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Evidence You Can Use To Communicate Library Value

This guide is one of the end products of the Research Imperative Task Force (RITF). The task force was formed in 2015 to support and advance health information research and evidence-based practice within our community. To this end, the guide provides access to research studies and data that members can use to advocate to employers and the public the value, impact, and benefits of health sciences libraries and librarians. The studies provided in this guide are not intended to be a comprehensive collection. Select studies have been chosen through comprehensive searches of the health sciences literature.

Objectives of this guide

Advocacy is critical to ensure the long-term viability and stability of health sciences libraries and librarians. This guide will assist you in raising awareness of important issues affecting library services and your profile within your organization and user community.

This guide provides studies that support the value of library and information services in health settings, broken into “Library Value Categories” that support your organization's mission and goals. These studies provide an evidence base for demonstrating value of library and information services and professional expertise to patient care, professional education, research, and reduction of health care costs.

How to use the guide

Pick and choose from the studies, data, and information in any of the Library Value Categories in this guide that you think are most helpful for communicating value to your user community. These categories are:

Librarians Improve Clinical Decisions and Quality of Patient Care
Librarian Training Equips Clinicians To Deliver More Rational, Evidenced-Based Care
Librarians Improve the Quality of Research
Librarians Help Reduce Health Care Costs
What Do Experts Say about Librarian-Led Lervices?

Each section consists of a brief description of what that Library Value Category includes, a list of references with key findings, and links to the full-text article.

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Librarians Improve Clinical Decisions and Quality of Patient Care

Evidence shows that librarians positively influence clinical decisions, improve quality of care, and help prevent adverse events in patient care.

Librarians change clinical decisions and patient care for the better

Multiple studies demonstrate that health information provided by clinical librarians directly informs better clinical decisions and the quality of care.

Select studies and key findings

Select Studies	What the Data Demonstrate
Aitken EM, et al., found that the presence of clinical librarians on the health care team led to positive effects on patient care, including clinical decision-making.	88% of respondents reported that they changed a treatment plan based on skills taught by the clinical librarian; 44% reported that they changed a diagnosis. 79% of respondents changed a treatment plan based on the librarian's mediated search support; 36% changed a diagnosis. Setting: Randomized control trial in a general medicine teaching unit in the United Kingdom; survey of 34 intervention groups of medical residents and clinical clerks
Ayre S, et al., demonstrated the value of clinical information skills training by librarians on lifelong learning and patient care outcomes.	75% of clinicians used the information skills obtained during training in patient care; 28% to support a treatment decision; 27% to help advise patients; 36% reported improved literature searching ability. Setting: Multi-centered study of the National Health Service in the United Kingdom, representing over 60 organizations; 534 survey responses
Brettle A, et al., This systematic review examined clinical librarian (CL) services, quality, and impacts. It found that clincal librarians (CLs) have a positive effect on clinical decision making by contributing to better informed decisions, diagnosis, and choice of drug or therapy.	68% of the studies reported that CLs had a positive impact on patient care. 67% of the studies reported that CLs have a positive effect on better informed decisions. Systematic review of 18 CL studies
Brettle A, et al., demonstrated that clinical librarians affect direct patient care, improve quality, and save money.	98% reported that CLs impacted on patient care; 45% reported that CLs ensure quality interventions; 16% reported CLs reduced referral, tests, and readmissions; 12% reported CLs reduced hospital length of stay; 25% reported CLs improved in patient and staff safety. 36% reported direct contributions to choice of intervention; 26% reported contributions to diagnoses; 26% reported increased patient involvement in decision making. Setting: Survey of the National Health Service in the United Kingdom; 340 questionnaires and 24 interviews with clinical librarians and users of librarian services
Marshall JG, et al., showed that using information obtained from the library impacts patient care. It saves time, changes care, avoids adverse events, and supports the practice of evidence-based care.	75% of health professionals report that they definitely or probably handled patient care differently. Survey of 4,520 health professionals in the United States and Canada
Marshall JG, et al., concluded that health professionals perceive library and information resources as valuable, patients receive better advice, and clinicians make more informed clinical decisions and report an avoidance of adverse effects.	75% reported that they definitely or probably handled patient care differently; 48% reported changes in advice given to patients; 25% reported changes in diagnosis; 33% reported changes in choice of drugs, 95% reported that information provided by a librarian resulted in better informed clinical decisions; 13% reported an avoidance in misdiagnosis and adverse drug reactions; 12% reported a reduction in medication errors; and 6% reported an avoidance of patient mortality. Large-scale multisite survey of 16,122 health professionals in the United States and Canada and 24 follow-up interviews
McGowan J, et al., concluded that librarians were able to provide an effective service that had a positive impact on patient care at a reasonable cost. Librarians locate information more quickly and less expensively than clinicians.	Over 80% of the participants indicate that the information provided was relevant and had a positive impact on both their decision-making and the care provided. Librarians provided responses to questions more quickly than health professionals (13.68 minutes/question compared to 20.29). Average salary cost per search far lower for librarians ($7.15 for librarians compared to $20.75+ for physicians). Setting: Randomized control trial of primary care providers in Ontario, Canada
Mulvaney SA, et al.,concluded that clinical decision-making, particularly regarding treatment issues, was significantly impacted by a clinical informatics consult service (CICS).	Clinicians primarily made requests in order to update themselves and were satisfied with the service results. Consults provided by the CICS had a greater actual and potential impact on clinical actions and clinician satisfaction than No CICS consults. Evidence provided by CICS primarily impacted the use of a new or different treatment. Randomized control trial In a large academic, tertiary care facility in Nashville, Tennessee; 226 consults over a 19-month study period were analyzed
Perrier L, et al., Quality studies showed librarian services saved health professionals time, influenced clinical decision-making, and reduced hospital length of stay of patients.	Studies showed that services provided to clinicians were effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient’s case. Systematic review of 25 published studies; studies were grouped into 3 categories of interventions: (1) librarians teaching search skills either in person or through the development of online modules, (2) librarians providing literature searching as a direct service, or (3) a combination of librarians teaching searching skills and providing literature searching.
Sievert ME, et al., showed that library services and resources impacted patient management decisions and reduce patient lengths of stay.	78.3% of respondents reported change in patient care based on their use of library services. 27.1% of respondents indicated that their use of library resources resulted in a reduction in patient length of stay. Survey of 328 health care professionals in 4 hospitals serving medium and large communities in Colorado and Missouri.
Weightman AL, et al., Research studies showed that professionally led library services have an impact on health outcomes for patients and may lead to time savings for health care professionals.	Positive impact was found in all studies, including better quality studies; impact varied considerably. Studies showed 37%-97% impact on patient care; 10%-31% on diagnosis; 20%-51% on choice of tests; 27%-45% choice of therapy; 1%-19% reduced length of stay Systematic review of 28 published studies

Information provided by librarians helps prevent and reduce adverse events

Research shows that the quality information that libraries provide to the health care team reduces adverse events for hospitalized patients.

Select studies and key findings

Select Studies	What the Data Demonstrate
Marshall JG, et al., concluded that libraries contribute to quality care and that adverse events were avoided as a result of using information obtained from the library.	Library-related variables in the study showed consistent relationships with positive patient care outcomes; study provides strong evidence that libraries and librarians contribute to patient care quality. Consulting more information resources was significantly associated with saving more time, making more changes to patient care, and avoiding more adverse events. Physicians and residents who used more information resources in their search reported avoiding more adverse events. Survey of 4,520 health professionals in the United States and Canada
Marshall JG, et al., concluded that information provided by the library was perceived as having an impact on patient care. The study showed that adverse events were avoided as a result of using information obtained from the library.	Respondents reported that the information allowed them to avoid the following adverse events: patient misunderstanding of the disease (23%), additional tests (19%), misdiagnosis (13%), adverse drug reactions (13%), medication errors (12%), and patient mortality (6%). Survey of 16,122 health professionals in the United States and Canada and 24 follow-up interviews

Librarian Training Equips Clinicians to Deliver More Rational, Evidenced-Based Care

Librarian educators with a proficiency in searching and evidence-based medicine (EBM) provide specialized training in undergraduate, postgraduate, and continuing medical education programs. This training makes a lasting impact on the search performance, medical competence, and lifelong learning of medical professionals. Research demonstrates that information skills training by librarians has an impact on education and learning outcomes and influences point of care decisions and practice.

Librarian training impacts teaching and learning outcomes and the medical performance of clinicians

Research shows that librarian training supports lifelong learning, research activities, and clinical decision making, and positively affects the attitudes and behaviors of medical practitioners.

Select studies and key findings

Select Studies	What the Data Demonstrate
Ayre S, et al., demonstrated the value of clinical information skills training by librarians on lifelong learning and patient care outcomes.	98% of respondents saw a benefit in their teaching or learning following an information skills training session. 75% of respondents in patient-facing roles used the training in patient care,to inform choice of treatment (28%), to advise patients/carers (27%), and in guideline and pathway development (27%). Setting: National Health Service in the United Kingdom; 534 survey responses, representing 61 organizations
Aitken EM, et al., concluded that the presence of clinical librarians on the health care team led to positive effects on clinician’s attitudes, information retrieval tendencies, and clinical decision-making.	88% of respondents reported that they changed a treatment plan based on skills taught by the clinical librarian; 44% reported that they changed a diagnosis. 79% of respondents changed a treatment plan based on the librarian's mediated search support; 36% changed a diagnosis. Setting: General medicine teaching unit in the United Kingdom; survey of 34 intervention groups of medical residents and clinical clerks

Librarian training impacts the quality of search performance of medical students and clinicians.

Research demonstrates that information literacy skills and EBM training by librarians markedly benefits the search performance of undergraduate and graduate medical students and clinicians.

Select studies and key findings

Select Studies	What the Data Demonstrate
Gruppen LD, et al., This comparative study found that librarian-led instructional sessions on EBM literature searches have a “marked beneficial effect” on the quality of medical student searches. Students trained by librarians had fewer search errors and correspondingly higher quality searches than those who did not receive librarian training.	The average number of search errors for each student was less for the intervention students (4.4 errors) than for the control students (6.2 errors). Intervention students had searches of higher quality (72.5% of a possible 95 points) than did control students (59.3%). Setting: 92 fourth-year medical students at an academic health center
Gardois P, et al., found that.the assistance of biomedical librarians significantly improves the outcomes of searches performed by pediatric residents in biomedical databases using real-life clinical scenarios.	Librarian assisted searches were quantitatively assessed as significantly more favourably (73.6) than non-assisted searches (50.4). Setting: Pediatric teaching hospital in United Kingdom; 18 randomized residents
Perrier L, et al., concluded that librarian-provided training services improved the skills of participants (e.g., students, residents, and clinicians) in searching the literature to facilitate the integration of research evidence into clinical decision-making.	Twelve studies, along with one companion report, showed a positive impact of librarian-led training on search skills of participants. Systematic review of 25 published studies

Librarians Improve the Quality of Research

Librarians make a positive impact on healthcare research. Studies show that librarians improve the quality of systematic reviews, the strongest and highest quality of evidence. Librarian involvement also helps institutions secure grant funding for research, innovation, and scholarship activities.

Library involvement impacts the quality of systematic reviews (SRs)

Librarian participation in the systematic review process ensures that published SR search strategies are of high quality.

Select studies and key findings

Select Studies	What the Data Demonstrate
Golder S, et al., concluded that search strategies and reporting methods used in systematic reviews of adverse effects need vast improvement and there were significant differences in the quality of literature searches carried out by information professionals compared to non-librarians.	Systematic reviews carried out by information professionals "were more likely to be reproducible, include more search terms, and search more databases” than searches conducted by non-librarians. Two information professionals assessed methods used to identify relevant research as reported in the 277 systematic reviews of adverse effects.
Koffel JB reported that having a librarian on the systematic review team predicts the use of appropriate systematic review methods.	Half of all authors reported that a librarian or search specialist was involved in the systematic review, often as the designer of the search strategy. Librarian involvement was strongly associated with use of the majority of recommended search methods. Librarians were significantly associated with searching two or more databases and with including the full search strategy. Authors recommended that “systematic review authors should ensure that they are following best practices for conducting and reporting searches in their reviews and consider working with librarians as a method to improve the quality of their searches.” Survey of 1,560 systematic review authors
Meert D, et al., concluded that systematic reviews (SRs) with librarian participation had better literature search methodology and reporting.	SRs with librarian coauthors/team members were associated with better reporting scores in almost all components of the methodology (per IOM standards): publication years (84% vs 71%), flow diagrams (84% vs 46%); date of search (48% vs 22%); reported search strategy (44% vs 11%); search subject databases (96% vs 51%); and gray literature (64% vs 36%). 186 SRs in 20 pediatric journals were scored for rigor of literature search reporting
Rethlefsen ML, et al., concluded that librarian participation was significantly associated with search reproducibility and better reporting.	Level of librarian and information specialist participation was significantly associated with search reproducibility from reported search strategies. Librarian co-authored SRs had significantly higher odds of meeting 8 of 13 analyzed search standards than those with no librarian participation and 6 more than those with mentioned librarian participation. SRs from high-impact general internal medicine journals were reviewed for search quality characteristics and reporting quality by independent reviewers.

Library services and collections play a key role in successful grant proposals

Research indicates that library involvement in the process of securing grants is a key element in getting grant proposals funded.

Select studies and key findings

Select Studies	What the Data Demonstrate
Luther J This case study quantified the library’s contribution to the process of securing grants and demonstrated that libraries provide economic benefit to institutions through successful grant awards.	95% of responding faculty stated that citations were important in securing grant awards; 94% of responding faculty used citations in grant proposals; and 94% of responding faculty obtained citations via the campus network or library gateway. Setting: Academic research institution

Librarians Help Reduce Health Care Costs

Evidence shows that librarians create significant cost-savings for their institutions. Multiple studies reveal that librarians have a positive impact on reducing hospital charges. By providing timely expert search results to health care teams, clinicians are able to spend more time with patients. Investments in library services have also been shown to produce financial returns to their institutions and communities. Additionally, library services and resources contribute greatly to successful grant awards and ultimately, to improving an institution’s bottom line.

Librarians help institutions save costs

Studies indicate that health sciences library services reduce the cost of services for patients.

Select studies and key findings

Select Studies	What the Data Demonstrate
Banks DE, et al., concluded that a librarian’s presence at morning report correlated with lower hospital charges and length of stays.	Librarian contributions to morning report led to a decrease in hospital length of stay from 5 to 3 days and hospital cost savings of $1,392 per case. Setting: University Health Center in the United States; 55 morning report cases, with a comparison group of 136.
Brettle A, et al., concluded that clinical librarians impact patient care and help reduce organizational costs.	98% reported an impact on patient care; 16% reported reduced referral, tests, and readmissions; 12% reported cost savings through reduced hospital length of stay; 25% reported improvement in patient and staff safety. Setting: UK National Health Service; 340 questionnaires and 24 interviews with clinical librarians and users of librarian services.
McGowan J, et al., concluded that librarians free up health care providers’ time so they can focus on patient care. Librarians locate information more quickly and less expensively than clinicians, and decrease the need for consultations, return patient visits, and referrals so that patient care costs decrease. Over 80% of the participants indicate that the information provided was relevant and had a positive impact on both their decision-making and the care provided.	Librarians provided responses to questions more quickly than health professionals (13.68 minutes/question for librarians compared to 20.29 minutes/question for physicians). Average salary cost per search far lower for librarians ($7.15 for librarians compared to $20.75+ for physicians) Setting: Primary care services in Ontario, Canada

Librarians save health professional’s time

Studies show that library services health sciences libraries free up health care providers’ time so they can focus on patient care.

Select studies and key findings

Select Studies	What the Data Demonstrate
Marshall JG, et al., concluded that health professionals perceive library and information resources as valuable in this large-scale multisite study. Patients receive better advice, and clinicians make more informed clinical decisions and report an avoidance of adverse effects.	75% reported that they definitely or probably handled patient care differently; 48% reported changes in advice given to patients; 25% reported changes in diagnosis; 33% reported changes in choice of drugs 95% reported that information provided by a librarian resulted in better informed clinical decisions; 13% reported an avoidance in misdiagnosis and adverse drug reactions; 12% reported a reduction in medication errors; and 6% reported an avoidance of patient mortality Mean amount of time library services and resources saved clinicians was 2.5 hours per event. Survey of 16,122 health professionals in the United States and Canada and 24 follow-up interviews.
McGowan J, et al., concluded that librarians free up health care providers’ time so they can focus on patient care. Librarians locate information more quickly and less expensively than clinicians, and decrease the need for consultations, return patient visits, and referrals so that patient care costs decrease. Over 80% of the participants indicate that the information provided was relevant and had a positive impact on both their decision-making and the care provided.	Librarians provided responses to questions more quickly than health professionals (13.68 minutes/question to 20.29) Average salary cost per search far lower for librarians ($7.15 for librarians compared to $20.75+ for physicians) Setting: Primary care services in Ontario, Canada
Perrier L, et al., concluded that librarian services save health professionals time, influence clinical decision-making, and reduce hospital length of stay of patients.	Librarian-led services improve clinician searching skills and clinical decisions, and save clinicians’ time 5 studies in the systematic review showed that literature searching by librarians had a positive effect on decreasing the time of busy physicians Systematic review of 25 published studies
Weightman AL, et al., concluded that librarian services impact general patient care, diagnosis, choice of tests, choice of therapy, and reduce hospital length of stay of patients. Clinical librarian services directly benefit patients and save health care professionals time.	Studies show 37%-97% impact on patient care, 10%-31% on diagnosis; 20%-51% on choice of tests, 27%-45% choice of therapy, 10%-19% reduced length of stay. Four studies of clinical librarian projects suggested that professionals saved time as a result of clinical librarian input. Systematic review of 28 published studies

Libraries are a wise investment for their institutions and user communities

Research demonstrates that libraries provide significant economic benefits and a positive return on investment (ROI) to institutions regarding the grant process. Grant applicants’ view library resources as essential to securing grant funding.

Select studies and key findings

Select Studies	What the Data Demonstrate
Jemison K, et al., concluded that hospital libraries in the US Veterans Administration provided a good return on investment (ROI).	ROI studies in 5 VAs showed a cost benefit range of 3:1 to 11.5:1 and return on investment (ROI) range 210% to 1050%. Business impact measures showed a cost per use ranging between 13%-46% lower than cost per use for commercial services; interlibrary loan annual cost savings and cost avoidance showed a range of $77,745-$1,083,755; and librarians' searches reaped a clinician-estimated hospital savings ranging from $159,493-$1,977,783, and a time savings for clinicians valued from $50,818-$630,170. ROI analysis based on tools/worksheets developed/tested specifically for VA hospital libraries; tools covered business impact, demonstrated value, library uses versus outputs, and intangible benefits.
King DW, et al., showed that library collections save faculty time and effort, resulting in a significant return on investment to the academic institution.	Library journal collections provided an estimated return on investment of between 3.3-3.6 to 1. ROI analysis, based on a survey of faculty at five US universities, was calculated through contingent valuation. Library collection costs included all purchasing, licensing, and maintenance costs and the cost faculty was derived from salaries, benefits, and time spent interacting with the journal literature.
Luther J This important case study quantified the library’s contribution and value to the process of securing grants and demonstrated that libraries provide significant economic benefits to institutions through successful grant awards. Authors reported a positive return on investment for their institutions in several other areas, such as non-grant funded research and education.	95% of responding faculty stated that citations were important in securing grant awards; 94% of responding faculty used citations in grant proposals; and 94% of responding faculty obtained citations via the campus network or library gateway. Study showed a return of $4.38 in grant income to the university for every dollar invested in the library. Setting: Academic research institution

What Do Experts Say about Librarian-Led Services?

Health sciences librarians are recognized experts in the field of health information and library services. They are highly educated and skilled experts in finding, evaluating, synthesizing, and delivering authoritative health information. Librarians are integral partners in improving health, education, and research outcomes.

MLA professional credentials, competencies, and standards

As the most visible and trusted association of health information experts, MLA provides credentialing, education, and standards programs that foster excellence in health library information practice and research.

MLA credentials, competencies and standards

Standards

MLA Academy of Health Information Professionals (AHIP) is a peer-reviewed professional development and career recognition program of MLA. Members of the academy are credentialed as health information professionals by demonstrating their academic preparation, professional experience and professional accomplishments. Admission to and the level of academy membership (Provisional, Member, Senior, Distinguished and Emeritus) is a recognition of exemplary professional performance.

MLA Competencies for Lifelong Learning and Professional Success defines core professional skills and abilities that are required to provide quality information, research, and data to health care professionals, educators, students, researchers, and the public. They equip health information professionals across the country with a mastery of skills to assess end-user needs for health information and enhance library services to meet those needs in their home institutions and communities to improve health, education, and research outcomes.

MLA Standards for Hospital Libraries guide hospital libraries in advancing and sustaining their role as partners in providing quality health care, achieving their institutions’ missions, and ensuring that knowledge based information (KBI) and resources are readily available, current, and authoritative to the hospital communities they serve. These standards embrace key principles and critical elements that are used by other accrediting bodies to determine appropriate levels of library staff, services and resources. Additionally, they can also be used to assess library services and collections and communicate library needs and accomplishments to stakeholders.

Organizations that create standards for systematic reviews

Authoritative guidelines and standards for systematic reviews recognize the essential involvement of health sciences librarians and information professionals in conducting systematic review searches for evidence.

Systematic review guidelines and standards

Select Organizations

Cochrane Handbook for Systematic Reviews of Interventions. The handbook is the official guide that details the process of preparing and maintaining Cochrane systematic reviews on the effects of health care interventions. It recommends that systematic review teams and review authors seek the guidance of a local healthcare librarian or information specialist when designing search strategies, running searches, and accessing information at their institution.

European Network for Health Technology Assessment (EUnetHTA) The guideline on the “Process of information retrieval for systematic reviews and health technology assessments on clinical effectiveness” recommends that “Information specialists should form an integral part of the project team of a systematic review from the beginning of the project.” It also acknowledges that such involvement is supported by research findings

Institute of Medicine. Systematic review standards of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) recommend that systematic review project teams include librarians and information professionals for their expertise in literature searching.

Accrediting standards

Every American and Canadian college of medicine, nursing, pharmacy, veterinary medicine, public health, dentistry, and osteopathic medicine is required to provide timely access to health information resources and professionals appropriate to the needs of the school, as specified by the accrediting body.

Accrediting bodies for health sciences education

Accrediting Bodies for Health Sciences Education

Accreditation Council for Graduate Medical Education. ACGME institutional requirements [Internet] Chicago, IL: The Council; 2016. [BAD LINK]

Accreditation Council for Pharmacy Education. Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. [Internet] Chicago, IL: The Council; 2015.

American Dental Education Association. Competencies for the New General Dentist. [Internet] Chicago, IL: The Association; 2008.

American Osteopathic Association. AOA Basic Document for Postdoctoral Training. [Internet] Chicago, IL: The Association; 2016.

American Veterinary Medical Association. Council on Education Accreditation (COE) Policies and Procedures: Requirements. [Internet] Schaumburg, IL: The Association; 2016.

Council on Education for Public Health. Accreditation Criteria Schools of Public Health [Internet] Silver Spring, MD: The Council; 2011. <http://ceph.org/assets/SPH-Criteria-2011.pdf >.

Commission on Collegiate Nursing Education. Standards for Accreditation of Baccalaureate and Graduate Nursing Programs [Internet] Washington, DC: American Association of Colleges of Nursing; 2013.

Liaison Committee on Medical Education. Accreditation standards [Internet] Washington, DC, and Chicago, IL: The Committee; 2015.

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