It’s a question of standards

Case study


Module 5: Libraries on the agenda


Topic 2: Developing an advocacy role


This case study highlights the significant role that library associations can play in developing and fostering the use of library standards that can measure the quality of library programs and support their improvement. The Medical Library Association (MLA) uses its hospital library standards to advocate the value of libraries at the institutional level of the hospital, as well as at the sectoral level through agencies responsible for the formal accreditation of health services. A number of success stories are presented.

Key Ideas

As you read the case study, think about the following issues:

  1. How library associations support their members
  2. The resources provided by associations
  3. The role played by standards and benchmarking in service quality
  4. The importance of advocacy


The Association of Medical Librarians was founded in the United States (US) in 1898 by four librarians and four physicians. The name was changed to the Medical Library Association (MLA) in 1907. The Medical Library Association describes itself as is a non-profit, educational organisation with more than 1,200 institutional and 3,800 individual members in the health sciences information field (MLA, 2010). There are 23 special interest Sections in the association, as well as 13 chapters reflecting the geographic distribution of members. The association is committed to educating health information professionals, supporting health information research, promoting access to the world’s health sciences information, and working to ensure that the best health information is available to all. MLA is directly involved in the development and promulgation of meaningful professional standards to ensure that health services are supported by good quality medical library services, resources, and facilities.

When the Medical Library Association (MLA) was founded in 1898, it was reported that there were only 24 hospital libraries in the US. After World War II government funding for social security and health care increased, resulting in the establishment of many new hospital libraries across the country. However, administrative changes and financial pressure in more recent times have proved challenging and it is believed that the number of hospitals with libraries reduced from around 44% in 1989 to around 30% in 2006 (Thibodeau, 2009). The current economic climate and the process of health care reform means that the status of hospital libraries and librarians remains volatile.

Ongoing concerns about the situation led the MLA to form the Task Force on the Status of Hospital Librarians in 2004 with the explicit goals:

  • To identify existing data and trends concerning the status of hospital librarians
  • To develop an action plan that the MLA could pursue to address the trends and influence decision makers and other key health care leaders

The MLA conducted a major survey of hospital libraries in 2005-06 to capture detailed data on hospital library services. In late October 2006, the association introduced a “change of status” form to encourage hospital librarians to report any significant changes to their libraries or the services they provided. The librarians could request that letters be sent by the MLA to their administrators: association staff liaised with the librarian to determine the immediate circumstances, with the final letter signed by the MLA President and the MLA executive director.


Librarians are commonly required to provide evidence about the quality and impact of library services to justify budgets, staffing and other resources. Library associations have supported their members by developing tools such as library standards to encourage evidence based decision making. Standards are reported to give libraries “a tool for identifying strengths and selecting areas of improvement in order to provide better services to their communities” (Maine Public Library Standards, 2007). Funk (2008) has described standards in the following way:

A standard is something set up and established by an authority as a rule for the measurement of quantity, weigh, extent, value or quality.

A standard has been variously described as:

  • The set of parameters we use to determine what is acceptable
  • A level of expectations designed to bring out the best in us
  • Realistic, consistent guidelines set to help us attain our goals
  • An adaptable goal set at a challenging, but achievable level in which a framework can be developed to assist in reaching that goal
  • A tool to measure a rival’s product in order to compare it with and improve one’s own product

Standards help provide consistency in performance, set expectations by the user, and set goals to which one may aspire. They must be based on reliable and authoritative measures to be credible. The MLA has established different sets of standards for different types of health sciences libraries, including the Hospital Library Standards, developed by the Hospital Libraries Section of the association [name & reference]. The MLA has also worked with medical and health related accrediting bodies to ensure that the library services provided reflect these standards. Standards can also help libraries benchmark their services as part of a continuing improvement process. More than 400 MLA members contribute key library performance data to a benchmarking network to assist them evaluate their resources and services. The MLA standards can be used as a critical advocacy tool to counter the vulnerability of hospital libraries.

The medical librarian at Maine Medical Centre has highlighted the value of the MLA standards. In 2002, she was asked to operate the library with a 50% cut to her budget. The benchmarking data indicated that the service was ranked highly, so the reduction in budget would still be ‘acceptable’. When, in 2004, the hospital planned to increase the number of medical students, the librarian was asked to determine the impact on the library: by referring to standards and the benchmark data, she was able to calculate the level of funding required. The library consequently received an increase of US$1.3 million over the next five years (Cowen, 2007).

Another medical librarian has reported how she utilised the MLA standards to increase the staffing levels and the budget for her medical library (Chastain-Warheit, 2004). The benchmarking data was used to demonstrate the value and return on investment (ROI) of the service, measuring the figures for the library budget, including salaries, and for the number of ‘library service units’ to determine the ‘cost per unit of service provided’. This information could then be related to the size of the institution and the number of library clients. Figures were also extrapolated to highlight service demand and the value of the library to the health service as a whole.

In a further example, the analysis of quantitative data on library usage and qualitative data on the services provided led to administrators gaining a deeper understanding of how the hospital benefitted financially, with health practitioners reporting how the information they received through the library avoided unnecessary tests, lowered the number of patient admissions and reduced the length of stay in hospital. By benchmarking the service against other similar services, the librarian was able to show that the library was understaffed. As a result of measuring the services against the MLA standards, a new position was created.

In many countries, hospitals and health service are subject to accreditation processes. Over the past few years, the MLA/HLS has undertaken advocacy work with the accrediting bodies to encourage them to incorporate the library standards into their quality assessment standards in order to underscore the role of authoritative medical information in the provision of good patient care. In several states, there has been a positive response from the authorities, which has meant that the hospital libraries are in a stronger position to counter proposed budget cuts and/or library closures.


Professional associations can play an important role to develop standards, to endorse those standards to give them weight and authority, and to encourage their adoption and use. IFLA (2010) has published a number of sets of standards and guidelines which have been adopted by library associations around the world. The MLA has developed effective hospital library standards and provides members with access to the standards and the related benchmarking tools, along with opportunities for training about how to effectively use the tools for advocacy purposes. The standards were revised in 2007 by the MLA/Hospital Libraries Section Standards Committee chaired by Margaret Bandy (Bandy et al, 2008). In other contexts, public library standards have also been developed and ratified by national and state library associations to strengthen the case for quality library services to the community. In challenging times, library associations can provide the resources, the tools and the influence to support members at the local level.


  1. Could your association and members use these tools and resources? How?
  2. Who would benefit from this kind of advocacy?
  3. What benefits could you envisage for your organisation if it developed standards and benchmarking tools to help members advocate for better funding and services?
  4. Are you familiar with the guidelines and standards developed by IFLA? Have these or other measurement tools been used by your association? Which have been used, and in what situations? Can you provide some examples or illustrations of where they have been used successfully?
  5. What steps would your library association need to take to develop a set of library standards? What role would your executive committee play?
  6. Outline one of the specific goals of your association and think about how suing standards and/or benchmarking could progress the outcomes of that goal.

Case Notes

Resource: Case study
Country: United States
Region: North America
Agency: Medical Library Association (MLA)
Topic: Advocacy
Keywords: standards, benchmarking, libraries, librarians, benefits, value, evidence based practice


Bandy, M. et al (2008). Standards for hospital libraries 2007. Journal of the Medical Library Association, 96(2), 162-169.

Chastain-Warheit, C. (2004). It’s not an urban legend: Medical librarians’ success stories with MLA benchmarking data. Available online:

Cowen, J. (2007). Research vignette. Available online:

Funk, C. (2008). Using standards to make your case: Examples from the medical library community. New Library World, 109(5/6), 251-257.

IFLA (2010). Highlighted publications: Guidelines. Available online:

Maine Public Library Standards (2007). Striving for excellence. Available online:

Medical Library Association (MLA). (2010). About MLA. Available online:

Thibodeau,P., & Funk, C. (2009) Trends in hospital librarianship and hospital library services: 1989 to 2006. Journal of the Medical Library Association, 97(4), 273-9.

Associations, Building Strong Library Associations

Last update: 21 October 2012