BENCHMARKING DATA WORKSHEETS
Print these worksheets to organize your responses before entering them on the live Web questionnaires. (DO NOT submit this form to MLA; it is for your use only.) The JavaScript pop-up data definitions feature is not available on this worksheet. Read or print definitions from the definitions page.
Time Period
| PA01. Indicate the year for which you are reporting this data: | ___ calendar year OR
|
General Hospital Information
| PA02. Indicate your hospital's OWNERSHIP status: | ___ government ___ investor-owned ___ nongovernment nonprofit ___ other |
| PA03. Indicate whether your institution is: | ___ teaching hospital ___ non-teaching hospital |
| PA04. Indicate your institution's care category (choose ONLY one): |
___ general medical and surgical
|
| PA05. Total number of physicians in the hospital (please include both full-time physicians employed or appointed by the hospital and any affiliated community physicians): | ________ |
| PA06. Total number of hospital (not library) full time equivalents (FTEs) (exact as known, OR according to the most recent AHA Guide): | ________ |
| PA07. Total number of patient discharges annually? | ________ |
| PA08. Total number of hospital outpatient visits annually (exact as known, OR according to the most recent AHA Guide)? | ________ |
| PA09. Total bed count in the hospital (exact as known, OR as defined by the most recent AHA GUIDE): | ________ |
| PA10. Total number of admissions in your institution annually (exact as known, OR according to the most recent AHA Guide): | ________ |
For Teaching Hospitals Only
Non-teaching hospitals continue to Question PA17.
| PA11. How many post-graduate training position concurrent slots are available in the hospital annually? (e.g., you may have 5 slots with 20 residents rotating through within a year) | ________ |
| PA12. How many medical school clerkship slots are available in the institution annually (e.g., there may be 25 slots, but 100 students that rotate through within a year?)? | ________ |
| PA13. Does your library provide services to any School of Nursing students or faculty? |
___ yes ___ no |
| PA14. If "yes," how many School of Nursing student slots are available annually in the institution(s) your library serves? | ________ |
| PA15. Does your library provide services to any School of Allied Health students or faculty? |
___ yes ___ no |
| PA16. If "yes," how many Allied Health student slots are available annually in the institution(s) your library serves? | ________ |
General Library Information
| PA17. Does your library have a branch location? | ___ yes ___ no (If no, skip to question PA19.) |
| PA18. If yes, will your data for this benchmarking survey (all questionnaires) INCLUDE branch location data? | ___ yes ___ no |
| PA19. What is the total AREA of your library, in square feet? | ________ |
| PA20. How many hours per 7-day week is the library open for service? | ________ |
| PA21. Does your library provide 24-hour physical or electronic access to any medical staff? | ___ yes ___ no |
Single Library Profile Comments
Use this space to provide comments, ask questions, or suggest other questions for Single Library Profile.
Time Period
| PB01. Indicate the year for which you are reporting this data: | ___ calendar year OR
|
General Institution Information
| NOTE: For related questions PB03 and PB04 through PB15 and PB16, your answers MAY BE the same for both related questions, depending on your library's status. | Enter numbers below. DO NOT use commas. Use decimal points as needed. |
| PB02. How many hospitals are in the health system? | ________ |
| PB03. Indicate your health system's OWNERSHIP status: | ___ government ___ investor-owned ___ nongovernment nonprofit ___ other |
| PB04. Indicate whether your institution is: | ___ teaching hospital ___ non-teaching hospital |
| PB05. Indicate your institution's care category (choose ONLY one): |
___ general medical and surgical ___ tertiary care ___ psychiatric or mental health ___ rehabilitation or chronic disease ___ research facility ___ pediatric or other speciality ___ other (please list): |
| PB06. Total number of physicians in the health system (please include both full-time physicians employed or appointed by the system and any affiliated community physicians): | ________ |
| PB07. Total number of physicians in the institution(s) your library serves (please include both full-time physicians employed or appointed by the system and any affiliated community physicians for your specific institution): | ________ |
| PB08. Total number of health system (not library) full time equivalents (FTEs) (exact as known, OR according to the most recent AHA Guide): | ________ |
| PB09. Total number of full time equivalents (FTEs) in the institution(s) your library serves (exact as known, OR according to the most recent AHA Guide): | ________ |
| PB10. Total number of patient discharges annually in the total health system (exact as known, OR according to the most recent AHA Guide)? | ________ |
| PB11. Total number of patient discharges annually in the institution(s) you serve (exact as known, OR according to the most recent AHA Guide)? | ________ |
| PB12. Total number of health system outpatient visits annually? | ________ |
| PB13. Total number of outpatient visits annually in the institution(s) you serve? | ________ |
| PB14. Total bed count throughout the full health system (exact as known, OR as defined by the most recent AHA GUIDE): | ________ |
| PB15. Total bed count in the institution(s) you serve (exact as known, OR as defined by the most recent AHA GUIDE): | ________ |
| PB16. Total number of admissions throughout the full health system annually (exact as known, OR according to the most recent AHA Guide). | ________ |
| PB17. Total number of admissions in the institution(s) you serve (exact as known, OR according to the most recent AHA Guide). | ________ |
For Teaching Hospitals Only
Non-teaching hospitals continue to Question PB26.
| PB18. How many post-graduate training position concurrent slots are available in the hospital annually (e.g., the system may have 20 slots with 80 residents rotating through within a year)? | ________ |
| PB19. How many post-graduate training position concurrent slots are available annually in the institution(s) your library serves (e.g., you may have 5 slots with 20 residents rotating through within a year)? | ________ |
| PB20. How many medical school clerkship slots are available throughout the health system annually (e.g., there may be 75 slots, but 300 students that rotate through within a year)? | ________ |
| PB21. How many medical school clerkship slots are available in the institution(s) your library serves (e.g., there may be 25 slots, but 100 students that rotate through them within a year)? | ________ |
| PB22. Does your library provide services to any School of Nursing students or faculty? | ___ yes ___ no |
| PB23. If "yes," how many School of Nursing student slots are available annually in the institution(s) your library serves? | ________ |
| PB24. Does your library provide services to any School of Allied Health students or faculty? | ___ yes ___ no |
| PB25. If "yes," how many Allied Health student slots are available annually in the institution(s) your library serves? | ________ |
General Library Information
| PB26. Library services within the health system are... |
___ centralized ___ decentralized |
| PB27. How many libraries are within the health system? | ________ |
| PB28. Within the system, how many institutions maintain separate listings in the AHA Guide?: | ___ |
| PB29. Does your health system operate under a single state license?: |
___ yes ___ no |
| PB30. Does your library configuration serve only a specific population within the system?: |
___ yes ___ no |
| PB31. How many hours per 7-day week is YOUR library open for service? | ________ |
| PB32. Does YOUR library provide 24-hour physical or electronic access to any medical staff? |
___ yes ___ no |
| PB33. Do ANY OTHER libraries in the health system provide 24-hour access to any medical staff? | ___ yes ___ no |
| PB34. What is the total square footage of YOUR library? | ________ |
System Library Profile Comments
Use this space to provide comments, ask questions, or suggest other questions for System Library Profile.
Library Personnel
| Enter numbers below. DO NOT use commas. Use decimal points as needed. | |
| A01. Indicate the full-time equivalents (FTEs) of all employees in your library: | ________ |
| A02. A full-time employee in my institution works: |
___ 35 hours per week ___ 37.5 hours per week ___ 40 hours per week ___ other if other, indicate hours:____ |
| A03. Indicate the total number of FTE PROFESSIONAL STAFF in your library (includes librarians, archivists, network staff, etc.): | ________ |
| A04. Indicate the total number of FTE SUPPORT STAFF in your library (DO NOT include student assistants to be counted in question A06): | ________ |
| A05. Indicate the total volunteer hours of all volunteers who work in your library; report as hours per month: | ________ |
| A06. Indicate the total student assistant hours of all student assistants who work in your library; report as hours per month: | ________ |
| A07. In the institution's organization chart, is the library considered a separate department with a distinct budget? |
___ yes ___ no |
| A08. In the institution's organization chart, under what area does the library report? |
___ hospital education ___ information systems ___ medical education ___ medical records ___ medical staff/medical director ___ other |
| A09. What is the title of the person to whom the director of the library reports? | ________ |
| A10. Does your institution maintain a library committee? | ___ yes ___ no |
Library Operating Expenditures
| A11. Please indicate how you would like us to handle your financial data (choose ONLY one): | ___ I can enter data, and MLA can report it in aggregate or individually. OR ___ I can enter data, but MLA should only report it in aggregate or within pre-selected ranges (with other members' data). OR ___ I can't report any financial data. |
| NOTE: DO NOT include one-time or capital purchases, such as security systems, in your operating expense figures. | Enter financial data below. DO NOT include commas, dollar signs, or decimals. Round amounts to the nearest whole $. |
| A12. Total expenditures for salaries and wages (exclude fringe benefits): | $ ________ |
| A13. Total expenditures for staff development and professional travel: | $ ________ |
| A14. Total expenditures for monographs: | $ ________ |
| A15. Total expenditures for print serials: | $ ________ |
| A16. Total expenditures for audiovisual/media resources: | $ ________ |
| A17. Total expenditures for electronic information resources: | $ ________ |
| A18. Total expenditures for delivery services: | $ ________ |
| A19. Total expenditures for computer/network equipment (approximate, if institution centralizes): | $ ________ |
| A20. Report any other operating expenses not listed above: | $ ________ |
| A21. Total operating expenses: | $ ________ |
Library Income
| A22. Does your library receive any financial support from the medical staff in the hospital? |
___ yes ___ no (if no, skip to question A24) |
| A23. If yes, how much? (round to the nearest whole dollar amount) | $ ________ |
| A24. Does your library receive any income from fee-based services? | ___ yes ___ no (if no, skip to question A26) |
| A25. If yes, how much? (round to the nearest whole dollar amount) | $ ________ |
| A26. Does your library have access to OTHER sources of funding? | ___ yes ___ no (if no, skip to comments) |
Administration Questionnaire Comments
Use this space to provide comments, ask questions, or suggest other questions for the Administration Questionnaire.
Information Services
| Enter numbers below. DO NOT use commas. Use decimal points as needed. | |
| PS01. Indicate the total NUMBER of reference questions received annually: | ________ |
| PS02. Indicate the total NUMBER of mediated searches performed in your library annually: | ________ |
| PS03. If known, how many of those mediated searches were directly related to patient care? | ________ |
| PS04. Indicate the total NUMBER of educational program sessions offered by your library annually: | ________ |
Resource Use
| PS05. Indicate the total number of participants annually in educational program sessions offered by your library: | ________ |
| PS06. Total number of monographs circulated from your library annually: | ________ |
| PS07. Interlibrary loaning/borrowing: indicate whether or not your library is an official LOANSOME DOC provider. | ___ yes ___no |
| PS08. Indicate the approximate NUMBER of items OF ALL TYPES your library borrows or receives from outside sources annually (include ILL AND commercial document delivery services): | ________ |
| PS09. Indicate the approximate NUMBER of items OF ALL TYPES your library lends or sends to outside sources annually: | ________ |
Public Services Questionnaire Comments
Use this space to provide comments, ask questions, or suggest other questions for the Public Services Questionnaire.
| SP01. Indicate whether or not your library provides these types of photocoping services: | ... mediated photocopying services
(library staff performs the service) ___ yes ___no ... self-serve photocopying services (library provides the equipment for end-users to copy materials) ___ yes ___no |
| SP02. Does your hospital/library maintain a clinical medical librarian program? | ___ yes ___ no |
| SP03. If yes, how many FTEs are dedicated to this program? | ________ |
| SP04. Does your library maintain your institution's archives? | ___ yes ___ no |
| SP05. Is your library responsible for a multimedia center/learning center or institutional audiovisual services? | ___ yes ___ no |
| SP06. Indicate whether or not your library provides these Web access services to end-users/clients (Internet or Intranet): | ...basic page ___ yes ___no ...interface access to bibliographic databases ___ yes ___no ...online public access catalog (OPAC) ___ yes ___no ...specific services (e.g., library forms, electronic reference or ILL) ___ yes ___no ...computer workstation(s) for Web access ___ yes ___no ...support to institution-wide intranet or Internet development ___ yes ___no ...support for Website/Web page design ___ yes ___no |
| SP07. Indicate whether or not your library manages any of the following CME services: | ... allocate portion of library budget to purchase materials that
directly relate to CME ___ yes ___no ... regularly schedule CME sessions for physicians ___ yes ___no ... record and maintain the institutions' physician CME records ___ yes ___no |
| SP08. Indicate whether or not your library maintains these consumer health information services: | ... provides services and information to
medical staff ___ yes ___no ... provide services and information to patients and families ___ yes ___no ... provide services and information to the general public ___ yes ___no ... maintains a separate consumer health information facility either within or outside the library ___ yes ___no |
| SP09. Indicate the number of consumer health reference questions answered annually: | ________ |
| SP10. Indicate whether or not you offer any of the following as REVENUE PRODUCING SERVICES to any part of your clientele: | ... self-service photocopying
(e.g., coin-operated machine) ___ yes ___no ... mediated photocopying ___ yes ___no ... mediated searching ___ yes ___no ... ILL services ___ yes ___no ... AV equipment circulation ___ yes ___no |
Special Services Questionnaire Comments
Use this space to provide comments, ask questions, or suggest other questions for the Special Services Questionnaire.
| Enter numbers below. DO NOT use commas. Use decimal points as needed. | |
| TS01. Indicate the total NUMBER of print monograph titles in your library's collection: | ________ |
| TS02. Indicate the total NUMBER of of current print serials titles: | ________ |
| TS03. Indicate the total number of electronic full-text serials titles that are ALSO received in print format which are accessible from your library: | ________ |
| TS04. Indicate the total NUMBER of electronic full-text serials titles that are NOT received in print format which are accessible from your library: | ________ |
| TS05. Indicate the total NUMBER of electronic full-text monograph software applications in your library which are accessible from your library; i.e., count each individual unique title: | ________ |
| TS06. Report the NUMBER of externally-produced bibliographic databases for which you have PURCHASED access for your users, including purchase through consortial contracts: | ________ |
Technical Services Questionnaire Comments
Use this space to provide comments, ask questions, or suggest other questions for the Technical Services Questionnaire..