Health library standards, value & return on investment (ROI)

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  • Updated.jpg 23 November 2016


See also Accreditation | Advocacy | CHLA/ABSC (Canada) 800px-Flag of Canada.svg.png | Clinical librarianship | Human resources | Managing health libraries | Users of health libraries

Today, health librarians are expected to demonstrate their value to their constituents (and within their institutions) in compelling evidence-based and "quantitative terms". The growing need to provide a response to the question "Of what enduring value do health libraries bring to the health care organization? and even the health care system" is now part and parcel of a health librarian's career. According to the American health librarian, Scott Plutchak, at the University of Alabama at Birmingham: " used to be that the way you put together a library budget was to look at like institutions and then argue for a little more. Now my provost is saying to me, If I give you x dollars, what is the return on investment to the University?". In making decisions about competing priorities, academic and hospital administrators must evaluate their options in terms of how to allocate resources in a way that will enable the institution to achieve its goals. This is precisely why health libraries should be prepared to demonstrate their value with hard numbers using rigorous methods.

Health library standards & (e)valuation

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ROI (return on investment)

The definition for return on investment varies depending on the context. ROI is frequently expressed as income received as a percent of the amount invested in a specific asset. In the context of health libraries, ROI may be defined as a return on the life investment of the materials and resources of the health library, and an ability to demonstrate intellectual, cultural or social gains on the investment. Social return on investment (SROI) is an emerging concept that is being used to document cost savings from public sector projects that warrant renewed investment in a community. SROI attempts to quantify social benefits by expanding ROI to include factors previously unmeasured. Where cost/benefit analysis is used at the outset of an investment or retrospectively to determine its value, SROI is a practical management tool that supports informed decision-making for the long-term social, cultural and intellectual health of an organization. See example

Quality assurance in libraries

Studies of the value of health libraries

The Australian Law Library Association, Health Libraries Inc (HLInc), Health Libraries Australia (ALIA HLA, a national group of the Australian Library and Information Association) and the Australian Library and Information Association commissioned award-winning firm SGS Economics and Planning to survey special libraries across the nation and from this to assess the return on the annual investment in these services to their organisations. The definition of ‘special’ includes health, law, government, business, industry, media, research and other library and information services that are designed around a specific user group. These services are often hidden from public view, but are essential contributors to the knowledge-base of their organisations. The survey took place between June and September 2013, and was supplemented by in-depth case studies. The indicative result from this work is that special libraries have been found to return $5.43 for every $1 invested — and that’s a conservative estimate of their real contribution. For example, it takes into account the time saved by doctors, lawyers, corporate executives and political advisors searching for answers, but it does not take into account the improved quality of the results supplied by trained information specialists. It looks at how much it would cost users to have to buy the information they gain for free from the library, but it does not assess the savings achieved by library staff negotiating advantageous prices with information suppliers.

The results of this study show that health libraries return $9 for every $1 invested — and that’s a conservative estimate of their real contribution to health care. The results takes into account the time saved by medical practitioners in searching for answers but does not take into account the improved quality of results supplied by trained information specialists. The study looked at how much it would cost users to have to buy the information they gain for free from the library, but does not assess the savings achieved by library staff negotiating advantageous prices with information suppliers.

This paper presents the Canadian results from a larger, international study with the objective of assessing the value of health library and information services and their impact on patient care. Methods: Data were collected using a web-based survey of healthcare providers in 13 Canadian hospitals collectively served by four libraries, and data were analyzed statistically using SPSS. The survey centred on a specific, recent, patient care incident for which the respondent had sought information. Follow-up semi-structured phone interviews with librarians at the participating sites provided supplemental data. Results: Twelve hundred and thirty-one people from the Canadian sites responded to the survey. Over 70% indicated that their management of the clinical situation changed as a result of the information. Positive changes included advice given to patient or family (48%), choice of drugs (31%), and choice of treatment (30%); adverse events that were avoided included patient misunderstanding of disease (23%), additional tests or procedures (18%), and patient mortality (5%). Results also showed which information resources were used and from where they were accessed. The information resources were valued as much, if not more, than other sources of information such as laboratory reports or medical records. Discussion: The results showed that participants perceive health library and information services to be highly valued and reported that their use has a positive impact on a range of patient care outcomes. They also highlighted the preferred information resources and access points among different groups of health professionals.

Based on a survey done in September 2012, the report shows how people use health library and information services in the country, and the impact usage has on clinical care and education.This is the type of report we need to conduct in Canada to answer to those who want to close health and medical libraries. Library and information service users were asked how they believed their use of the service over the last year had helped them.

95% said it helped them discover new information
86% said it helped keep them current with the latest clinical developments
83% said it helped them improve health outcomes for patients
82% said it helped them progress their research
76% said it improved their diagnosis or treatment plan for a patient
76% said it helped them achieve higher marks in exams
65% said it helped confirm their diagnosis or treatment plan

HLI and ALIA are using the report to advocate for renewed investment in health libraries in Australia. The survey shows that despite significant increases in users, budgets for books, staffing levels and floor areas have declined with no prospect of improvement in 2013.

This report argues that health librarians in Ireland have the capacity to match international best practices and to continue to make a significant contribution to health care. For this to be realized, health librarians must see that the diverse and valuable roles they currently play in the health system are fully recognized. Greater advocacy and systematic evaluation of health libraries will provide the evidence base that will consolidate the supportive view of the profession held by stakeholders and academia. It is essential to leverage this support so that health librarians can fully play their role in the development of an efficient, evidence-based and progressive health service in Ireland.

Classic article

Abstract: Health libraries continue to be under increasing pressure to evaluate services and to justify their value. Hospital libraries face a particular challenge because the goals of the health care system demand that the relevance of library services to patient care be determined. The hospital librarians in Rochester, New York, responded to this challenge by developing a research project that explored the impact of library services on clinical decision making. A systematically sampled group of 448 physicians in the Rochester area agreed to participate in the study between September 1990 and March 1991. The physicians were asked to request information related to a current clinical case and then to evaluate its impact on the care of their patients. Senior medical staff acted as study facilitators in each of the fifteen participating hospitals. As a result of the information provided by the library, 80% of the 208 physicians who returned their questionnaires said that they probably or definitely handled some aspect of patient care differently than they would have handled it otherwise.

Changes to these aspects of care were reported by physicians

  • Diagnosis 29%
  • Choice of Tests 51%
  • Choice of Drugs 45%
  • Reduced Length of Hospital Stay 19%
  • Advice Given to the Patient 72%

Physicians said information provided by library contributed to their ability to avoid

  • Hospital Admission 12%
  • Patient Mortality 19%
  • Hospital-Acquired Infection 8%
  • Surgery 21%
  • Additional Tests or Procedures 49%

The physicians rated the information provided by the library more highly than that provided by other information sources such as diagnostic imaging, lab tests, and discussions with colleagues. In addition to confirming earlier research findings that information provided by hospital libraries is perceived by physicians as having a significant impact on clinical decision making, the results increase our store of scientific knowledge about the specific nature and extent of the impact of information provided by the hospital library.

Abstract: Hospital health sciences libraries represent, for the vast majority of health professionals, the most accessible source for library information and services. Most health professionals do not have available the specialized services of a clinical medical librarian, and rely instead upon general information services for their case-related information needs. The ability of the hospital library to meet these needs and the impact of the information on quality patient care have not been previously examined. A study was conducted in eight hospitals in the Chicago area as a quality assurance project. A total of 176 physicians, nurses, and other health professionals requested information from their hospital libraries related to a current case or clinical situation. They then assessed the quality of information received, its cognitive value, its contribution to patient care, and its impact on case management. Nearly two-thirds of the respondents asserted that they would definitely or probably handle their cases differently as a result of the information provided by the library. Almost all rated the libraries' performance and response highly. An overview of the context and purpose of the study, its methods, selected results, limitations, and conclusions are presented here, as is a review of selected earlier research.

Purpose: To examine the associations between (1) the economic indicators of hospital costs, charges, and length of stay (LOS) for inpatient cases and (2) the use of MEDLINE searches for such cases. Method: An outcome-based, objective, prospective study with an economic evaluation was conducted from September 1989 to September 1990 at three metropolitan Detroit teaching hospitals representing both allopathic and osteopathic care. The study consisted of (1) 192 test cases, derived from a consecutive sample of inpatients of all ages for whom MEDLINE searches were requested at the participating medical libraries, and (2) 10,409 control cases, which were of the same diagnosis-related groups (DRGs) as the test cases but did not involve identified MEDLINE searches. Statistical analysis included the use of multivariate analyses of variance and correlation coefficients. Comparisons of cases were made on case-by-case and DRG bases regarding total patient costs, charges, and lengths of stay for cases with or without MEDLINE searches. RESULTS. The test cases were found to have a higher severity of illness. Among test cases, statistically significant relationships existed between (1) hospital expenses and LOS and (2) hospital expenses and the timing of the search during hospitalization when controlling for LOS. When cases were matched for DRG and LOS, the cases with early searches (i.e., conducted during the first half of hospitalization) had significantly lower expenses. CONCLUSION. Of the test-case patients (for whom MEDLINE searches were conducted during hospitalization), those whose searches were conducted earlier had statistically significantly lower costs, charges, and lengths of stay than those whose searches were conducted later.



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