A part of my responsibilities was to contact each chief of service to find out what he or she would want from his or her medical library. (A chief of service is the senior physician in charge of a specific medical department.) We had to make sure that our library addressed the basic needs and subject specialties of this hospital. I was surprised to learn that our users were not aware of many of our new acquisitions.It became clear to me that our users needed to be reintroduced to our updated skills and services. For this hospital library to be repositioned, we had to develop a deliberate strategy for success.
 

Diagnosis and Treatment
Mount Sinai is a small, community-based, city teaching hospital with approximately 465 beds. Each department has its own subject specialty, and therefore its own unique information needs. It is easy to lose sight of the individual information needs of each group. Although our staff had created a comprehensive intranet site that included all of our new resources, we were receiving feedback from our patrons that they didn't know which resources they needed to use. Our users wanted to have access to their own personalized intranets as opposed to the library's all-encompassing intranet. But of course, creating individual intranets is not practical. However, applying what I'd learned as a consultant made me realize that the only way for a library to be seen as relevant to each group within a diverse organization is to create the illusion that each department is our only customer—in essence, to focus on the "customer of one."

In order to accomplish this task, we incorporated a myriad of traditional and cutting-edge communications methods to get the message out to the hospital community that the library did not just take a cookie-cutter approach to everyone's information needs. So, the library began to treat each department with the same standard of excellence and customer service focus as the hospital uses to treat each of its patients.

To demonstrate our commitment to customer focus, we needed to start by redesigning our actual library space. In truth, the entire library staff area was anti-customer service. We didn't have an adequate reference desk. We also did not have enough computer terminals for either staff or users, and we had no facilities for group training. But we didn't have any funding for this project, so I worked out a deal with Informatics (our hospital's IT department) to create a computer learning lab in a corner of the library reading room. Space is always at a premium in our hospital, so exchanging part of our valuable library area to create a shared computer lab was a big move. But it put us in a better position to offer training and gave us new equipment at no cost.

In this partnership, we did relinquish some prime real estate. But we gained an immediate reputation for being flexible, and demonstrated an ability to address the hospital's bigger needs. Best of all, we did not have to pay for the nine new computers, printer, or redesign of our reading room. Our new space is now an accessible, welcoming environment, giving a visual facelift that corresponds to our commitment to change.

To inform our users about the new features of the library, we published an article in the in-house hospital newsletter. We peppered the article with testimonials from regular library users from various hospital departments, and included a sidebar highlighting features of the intranet.

We also set up traditional cork bulletin boards outside of the library with instruction materials on how to use key resources and hints on how to access the library's intranet 24/7. In a related initiative, we made each library staff member responsible for highlighting a library service in our hospital newsletter or library news Intranet section. Basically, we try to ensure that one service is highlighted each month in either publication. I have been attempting to coordinate our library news with relevant activities and special programs featured throughout the hospital.

After I reviewed our salary budget, I saw that I could afford a one-day-a-week position, so I was able to hire a part-time library marketing consultant. When Susan Massarella joined the library in this position, we quickly realized the short- and long-term successes we could create from continuing the "customer of one" service idea. Now she works for us every Monday, and that's when we focus on our marketing projects. This means that every Monday we update our intranet site and work on our marketing and communications issues. After our space redesign, we decided that we were ready to repackage our content for our end-users.


Partnerships with Nurses
The Sidney Liswood Library had been established as a medical library—the existing collection and intranet were designed primarily for physicians. But the nursing department used the library heavily without the appropriate support materials. Nursing reference questions, training sessions, and interlibrary loans were a growing percentage of library usage.

Without any prospective funding available from the library's budget, I chose to draft a collection development proposal for the nursing department. I wanted to address its core print and electronic needs, and I offered to create a specific nursing intranet site. I had one of our volunteers compare our existing print collection against the Brandon-Hill List for Nursing and Allied Health, a benchmark collection guide for nursing resources. Based on the results of the analysis, I presented nursing with a list of recommended titles, both print and electronic, that was required to create a basic collection. Consequently, the library was funded and we acquired the print and electronic content reviewed by our clinical nurse specialists, with the proviso that in return for the funding, the library would market the collection and offer training on how to use the nursing resources.

Once the content was in place, we again needed to look at the packaging. Merely providing access to content was not going to solve the information needs of our nurses. The resources were already scattered under various headings (databases, e-journals, e-books) on the existing library intranet. So Susan began to create the e-nursing intranet site, a subset of the library intranet. She created a single-point search solution where all of the nursing resources and corresponding instruction guides were gathered together. When it was ready, we put an "e-nursing" button on the library intranet to direct nurses right to "their" section.

Now we're implementing a customized marketing launch and outreach for our nurses. Clinical nurse specialist Patricia Hynes Gay and I have dedicated ourselves to going to each nursing station to announce and demonstrate the new e-nursing site. Our initial visits to nursing stations occurred during Nursing Week, and thus became part of the larger publicity in the hospital surrounding the week.

This marketing launch has followed the same communications pathway as the library's strategy to market our other services throughout the hospital—using careful individualization according to the information needs of each group. When we visited the nursing administration group, we gave the members a complete demonstration of e-nursing, along with tips and guidelines on library services they'd find useful. Since the nursing administration department is an office environment, not a patient care center, they could schedule time into their day for our presentation. On the other hand, when Patricia and I visited the nursing station in the emergency department, the nurses there were coping with victims from a car crash, and we were not able to give a demonstration. We left pamphlets and assured the nurses that they could contact us for further information as their schedules permitted. In the neonatal unit, we had yet another experience: We gained access to the nursery where the staff was tending to the premature babies. I used the computer in the room to highlight the e-nursing site. I would explain the screen information, and then wait until each and every nurse nodded that she had noted the information. Sometimes it took several minutes for each nurse to view the information, as they continued with their work.

Serving each group of nurses in their own work areas, in their own time frames, proved that we were serious about supporting their information needs.

By going to the nurses in their work areas and at the same time respecting their work with the patients and adjusting our presentations accordingly, we emphasized that e-nursing is a tool designed to work for the nurses. However, this marketing approach would not have been possible without the cooperation of the nurses and their willingness to learn more about research tools specific to their needs.
 

Designing Group Therapy
In addition to acknowledging the diverse information needs within the hospital structure, within each department individuals have varying experiences with computers. Individual skill needs must be addressed through training initiatives, so that everyone can benefit from the resources on the intranet. Again, focusing on the concept of the "customer of one," we started to develop training plans for all learning types.

Some of our clients were used to searching electronic resources and wanted desktop access and online guides to using the sources. Others had limited computer skills and would need help even searching the Internet, let alone understanding how to access and use specific clinical resources. Of course, other employees had computer skills, but were weak on searching clinical electronic resources. Effective training is one of the most valuable promotional tools of an electronic collection, because training helps to limit anxiety associated with electronic searching.

We developed a series of hands-on workshops to train people to search specific tools; they're conducted onsite in our new joint training lab. We also offer one-on-one training, which is vital for clients who need extra help.

We also provide the option of arranging for group presentations in a given department. By going into a department, participants have training that's arranged to fit into their work schedule, and that's adapted to meet their group's specific information needs. Again, by being flexible and by offering a variety of training sessions, we are marketing our electronic collection to the community as accessible, usable, and relevant.

For people who are more experienced with computers but need point-of-use help, we took advantage of Help files created by the vendors themselves. We procured vendor brochures and made them available throughout the library. Product brochures are an excellent first step to marketing resources, since you get a professional information guide for free.

Our library made the Help guides even better by having our senior researcher create PowerPoint Help files for each resource, using examples specific to the Mount Sinai Hospital community. The PowerPoint Help files are accessible from the intranet 24/7, which also offers the added bonus of fitting training into people's busy schedules outside of library hours.

... the only way for a library to be seen as relevant to each group within a diverse organization is to create the illusion that each department is our only customer—in essence, to focus on the 'customer of one.'

I got another great promotional opportunity when I was invited to participate in Grand Rounds. Grand Rounds are monthly learning sessions where specialists present leading-edge case scenarios for continuing education accreditation and lifelong learning in a given specialty. My role here is to sit with the presenting doctor and, at the appropriate times, introduce our resources, research skills, and services into the scenario. This shows doctors how the library can support their information needs in patient cases and help them give the best possible care. This type of participation reaches an audience seeking knowledge of specific clinical information, so it's an opportunity for me to promote tools that are specific to clinical practice.
 

Alternative Medicine: Trying Out PDAs for M.D.'s
In trying to identify various departmental needs of a hospital library, I found that not only do these departments have diverse content needs, but that some of the departments also have specific format preferences. For example, our hospital does not currently have remote access to our intranet. Our response is to pursue new licensing of Web products, thus helping the users who need intranet access from home.

I also discovered that our pharmacy department was paying for Micromedex, and knew that other departments could benefit from access to the product. I worked with the pharmacy to alter its license so that Micromedex could be positioned on the library and pharmacy intranet, available to the entire Mount Sinai Hospital community.

Effective training is one of the most valuable promotional tools of an electronic collection, because training helps to limit anxiety associated with electronic searching.

But the Mount Sinai Hospital Critical Care Unit best exemplifies how we're applying library content and technology to specific job and departmental requirements. Dr. Stephen Lapinsky, associate director of the Critical Care Unit, has determined that in his daily work practices, he requires quality content at the bedside. Personal digital assistants (PDAs) are the preferred method of delivery. The reference question "Can you get me good, quality medical content on my handheld?" started almost a year and a half ago, but the products weren't available then. I had inquired about the specific resources that Dr. Lapinsky wanted to access, but found that these resources relied on remote access to large, central databases, and were not formatted for hand-held devices.

In order to address the dearth of quality medical content formatted for PDAs, I took a proactive approach by contacting the vendors directly and telling them what information the critical care team needed to complete its daily tasks. As an incentive to the vendors to make the information available, I arranged to beta test our pharmacopeia, and was excited to be a beta site for Ovid@Hand this past summer. (Ovid@Hand is the mobile-device version of Ovid's electronic resources.) As a result, Dr. Lapinsky will be able to gauge the benefit of using PDAs in the Critical Care Unit as tools for accessing essential medical information.

My relationship with our vendors has changed. A librarian must communicate with vendors to drive the delivery of their content to address our end-users' requested needs. Do tell your vendors what your users want, and what you need. By working closely with vendors, we are in essence ensuring that our needs are going to be addressed.


Giving Out Referrals
Our library does not have an extensive academic collection; we have focused on resources that complement the hospital's specialties. But our library staff has ensured that we have connections to outside sources. With limited staff and budget, we cannot be experts to everyone. But, we can be experts in our referral process. The University of Toronto and the Health Science Information Consortium of Toronto are our best allies in supplementing our resources and clinical information needs. The referral process assures our users that we are the one place to go for information, and makes our collection appear limitless.


Prescription for the Future
Since embarking on the project to better position the Sidney Liswood Library within the Mount Sinai Hospital, I have received additional staffing and an increase in my budget that could be calculated at over 50 percent (including input from partners, etc.). We've also had the pleasure of getting the volunteer assistance of a number of librarians, library technicians, retired business professionals, and university students from our volunteer office. And finally, our pathology department has hired a contract librarian to support a project we're working on at its request.

We've been inundated with requests from other departments to create focused sites for them akin to e-nursing, so we've begun an organized process of adding client-driven one-stop buttons to our intranet site. To date we have added social work, business and administration, and we're now launching e-clinician. This will be a pathfinder for evidence-based resources within our library for physicians. We will continue to work with specific departments and add to our resources.

We have also been added to the schedule of the orientation for hospital interns. In this way, we will be able to target all of the interns who have not been exposed to the library services. At the same time, we have retooled our segment in the general employee orientation session. We now present the resources available on our intranet, as opposed to our previous practice of giving new employees a tour of the library. Thus, the Sidney Liswood Library is seen as a content provider rather than a physical space.

Our goal now is to ensure that our information efforts do not get stale. We can't let the prescription lapse beyond its expiry date—we have to keep our marketing efforts going. By continually updating our intranet site and our training, and by keeping the library prominent in the hospital newsletter, we will ensure a healthy future for the Sidney Liswood Library.
 

Susan Massarella is a library consultant based in Toronto. Currently she is helping to redesign the Sidney Liswood Library's intranet and is implementing the library's marketing strategy in the Mount Sinai Hospital community. Her e-mail address is smassare@vianet.on.ca.