional demeanor is important for credibility. It is hard to describe to a volunteer exactly what "professional demeanor" means, especially to someone who wants to cheer up a patron. It is hard, even for the professional librarian, to find the correct balance between detachment and over-involvement. Your staff or volunteers should be trained to be empathetic, but not to say, "I know what you mean" when they do not personally have the disease or disability themselves. Nor should they be overly solicitous or inquisitive about personal matters or tell the patron about their family member or friend "who had the same thing." Most importantly, they need to be discreet in dealing with the patron and not discussing with anyone what was said during the encounter.
Source of Materials and Networking
There is a lot of information on the Internet - some of it good and some of it unreliable. Librarians have the skill to evaluate sites (another good reason to have a professional librarian manage the library) and they can put these links on your library Web Page, if one is available, or print out a list for use by patrons. Another source of materials can be found on the Medlineplus pages, with link to support groups and clearinghouses. We use Web-based Health Source Plus (Ebsco) and Health Resource Center (InfoTrac) for full-text printouts of materials for our patrons - both are expensive but they save us time, are reliable sources of information and eliminate the need for material storage space. I also have an extensive list of bookmarked sites that I use. [A list of medical sites will be available at the workshop]
Networking with other consumer health libraries, hospital, medical or university libraries and government or community health organizations can yield good sources and bibliographies of consumer materials. If you can negotiate to become a member of a consortium of health libraries, materials can sometimes be freely loaned or exchanged.
Once you have your attractive library set up in a visible location and are linked to the Internet, how do you get patrons to come in the door and continue to return? Getting the word out about your services is an on-going project. Since a lot of the continued and new funding for libraries is determined by the amount of usage by the public, it is important to do a lot of public relations work. An opening reception is a must to thank those that have made the establishment of the library possible and perhaps to get some publicity from the local news outlets. Giving talks to community groups about the library or going to local schools and giving book talks initiated large donations to our Family Library. Giving talks at conferences (not necessarily library conferences) also helped to publicize the library. Web sites, brochures in public areas are useful. Helping healthcare givers find patient information will establish a good relationship and will facilitate them referring their patients to you. The important thing is to keep the library in public view and, of course, the best PR is to send the patron away satisfied with the service he or she got from the staff.
Proving that the library is being used and how it is being used is important and maintaining a User Log is a necessity. Either the patron can fill out a request form or the library staff member can fill it out after the patron has left. At Children's we note on the form how we searched for the information - Internet or databases - and the search strategy used. When we show them books, we also note the title. This helps us if we have to go back and recreate the search or another staff member helps the same patron and doesn't want to duplicate the previous work. As an added benefit, keeping the User Log helps with collection development because we also write a message saying we need more materials on the subject. We keep the logs for a year and add the statistics to our monthly report.
I have not gotten into the details of setting up a library, because there are sources on the Internet and books published about this subject, and also because of local customs that determine what you do. What I want to emphasize are the universal qualities that will make the successful consumer health library work. Remember the three C's - Customer Service, Credibility and Confidentiality.
Establish your credibility with the public. Do not give out misinformation. Make sure you understand what information the patron really wants. Be sure you have enough of the right resources to fill these requests. A library that has only a few pamphlets on the shelf is not going to serve the public well and people will not return. A disgruntled patron may say to their friends, "they don't have anything there, don't bother going", and that bad publicity is worse than no publicity for the library. Be sure that the public knows that the materials you hold cover a wide spectrum of beliefs, and what they read might not agree with what their healthcare giver has told them. Be sure you have a disclaimer on all your materials stating this, and do not explain what is in the material unless you are an expert in the area.
Maintain confidentiality. This is important in any business or library, but more so in a consumer health library. A patron's health problems are personal, and staff and volunteers must never discuss them with friends or even with each other. Public confidence in knowing that what they discuss in the library will never be repeated outside the reference interview is essential.
Most importantly, give great customer service. Pleasant, well-informed, helpful staff and volunteers are the keys to a successful library. Go beyond the minimal procedures for the patron and give the most comprehensive answer possible. Remember your Mission Statement - internalize it and work by it.
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