Section Council of the Medical Library Association

MLA Section Council Standards Committee

MLA Hospital Libraries Section Standards Committee

Prepared by Jeannine Cyr Gluck

February 2004

These guidelines have been developed as an aid to those embarking upon the creation of standards for professional associations. They grew out of the HLS Standards Committee’s experience in developing the “Standards for Hospital Libraries 2002″ (SHL2002). The committee found very little published material concerning the creation of standards. At the same time, members were involved with, and able to tap into the knowledge of, other standards organizations, including the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO); the Accreditation Council for Continuing Medical Education (ACCME); and the Connecticut State Medical Society (CSMS). Articulating the right questions and having a clear vision of the purpose of the standards are crucial to the success of this endeavor.

See also http://www.jornadasbibliosalud.net/ponencias/conferclausura.doc [NOTE: No longer available online 8/18/08] for a discussion of the development process for the “Standards for Hospital Libraries 2002.”

Background

Define the purpose(s) of the standards. What are they intended to accomplish? How will they be used? For example:

• Will they increase uniformity of the function, to enhance interaction between professionals?
• Will they serve as a measure of acceptable levels of practice, to help secure reliable support from parent organizations?
• Will they aid accreditors in assessing the quality of the service?
• Will they fill gaps in larger sets of standards addressing the parent organization?

If there are existing standards, articulate the need for an update.

• Have there been major changes (technological, legal, philosophical, procedural, etc.) in the profession that are not addressed in older standards?
• Have there been major changes in the larger arena in which your profession operates?

Be very familiar with the group for which you are developing the standards

• In terms of history and politics;
• With the profession in general;
• With other groups with which your profession must interact.

Become as familiar as possible with previous standards for your group, if any exist.

• Talk to those who developed them.
• Learn their reasons for writing them as they did, and the thoughts of the authors as to what they felt worked best, what they would do differently.
• They are the people who will have the most insight, and will likely be happy to share what they have learned.

Become familiar with other sets of standards affecting your area of practice

• those affecting the institutions in which you practice;
• those of similar associations,
• subgroups within your association,
• parallel associations from other areas.

Even those from groups that may be only peripherally related may be useful, in terms of content and/or structure. For example, when developing “Standards for Hospital Libraries 2002,” (SHL2002) we looked at JCAHO standards; those from the medical education field; medical groups with some library content in their standards; other national library associations within the US and in other countries; state library associations and MLA chapters. If you know anyone who has developed standards for another organization, talk to him or her about how the project was approached and how standards were developed.

If the committee with which you will be working is not already in place, try to recruit a diverse group of volunteers.

• well-respected people with experience in the field;
• newcomers with energy and fresh ideas;
• people from various geographical areas, especially those with different conditions;
• a cross-section of people from different types and sizes of institutions served by your profession (if applicable).

Read any relevant articles you can find which

• discuss quality as it pertains to your function;
• review important changes in the profession;
• present the “state of the art.”

Writing the standards

Determine whether to revise existing standards or begin anew, and which indicators to include.

Determine the most important factors in ensuring quality service in your profession.

• Brainstorm with members of the committee as to what are the most important factors.
• Take the best of previous standards and other relevant standards you have looked at.
• You cannot include everything, so look for those factors which, if in place, would indicate that other items would likely be in order.
• Realize that you can lift or lower others’ perceptions of your profession by your choice of indicators.
• If there are standards from a larger entity to which your parent organization must adhere, avoid direct conflict. If you can identify important gaps, address those.
• Once a list of possible inclusions has been developed, one method of determining relative importance is to ask each member of the committee to assign 100 points to any combination of those factors-more points to the most important, fewer or none to those considered less crucial.
• Combine and bar graph these scores.
• Keep those items about which there is general agreement.
• Eliminate those receiving few points.
• Continue discussion about mid-level items, until some consensus has been reached.
• See if it would make sense to consolidate some items. For example, in developing SHL2002, we consolidated measures of levels of different types of personnel.
• Ask for another assignment of points to the revised list.
• You may want to ask someone outside your group to assign points to the list, to compare perceptions. For SHL2002, a hospital administrator participated in this exercise.

Determine the barriers to good service, and consider inclusion of a standard to address the problem. For example, the greatest barriers to quality hospital library service are downsizing and lack of support from administration. A standard requiring a staffing level in proportion to the total hospital FTE, and another requiring departmental status for the library and a direct report to a senior administrator, address these problem areas.

Compare these to the existing standards, if any.

• If the fit is not good, it is probably best to start from scratch.
• You can always include any item from the older version, but can make it fit new structure.

Determine structure of the standards

For each of the factors considered important, draft an indicator of performance. Indicators must be both meaningful and measurable. In general, simple is best. Indicators which require considerable time to compile or address may be ignored by practitioners in the field.

There are several types of standards:

• Quantitative standards state the level of a given factor that must be present. This type of requirement is often also prescriptive. For example, the library must have x number of square feet or x number of FTE staff. If at all possible, determine those numbers by using statistics and/or benchmarking data from relevant sources. The HLS Standards Committee used statistics from the HLS Benchmarking Project.
• Qualitative standards state that something must be present, but does not attach a numerical value. For example, the director of the library must be a qualified librarian.
• Prescriptive standards state the input to the function. The items used as examples in quantitative standards, above, are also prescriptive.
• Outcomes-based standards describe the desired result, and leave it to individuals how best to achieve that result within their particular circumstances. Evidence will usually be required to demonstrate that the standard is actually met in practice. For example, SHL2002 calls for a link between library services and the QI function. Several examples are given of how an institution may meet that standard. The institution is asked to provide some evidence that the standard is met in practice, rather than only on paper.
• Criteria referenced standards include a statement as to the score an organization will receive if a given level of compliance is met. These are generally used in more formalized situations, such as accreditation, and may be either quantitative or qualitative. For example, if x is done 100% of the time, a score of 1 will be given. If x is done 80% of the time, a score of 2 will be given.

If there are larger sets of standards to which your parent organization must adhere, look at their structure and consider whether it would also work for the standards you are writing. There are instances in which you may choose to diverge from that form. However, closer alignment may be in your favor, since people within your field will already be accustomed to that style.

Look at how much diversity exists among individuals/facilities within your profession, and among the parent organizations within which they function. Greater diversity may be better accommodated by outcomes-based standards. For example, hospitals vary greatly in size and complexity, from small rural facilities to large metropolitan teaching hospitals within networks.

Consider the diversity of technology existing in institutions. For example, the JCAHO’s 2004 Information Management standards were specifically worded to accommodate entities with sophisticated information technology, paper-based, or hybrid systems.

In general, use the same structure throughout, unless there is a strong justification for doing otherwise. In developing SHL2002, we felt it necessary to use outcomes-based standards to accommodate the diversity of hospital libraries. However, the greatest threat to hospital libraries is downsizing, and there was a consensus that a quantitative staffing standard was needed.

If staffing levels are addressed, they should be presented in conjunction with a scope of services statement. This gives an indication of the variety of tasks that can be expected within the parameters set by the staffing standard.

Use accepted definitions, and coordinate with those who have developed these definitions to ensure that no major changes are expected. The SHL2002 committee coordinated with the American Library Association about difficulties they saw with the accepted definition of a qualified librarian, and learned that ALA had addressed those issues and was in the process of a revision. Had this not been done, SHL2002 would have included a definition that would have been immediately outdated.

Conversely, avoid jargon-terms used only by those within your profession. Aim for clear explanations understandable by any intelligent layperson.

In choosing wording, aim for a long “shelf life.” SHL2002 states that all library functions must be performed in accordance with applicable laws, regulations, and licensing agreements. More specificity would have resulted in a perceived “staleness” if new regulations are imposed in the future.

Carefully distinguish among “must” and “should.” “Must” leaves no leeway, and this may or may not be intended. “Should” or “shall” strongly recommends that a statement be followed, but implies that on occasion, there may be good justification for doing otherwise.

Refining draft

Once the first draft has been prepared, seek further input from all members of the committee, and expect-even welcome-disagreements. There may be suggestions on which the group chooses not to act, but it is important to ensure that each member’s views are heard and respected. The buy-in of each member is important.

Once there is a draft that is ready for wider circulation, seek input from as many as possible within your profession. If possible, present to a geographically dispersed group by posting the document, clearly labeled as a draft, to the web, with an FAQ document and easy link to an e-mail address for responses. A face-to-face meeting may be most effective for a smaller group. Follow up on as many of these responses as possible. You may receive a suggestion which you discount, only to realize in the subsequent discussion that the respondent brings up an important point which may not have been clearly communicated initially. If a suggestion is truly unwork-able, give that person a thoughtful explanation. Again, each person needs to feel that his or her point of view has been heard and respected.

If you encounter very vocal critics, be grateful, as you have been presented with an opportunity. Dig deeper to learn the root of this person’s concerns. Communicate with him or her, and listen well enough to hear what he or she has to say. You very well may find that he or she has very valid points. If your standards are going to withstand the scrutiny of the entire profession, they should be able to withstand a vocal opponent. Your negotiations may lead to common ground, and the vocal opposition may eventually become vocal support.

Ask people outside your profession, especially those with a particularly broad view, to review and comment on the draft. Administrators of your parent organization are among this group. They will likely bring fresh insight.

You will probably have several drafts.

At some point, you will reach the point at which the standards are voted upon by your association, and hopefully accepted.

The work is not yet finished

Standards should not exist in a vacuum. A great deal of work goes into their creation, so it is important to ensure that they do not simply sit on a shelf.

Promote standards

Actively publicize the standards to appropriate groups. First should be the members of your association. If the standards are very different from those that preceded them, guidance in meeting the standards may be needed. An article in a professional newsletter or journal or a presentation at a meeting may be appropriate.

If your parent organization has a broader set of standards to which it must comply, you may want to contact the body which creates those standards, to determine whether your standards can be referenced within them.

Work to make standards enforceable

Ideally, standards should be enforceable-there should be a consequence for non-adherence. It is not always possible to make this happen, but avenues should be explored. “Raising the bar: the importance of hospital library standards in the continuing medical education accreditation process” Bull Med Libr Assoc. 2001 Jul;89(3):272-6, outlines the adoption of the “Minimum standards for health sciences libraries in hospitals” by the Connecticut State Medical Society as a component of their continuing medical education accreditation process. The CSMS later voted to adopt SHL2002. Efforts are ongoing in other states to promote the standards as a useful adjunct to CME accreditors.

Review standards periodically

Previously, the MLA’s hospital library standards were entirely rewritten once per decade. Continually reviewing them, and making incremental changes, may be a more workable solution for the future. An ongoing standards committee may be more effective than an ad-hoc group, in that they will remain current with the profession, and recognize when an amendment or new set of standards may be needed. They may also be charged with monitoring the use of the standards by practitioners within the field-valuable information for the continual refinement of the standards.