The Disappearing Medical Library

Recently there has been a lot of discussion on the medical library email listserv about the closure of another hospital library.  Also in the news the CBC reported on the reprehensible state of their Health Canada library.

“Health Canada scientists are so concerned about losing access to their research library that they’re finding workarounds, with one squirrelling away journals and books in his basement for colleagues to consult.”

Not only are the collections missed by researchers but the librarians as well.  Multiple researchers commented to the CBC on how important the librarians are to their research.

“My staff can do so much in sort of Googling around and trying to find this and that or stuff that may come into us. But being able to use the experts and to get their assistance makes a world of difference.”

Like the cuts made to hospital libraries, Health Canada states the cuts were made to save money.  However there is a question as to whether those cuts indeed saved Health Canada any money. The CBC reports, “One of the stated goals of Health Canada’s contracting out of library services was to save money. According to the report, though, the new arrangement is more expensive.”

I have seen this happen in American hospitals that cut libraries AND American hospitals that don’t understand how to work with their librarians.  A hospital cuts the library believing it is a way to save money.  They often end up licensing duplicate online databases, journals, or delivery services.  Fail to understand the nuances of negotiating library resources and end up with a poor deal.  They fail to to get a decent ROI because they haven’t properly supported and integrated the resource into the system.  Why pay thousands of dollars for an online journal that nobody knows exists because you didn’t set up the IP addresses and just handed out the username and password to a few physicians that asked?  Another favorite of mine is a department buying a database for several thousand dollars, hoarding it among their employees in their department and then wondering why it was only used once a month.

The discussion on the medlibs listserv seemed to center around the question about what can be done about the situation and who should be doing it.  What can individual librarians do and what should MLA be doing to get hospitals, administrations, governing and standards organizations to keep libraries in hospitals.  Several people wrote that MLA should be doing more for hospital librarians and work to get the library back in the JCAHO standards or other accreditation organizations.

First I want to say that any medical librarian that believes the our salvation lies with getting JCAHO to reinstate the library as a requirement in hospitals is waiting for something that will never happen.  JCAHO has moved on.  It is a dead issue.  It isn’t even going to be re-animated as zombie issue. It is dead, dead.

So now that we have cleared the air of the JCAHO thing….

I will bring up the issue that some librarians think MLA should be doing more to ensure our survival.  Let me just say MLA staff (all 16 of them) are doing as much as the cany for the MLA members including advocating for them.  The MLA President and Board are doing as much as they can too. However it is unfair to compare the advocating clout of ALA (which has a staff of over 300 and over 56,000 members) to that of MLA.

The only way I see medical librarians continuing on is to work together to get our message out.  As many said on the listserv, medical librarians are too often preaching to the choir about our value and benefit.  We need to take our message out to our patrons.  Not only do we need to do this locally but nationally.  As much as I am in favor of our medical library journals, we need to stop publishing about the value of library services in them and start publishing those kind of studies in our patrons’ journals which is what they read.  Our patrons don’t read our professional journals.  We need to attend and present at their meetings.

One librarian noted that publishing articles and attending their meetings is a little lofty of a goal for the part time librarians who are just struggling.  I get it, you don’t have a lot time and some of that can be difficult.  But we aren’t asking everybody to do everything.  Work to your strengths. I am not good at research but I am good at social media and I am think of ways to get our word out via social media. (BTW at the suggestion of a person on the list, I have already tweeted Dr. Besser MLA’s 2013 speaker about the plight of medical libraries.  It isn’t perfect but it is a start somewhere.) (*update* Dr. Besser responded and retweeted my message to his 33,000 followers. It is a baby step, but you have to take steps before you walk.)

Just because you are part time doesn’t mean you can’t do something when you aren’t in the library and you are at home.  I am a working mother of 3 young children.  My work on my blog, tweeting on #medlibs, writing journal articles, teaching MLA CE classes, and some of my work on the MLA Board often is done during my PERSONAL time.  Almost everything I write is done when the kids are in bed and I’m watching TV.  I have often had to take my own vacation time to teach CE classes or attend some meetings.  Believe it or not I still find time to have a normal life with my family for vacations, kids activities, movies, and life.

If you doubt what regular ol’ working librarians can do please do a little looking into Ohio Public Libraries, 2009, budget cuts, and Governor Strickland.  In 2009, out of the blue the Ohio governor proposed a 50% cut funding to public libraries.  This type of cut would close many public libraries and leave many irreparably devastated.  Within 1 hour of the announcement the story hit Twitter and the hashtag #saveohiolibraries was created to categorize the Twitter messages.  A Facebook site was created and had over 50,000 followers in less than 3 weeks. Another librarian created a website, www.saveohiolibraries.com.  Not only did they get national attention but the Ohio legislature received between 37,000-45,000 emails in one week regarding the budget cuts.

(I live in Ohio so I remember much of this but I was able to find the specifics in the Introduction of Laura Solomon’s book the Librarian’s Nitty Gritty Guide to Social Media)

The thing to note was that ALA didn’t get involved within an an hour of the announcement.  Much of the ground work was done by regular librarians like you and me who saw the immediate need to advocate for their jobs.  Given the differences between the funding of medical libraries and public libraries, I think we medical librarians can’t afford to wait for the budget cut announcement.  We need to advocate for ourselves now!  MLA is helpful and they will do what they humanly can to support us. But we need to stop looking to them to make everything all better, we need to get the message out in whatever way possible.

I understand, we all are worried about the future of medical and hospital libraries.  Just because I have a full time job and and I’m active in the organization doesn’t mean I am not worried.  In fact it makes me more worried because I have seen how easily it can turn.  But I refuse to sit back and subscribe to what some of the “realist” librarians have said, “It doesn’t matter how proactive we are; it doesn’t matter who gets involved; it doesn’t matter how many people come to our defense; it doesn’t matter how much evidence we have to justify our positions; it doesn’t matter how much time we save for others; it doesn’t matter that after we are gone there will be problems for people who need our services. All of that weighed against the decision of the ‘powers that be’ that they can cut the librarian will not help. They will not change their minds.”  To those realists I say, “There’s no fate but what we make for ourselves.” I see you what you have made for your fate.  Your fate is not mine.

 

New Year, New Job Directions?

Don’t think of it as a New Year’s resolution, think of it as just taking inventory of your career path.  Whether you are looking to find a new job in a new organization or just trying to add a new direction to your current job, it is a good idea to think about, evaluate, and discuss (pick people’s brains) your ideas and options.

So tune in to #medlibs on Twitter tonight at 9pm Eastern.

See you there. :)

 

Reposted form (Medlibschapt.blogspot.com)

Join Heather Holmes (@LaMedBoheme73) and Michelle Kraft (@Krafty) for this week’s #medlibs talk as we discuss all good things related to jobs, such as: looking for a new job, preparations to move (yourself, your family, etc), learning or brushing up on skills, transitioning to a new position in the same institution, or transitioning to a related but totally different position. What are some of the positive reasons you are looking for or have accepted a new position or are seeking new skills and abilities? This won’t be a rant session, we want it to be a positive and constructive discussion so please join us and spread the word – we’d love to welcome library students and others interested in learning more about the field!

Some resources to consider:

Librarians, Welcome to the New Age

Perhaps I have been listening to my son’s music a bit too much or perhaps I am just overly tired from celebrating the New Year with friends and family.  Whatever the cause, when I heard Imagine Dragon’s “Radioactive” this morning it really hit a my librarian brain.

Granted, the lyrics have a post apocalyptic vibe to them that is more akin to Walking Dead or Terminator than the state of libraries. But it just hit a chord with me this morning.  I feel like we are in a new age of information and completely revolutionizing the way people find things.  Things have completely changed, and are still changing. The old way of doing things (the old world) is gone. We are waking up to the new age of information.

Just to prove I am not completely cracked (only half cracked), the singer, Dan Reynolds said the “song is about having an awakening; kind of waking up one day and deciding to do something new, and see life in a fresh way.”  We have to see librarianship in a fresh way if we are going to continue.

According to Reynolds, “A lot of people hear it [Radioactive] in a dark way.” The song is meant to be an empowering song, and I definitely hear it that way.  The changes in libraries can be empowering as well. Like music, it is all up to interpretation. Some may “hear” the library changes in a dark way.  Some may “hear” the changes as an anthem to wake up and do something new in the wake of all the changes.  They will end up shaping their world the way they hear the changes.

To quote a favorite line, “there’s no fate but what we make.”

 

 

Perception of Libraries

I heard someone say, “Change the way you look at things and the things you look at change.”  This is easier said than done, especially for librarians.  The results from the Pew Internet and American Life survey “How Americans Value Public Libraries in Their Communities” were recently released.  I have seen many in the library world praising what are definitely good results. Such as:

  • 95% of Americans ages 16 and older agree that the materials and resources available at public libraries play an important role in giving everyone a chance to succeed
  • 94% say that having a public library improves the quality of life in a community
  • 81% say that public libraries provide many services people would have a hard time finding elsewhere

These are definitely things to be proud of.  However, there are some statistics that concern me and I don’t seem to be hearing about them from the library world as much.

  • 52% of Americans say that people do not need public libraries as much as they used to because they can find most information on their own, while 46% disagreed.
  • 54% of Americans have used a public library in the past 12 months
  • 77% of those who have ever used a public library said they know only some of what it offers.  (Of that 77% about one in five say they don’t know very much about what is offered, and 10% say they know “nothing at all.”)

If 94-95% believe libraries are so important then why have only 54% used a library in the last year?  Doesn’t quite make sense.  So while people love their libraries, they don’t know much about their offerings and they don’t use them very often.

This is frustrating because it seems as though people like the idea of the public library as it exists in their heads, but have no idea what it does in practice.  Sounds familiar medical librarians?  I think in order for us to survive we have to do a better job of changing their perception of the library.  Thankfully they like us….but liking us isn’t going to get the tax levy renewed or the keep administration from cutting our budget.  We need to do a better job of demonstrating to our users and non-users how we can help them.  Informing users is tricky enough, but non-users…yikes!  But that is needed for us to turn the perception of a library and the know more about our other services and resources (not just that we have books).

This Thursday #medlibs will discuss the what we see coming to libraries in 2014 and beyond. What is the future of the library?  What do we need to do and where will be going?

Some ideas for the discussion are:

These are all important things to consider, but I also believe part of our future rests with changing perceptions.  If we don’t do that we are going to be the Norman Rockwell of professions. Nice to remember, or as somebody on Twitter said,  “an emotional remembrance.”So tune in on Thursday http://medlibschat.blogspot.com/ as we discuss the library of the future.

Killing Cows: #Medlibs Summary

Last Thursday a group of medical librarians got together online via Twitter to discuss the issue of change in libraries.  Specifically they discussed evaluating the sacred cows in libraries and librarianship within our institutions and whether they should be continued (successful programs) or killed (unsuccessful programs).

I thought I would briefly summarize the discussion for those who were unable to participate. Transcript is available here.

We had 30 people who participated in the chat and each participant tweeted an average of 11 tweets.  (Lively discussion.)

In an effort to set the tone or get some context for the discussion. Nikki Dettmar (@eagledawg) reminded us of Mark Funk’s (@funkme77) 2008 Presidential Address, where the gist, “We Have Always Done It That Way” is not the way we want to continue the business of libraries.

Several librarians gave examples of sacred cows they have either killed off or would like to kill off in their libraries.  These include:

  • Reference desk
  • Checking in hard copy journals
  • The catalog and cataloging
  • Regularly scheduled classes
  • Face to face classes
  • Table of contents lists
  • Reference collection
  • Printed books

Many had various thoughts on each of the above topics.  For some getting rid of the refernce desk was a sacred cow that was killed or needed to be killed. However, for others, their library’s reference/front desk was still doing a brisk business and killing it would be unwise.

The topic of cataloging while a lively topic at other discussion venues didn’t draw as much ire or skepticism.  Several thought small hospital libraries with solo librarians may want to re-consider the idea of an online catalog in favor of something easy, agile, and less time consuming.  Almost everyone agreed that the act of cataloging could be done much more quickly and simply that librarians stop fussing with minute details of cataloging and look at user tagging/catalgoing. Tony Nguyen (@TonyNguyen411) mentioned he was “Totally ok with collective cataloging. Original, just the easiest access points to get it quickly on the shelf.”

The rise of electronic collections caused many in the group to discuss alternatives to book and journal purchasing, collection development and management.  Teressa Knott (@tlknott) mentioned their circulation numbers has caused her to start thinking of a “strictly e-book collection.”  I mention how our institution got rid of our reference section.  Reference books were shelved next to the circulating collection.  Patrons don’t have to go to different shelves or locations within the library to find books on a topic depending on the book’s loan rules (which patrons don’t know).  All of the books are together making them easier to find.  A red dot on the spine indicates the book doesn’t leave the library.

The library classes seemed to be a bit of a problem among the #medlibs librarians.  As Amy Blevins (@blevinsa) stated, “(I) have mixed feelings about schedule classes. Love them when people randomly show up. Not so much when 0 show.”  This seems to a problem shared by several in the chat.  There were some librarians who got rid of their scheduled classes and only taught classes by appointment while others tried to get rid of them but had to bring them back because “admin wants to bring (them) back b/c other AAHSL libs do it.” I am not sure whether Stephanie Schulte’s (@s_schulte) referrence to admin was institutional administration or library administration.

In the second half of the hour the discussion seemed to venture away from the library and on to the profession itself and sacred cows within the profession such as:

  • The name librarian
  • Associations, organizations, societies, and certifications
  • Academic journals
  • Impact factors
  • Peer review

Besides our job title of librarian, I’m not sure how much impact we have in with the other sacred cows within the profession.  Additionally there were many that said the issue wasn’t the title of “librarian” but it was people’s out dated notions of librarians.  The issue of librarian vs. informationist, vs PubMed Whisperer, vs information specialist is probably a larger issue that could be discussed on another Thursday.

Overall it was a very interesting and fun discussion.  I challenge all librarians, not just the 30 on the chat, to think about our sacred cows.  I want to quote Mark Funk’s last Presidential blog post, “Remember that ‘We have always done it that way’ isn’t an answer, it’s an excuse. Boomers didn’t like that response in the 1960s, and we shouldn’t like it now.”

New MLA Members Hangout!

The best way to get the most out of your MLA membership is to get involved.  For new members it can be a bit daunting.  But never fear, the MLA New Members SIG is having a Hangout this Friday December 6th at 9pm Eastern.

If you are a new member you may not know exactly what a SIG is. A SIG is a Special Interest Group.  SIGs are “ad hoc groups open to all members of the association. SIGs range from a series of informal meetings on a specific, short-term issue to an established subgroup within an MLA section.”

There are 21 SIGs in MLA (view list here).  SIGs “provide a forum for members with unique interests to identify and meet with others with similar interests without having to fulfill the governance requirements of Sections. SIGs are generally created as less formal and more flexible organizational units, with the advantages of fewer reporting and no minimum membership requirements.” IMHO think of a SIG as the light version of Section. (For more information on SIGs go to MLA or my blog post.)

A SIG for new members is a great way to get some exposure and involvement in MLA because it is less formal and more flexible.

So if you are new member please consider joining other new members at the New Members SIG online event this Friday, Dec 6 @ 9pm Eastern.

They will be talking about the New Members SIG, preparing for MLA 2014, MLA resources, strategies for networking and meeting other medical librarians, and just getting to know each other.

More information can be found here http://bit.ly/1cVg0I2

While the Hangout is geared for new members, it is open to all.

Health Science Librarians Make A Difference Contest Winners

The winners for the Health Sciences Librarians Make a Difference contest sponsored by Wolters Kluwer Health have been announced.

First Place

University of Missouri – Kansas City Health Sciences Library:
Spot of Tea” Kristy Stiegerwalt describes how her research on green tea and liver toxicity helped a patient.  The requesting doctor asked colleagues the question and they had never heard of a connection between green tea and liver toxicity, but he showed them the systematic review she had provided them and after stopping his green tea consumption the patient was less jaundice.

Second Place

Florida Mental Health Institute Research Library, South Florida:
Why Research Matters” The librarian describes the creation of 15 videos in response to a discussion with graduate program chairs demonstrating how and why to use databases and other resources for the Graduate programs in Applied Behavior Analysis and Rehabilitation and Mental Health Counseling.  Showing the relevance, value and importance of good and thorough research to real life problems.

Third Place

CRAI Biblioteca de Medicina/Univeritat de Barcelona:
The Library, an Evergoing Relationship” The video depicts a medical student trying to get a grasp on his studies in the begining of the year and using the library to understand how it and the librarians can help him.  The student evolves from checking out books to using the library for research support, training, remote access, and beyond graduation.

Congratulations to all winners.  You can view other great submissions on the Ovid YouTube Channel.

Two things that I think are cool.

First is the praise that one of the judges, Sujana S. Chandrasekhar, MD, FACS, FAAO-HNS, gave to Kristy for her video, “As a busy, practicing physician who just tries to ‘Google it’ or ‘Pubmed it’ on the fly, but who wishes she had that type of support in unusual patient cases, that video absolutely tells the value of a great medical librarian.”

Second is you don’t have to a budding Steven Spielburg to win.  I’m always intimidated by video contests because I’m afraid my lack of video editing will hurt my chances. In this contest, Kristy and her colleague have shown you just need to point the camera and shoot and if you got good material you can win.

I ran across a web page indicating Ovid will hold this contest again in 2014 (unfortunately I can’t find that web page right now) so if you are making a difference and you have a web cam, cell phone cam, etc. make a video and submit it.  Who knows you might win!

Australian Healthcare Orgs Gain $9 for Every $1 Spent on Their Health Libraries

(Special thanks for Julia Esparza for her email directing me to this.)

Check out this cool infographic from the Australian Library and Information Association and Health Libraries Inc.  Basically it states that despite having budgets, staff and space cuts health science libraries provide $9 of benefit to their healthcare orgs for every $1 spent on them.

This infographic is part of a study conducted by Health Libraries Inc (HLInc) and Health Libraries Australia (ALIA HLA, a national group of the Australian Library and Information Association).

“The partners commissioned award-winning firm SGS Economics and Planning to survey health libraries across the nation and from this to assess the return on the annual investment in these services to their organisations.

The results provide a snapshot of the continued outstanding value of health libraries against a backdrop of significantly greater usage but declining investment. Patient and medical staff numbers and hospital expenditure are increasing, while health library budgets, space and staffing levels are decreasing.”

To view the full report, please click here. You can also find the SGS report here.

There are lots of very cool things in the infographic but the one that really stands out to me is at the bottom (unfortunately). It says, “The investment in these services (library) is just 0.1% of the recurrent expenditure in Australian hospitals.”

IMHO that information is HUGE.  Why are hospitals cutting such a SMALL percentage of their recurrent budget when it provides a healthy return on investment!?

One of the reasons I think this is happening is because we need to do this kind of study on a local level.  Hospital librarians need to figure out how we can show this information to our administration and also show how we are helping with their bottom line DESPITE our cuts.

While I think this is information is important, I don’t think running up to your administrator showing him this infographic (or emailing it to him/her) is going to help.  Administration has the mind set of, “What have YOU done for me lately?”  They will see this infographic and think “how nice for Australia, but what about our hospital?”  How are you helping your specific hospital with costs and patient care?  Please don’t answer them with the phrase, “I provide doctors and nurses with information.”

That is all fine and dandy but that answer doesn’t specifically detail how you are helping the hospital with costs and patient care.  Numbers matter to them.  Hospital librarians need to do these studies on a much smaller level in their own institutions. We need our own local numbers telling administration that we helped our OWN caregivers change their thinking and improve their diagnosis or treatment plan X%.

That is what matters to our administration.

Hospital librarians…we need to do our own research studies to survive. The research doesn’t have to publishable in a library journal but it has to be given to administration and make sense to them.  Heather Homes calls it the “small r research.”  It is research that doesn’t take a year or more to complete, it is specific to your department and institution, and it is what administration finds important.  All of these things run contrary to big R research. Big R research takes several years to complete, applies to libraries as whole, and is of interest to other librarians.  The little r research is about your job, the big R research is about the career of librarianship.

So lets start to deconstruct these great big R research projects like the Marshall study and this one from Australia so we can see how we can apply them for our own small r research in our institutions and in our jobs.

Who’s with me?!

MLA’s Rising Star Program: Apply Now to be a Star or Mentor/Host

(reposted from MLA-LMS)

The MLA Rising Star program has been developed for MLA members who are interested in attaining leadership roles in MLA but who have not yet become active at a national level. The one-year leadership development program matches each Rising Star with a mentor in a curriculum that includes:

  • learning how MLA succeeds through the volunteer efforts of its members;
  • the roles of the MLA Board and staff; and
  • project management skills applied to an actual MLA project.

Application and information can be found online at: http://www.mlanet.org/pdf/awards/20130827_rising_star_app.doc

Applications are due November 1, 2013. 

Also, if your chapter, section, or committee is interested in submitting a project for the program, the host/mentor application can be found online at: http://www.mlanet.org/pdf/awards/20130827_rising_star_host_app.doc

Host/Mentor applications are also due November 1, 2013.  

Cutting Muscle and Bone

One of our favorite movies is Raising Arizona.  We can sit back and watch it any time and we often quote movie lines to each other when it fits a situation.

In Raising Arizona, Nicolas Cage plays  H.I. “Hi” McDunnough and has quite a few interesting expressions and quips. One has been on a loop in my brain lately.  It one that in the first few minutes of the film. “These were the happy days, the salad days as they say, and Ed felt that having a critter was the next logical step. It was all she thought about.” A few moments later, Hi’s voice says, “Our love for each other was stronger than ever, but I ‘preminisced’ no return of the salad days.”

Sometimes I wonder if there were ever a salad days in medical libraries.  I know medical libraries had budgets, the money just wasn’t falling from the sky.  However, it seems these last few years medical librarians have seen their budgets continually cut.  Even “lucky” libraries who have had a flat budget for the past few years, are being told to cut their budget by a percentage.  Those are the lucky ones. They have weathered the storm well until now. Hospital reimbursement from the ACA are impacting the hospital budget, they are seeing less reimbursement.  Less reimbursement means less money, less money means they are cutting budgets.

Yet as hospital library budgets have been cut, the cost of resources have continually increased.  Depending on the vendor it could be anywhere from the rate of inflation to a 75% increase.  Librarians have done their best to watch all of their resources and cut anything that is under performing.  Journals that cost more per use than ILL fees…gone. Databases that don’t have a certain cost per use…gone.  Resources that up their prices to align with competitors because the competitor is more expensive…gone  If medical libraries were a steak, they would be the leanest toughest piece of leather on the plate. There is no fat left.  There is no chef’s steak sauce to compliment the “unique” flavor.

So what happens when you have trimmed the fat?  You trim the muscle and the bone.  The cuts in medical libraries have caused librarians to cut things we would never have cut 1-2 yrs ago. Guess what…We have now cut all of our under performing resources. We are now cutting products based on price alone.

Of course, what else can you do when you don’t have the money?  Donors like to fund projects they could put their name on, not operating budgets or resources that are annual.  A bake sale ain’t going to work. Yet the prices of resources continues to rise. Vendors have told me about the “VALUE” of their product and how important it is.  Big flipping deal.  I know it is valuable, I wouldn’t be talking to them if it wasn’t. Don’t talk to me about value.  But they persist, as if hammering me about the “VALUE”  will magically cause me to find money to pay for their 30% increase.  My answer: My car is a value to my job and my life.  But, if it breaks down and my family budget cannot pay for repairs or a new one, I have to take the bus.  Do I want to commute 1 1/2 hours each way via public transportation every day? Hell no, but if that is all I can afford that is what I do.

If I can’t afford your “VALUED” product, I am going to make do without it.  Sorry, but it could be the most valuable thing on the face of the planet but if I can’t buy it, I can’t buy it.

I know of a few great medical librarians, who are looking for new jobs out of librarianship.  They aren’t looking because they were laid off (although there are those too).  They are looking because they see no future in medical libraries.  The shrinking budget (even in well funded institutions) and rising cost of resources makes them feel like they can’t do their job.  Some question whether the rise in costs will inevitably force libraries to shift the costs to the institution as a whole. Thus the shift of the product’s cost to another cost center.  What will happen when that happens for every resource, in the library?  Don’t laugh, at 15%, 20%, 30% price increases when faced with a 3%, 5% or 10% budget cut, the pot of resources gets smaller and smaller.

It would be interesting if there was a survey where librarians could anonymously mention what percent their budget was cut and list the resources they cut as a result.  They don’t have to list costs.  Just the percentage they lost in their budget and the products that were dropped as a result.  I know the resources cut will vary by institution, but it would be interesting to see if there was a pattern.  What things people are holding onto until the bitter end?  What type of vendor cannibalizing is happening within the library?  Not only will it be interesting to see what products are eating the other, but what two (or more) products from the same company are eating each other.  For example: Does a rise in the cost for UpToDate effect LWW titles purchased?  Does a rise in the cost of AccessMedicine effect AccessSurgery (or other Access database)?  It could be any resource or vendor.

The funding model is unsustainable for hospital libraries.  Time will tell whether the reduction in reimbursements from ACA will make shifting the library resources cost to another department in the hospital unsustainable.  Who wants to take on another department’s cost for a product when they are also rquired to cut a certain percentage out of their budget?

In my Sacred Cows and Heretical Librarians post I mentioned we need to think evaluate our sacred cows.  At the time I meant services or how we do librarianship, but we probably need to apply the same principle to our resources.