Amy Six-Means, MLIS
Consumer Health Librarian
William V. Gervasini Memorial Library
Exempla St. Joseph Hospital
Denver CO 80218
January 30, 2011; Reviewed June 2013
Whether developing a plan for a new library, or considering changing some policies of an existing library, one question will always need to be considered, and possibly re-evaluated from time to time. Should we circulate the collection or not? You, or the department director you report to outside of the library, may be thinking, “Circulation - in a consumer health library?? Won’t they just walk away? Why would a visitor bring them back? What is our ROI for this? What are the potential benefits and risks, and will the benefits outweigh the risks?” All great questions when developing a circulation policy because these are the types of questions you will be asked. Yes, there are some risks to having your collection be a circulating one, but I believe the benefits outweigh the risks.
There are many issues to weigh that help to provide clarity in considering circulation of library materials, as well as providing an answer for your director and the patrons. Some of these issues are – What is the overall mission of the library? Do we have the staffing and organizational needs to carry this out? Should the whole collection circulate? What is the limit on how many one can borrow at a time? Who should we let borrow the materials? How long should the lending period be, will we allow renewal (how many), do we issue fines? What percentage of the collection are you willing to lose yearly due to items not being returned or damaged? Each of these questions will be explored in this article, and, when applicable, from both sides of the issue, to help you in your decision making process as to whether to lend or not to lend. In helping to sort through these questions I sought the experience and policies of other librarians who serve consumers looking for health information.
What is the overall mission of the library? One starting point when considering or evaluating a circulation policy is the overall mission or purpose of the library. Is it strictly a consumer health library, or is it part of a larger collection that does not itself circulate? Some respondents told me that their collection was part of a larger clinical collection or located in an area which was not conducive to circulating – where their mission was different from a strictly consumer health library. Some consumer health libraries are actually an extension of a local public agency, the public library or community health clinic which automatically meant that circulating was part of the original plan due to public tax funding. An alternative starting point seen by consumer health librarians was to look at the main reason for the patrons being in the hospital – that typically being for the purpose of visiting a patient or having out-patient service, not hang out in the library. Other starting considerations given are a commitment to reaching a broad patron base, making learning more about a health topic convenient, a needs assessment at the beginning of the library’s development, part of providing patient centered care within the hospital organization, and supporting patrons’ need for time to process health information in order to truly participate in health care related decision-making.
Do we have the staffing and organizational needs to carry this out? While your library’s mission might suggest the practice of circulating, are you truly able to carry this out; do you have staffing or other organizational limitations that make this difficult? Is your library staffed by a full or part-time professional librarian, paraprofessional library staff, volunteers, a mix of all? Do you have systems in place, such as a cataloging system, way to track material if it is circulated, or how to handle returns? Do most of the patrons really just want brochures which the organization provides to meet this need of their visitors? Maybe the annual budget is such that having to replace even a small percentage of the collection would be unfeasible, or your collection is so small that it would create a look of emptiness if too much of the collection circulated.
Should the whole collection circulate? What is the limit on how many one can borrow at a time? Determining what part of the collection circulates is often based on the type of collection you have, and the funding source for it. But this can also help you determine whether to circulate or not. Cost and material type are factors many looked at in determining which parts of the collection to circulate – most consumer level materials are relatively inexpensive while the professional are much more costly. Professional level reference, directories, dictionaries, and general consumer reference – such as the Mayo Clinic Family Health Book or the PDR for Herbals – generally do not circulate. Some librarians told me that they did not circulate due to the vast majority of the collection being reference material. Most, who do lend, circulate everything in the collection with the exception of the magazines and newsletters. Several libraries have a section of popular fiction, while one holds DVDs of popular movies to increase patronage, and some even have laptops and walkmans that circulate to specific patrons. The number of items that circulate may depend on the type of hospital, location of the library in or outside of the organization, connections with community partners, or usage history. For instance, children’s hospitals responded with a greater number of possible check-outs – and this may be due to the type of material generally held there, or reflective of the patron population which tends to be in the hospital for an extended period. Some were located outside of a hospital setting or had partnerships with community organizations for their lending practices which influenced this decision. Others changed this policy after a period due to the number of items not being returned when the borrowing limit was more liberal.
How long should the lending period be, will we allow renewal (how many), do we issue fines? How long can they borrow them? I found in asking other consumer health librarians that the average length of lending is from 2 -4 weeks and most renew. Some extend this if, upon asking, they determine that the patron will be returning for an appointment a little beyond the normal borrowing time. This was most often the policy where the patron base was hospital patients routinely returning for recurring treatments such as infusions or dialysis. Most consumer health libraries do not charge fines, but others have found it works as an incentive for book returns. One library includes, on the circulation application, a line for credit card information to be used in the event an item is lost, while others invoice the borrower if the item is not returned after a specific number of overdue notices have been issued – which may be waived upon return of the material.
Who should we let borrow the materials? This question is often answered by the mission and purpose of the library. The vast majority of librarians stated that they allowed patients, family members, the public and staff. One question that will need to be answered within this question is, what is the geographical limit to who may borrow? This will be necessary especially in the hospital setting where patrons might be visiting family members from quite a distance away – which would increase the likelihood of loss of materials.
What percentage of the collection are you willing to lose yearly due to items not being returned or damaged? Every library that circulates experiences losses, so having an idea of the potential percentage of losses from year to year will help in determining a budget to account for replacements. While the average of those asked was around 1-3%, some libraries have generous budgets that account for losses up to 60%. Some libraries are able to handle this due to the number of donations.
After reviewing these initial questions in order to write a policy, it is good to have feedback from other consumer health libraries, to hear their stories, their accomplishments, and barriers they have overcome to make their circulation practice a success. Below are some of these experiences and accomplishments shared by consumer health librarians across the country.
What has been the greatest advantage of having a circulating collection? Librarians have found that having a circulation policy has improved their relationships both outside and inside the organization. Most report the ability to better serve the needs of their patrons and the positive feedback, loyalty, word-of-mouth promotion and satisfaction from patrons they have experienced. Circulating the collection also has helped support the marketing of the library to community partners such as schools, parenting groups, local clinics, and public libraries. Some have also realized positive feedback from accrediting bodies that discover the library’s circulation policy when coming for an accreditation visit. Being able to offer patrons the ability to have time to absorb and learn information to better enable them to make informed decisions is another important realization. If they could only read the materials in the library, most would not as they don’t have the time to sit and leisurely read due to the reason they are in the setting where most consumer health libraries are located.
Other than the obvious, community patrons borrowing and never returning items, what has been the biggest pitfall of this service? Often, the answer to this question was similar to what public libraries also experience, but given the transitory nature of consumer health libraries may be felt more acutely. Too often there is only one copy of a title that is really popular but there isn’t the budget for multiple copies, as well as general wear and tear on the collection for those item heavily borrowed were most often stated. Other commonly stated pitfalls are the potential of having patrons who are visiting patients from outside of the limits of the eligibility policy, limited staff which in turn limits the opportunities to market the service to a wider base, the location of the library may make if hard for potential new patrons to find it easily, and items left throughout the hospital (which patrons tell you when you contact them once the item is overdue) that need to be tracked down.
One of the first considerations to review when considering or evaluating a circulation policy is the overall mission or purpose of the consumer health library. Learning from other consumer health librarians the experiences and rewards of circulating even part of the collection provides shared wisdom when creating this practice. With the mission in hand, statistics to show the number of patrons who have asked about borrowing, and a written policy about the circulation of the library materials, you have the first tools to initiate a practice that has the potential of improving not only the lives of your patrons, but their communication with health care professionals, and your library’s significance to the organization.