STRAIT to the future

8th Asia-Pacific Specials, Health and Law Librarians Conference

The impact of hospital networks on hospital libraries in Melbourne, 1995-1999

Andrew Rooke and Sue Cawthorn
Southern Health Care Network Library Service

Keywords: Hospital Library Mergers; Change Management; Library Administration

Abstract

In February 1995 the Kennett government in Victoria released the 2050 Plan signalling the restructuring of thirty-six Melbourne hospitals into seven new administrative Networks based on competitive principles. This profound change in the previously largely autonomous structure of hospital administration was precipitated by such factors as the changing demographics of Melbourne, shrinking government revenues, high public sector debt, and the Kennett government's aggressive approach to reform. In September 1995, October 1998 and April 1999, the Southern Health Care Library Service surveyed selected hospital libraries throughout all Melbourne's hospital Networks to ascertain the affects of network restructuring on hospital library services. Summary features of developments in hospital libraries attached to all Networks are provided to show the wide range of responses to this major socio-economic change in the Melbourne region. These varying responses range from fully administratively networked library systems, autonomous libraries, cooperative schemes, specialist library responses, the role of the Universities and the impact of major change on library staff morale.

Introduction

Like most modern Western societies, Victoria is subject to economic, political and demographic changes driving a new approach to managing the spiralling costs of public health care. These include an aging population, rapid technological change, the expansion of population 'growth corridors' outside the main city areas, a shrinking government revenue base, increasing costs of medical care, and the consequent need to cut costs, increase efficiency and eliminate the duplication of services between hospitals. Add to this potent mixture, the business dominated thinking of a conservative reforming government with an unassailable majority, Victorian Premier Jeff Kennett's zeal for tough decisive action, the need to manage a huge public debt inherited from the previous Labour government, and you have the recipe for rapid major change in the health industry! And so it has proved to be in the four years since this process was initiated by several milestone reports from government sponsored think-tanks. These reports include the formation of the Metropolitan Hospitals Planning Board and the 2050 Plan following the Premier's lightening visits to selected Melbourne teaching hospitals in December 1994/January 1995. The Board's Interim Report in April 1995 and the Phase 1 Report in June 1995 implemented the aggregation of thirty-six metropolitan hospitals around Melbourne into seven Networks. Local hospital boards of management were dismissed and new smaller boards for the seven regions appointed, composed of business-oriented, paid board members. Organisational changes included the introduction of the purchaser/provider commercial model of managed competition for the new regions, and the stage was set for the relocation of medical services away from the City to the suburban growth corridors. Two further reports Taking Melbourne's health care networks into the 21st century (1995) and A healthier future (1996) consolidated and further developed these administrative changes.

In September 1995 and again in October 1998 and April 1999 Southern Health Care Network Library Service undertook telephone surveys of hospital libraries in all the Networks. We surveyed the professional literature regarding academic library amalgamations in the 1980s around Australia as a possible guide to what we could expect in the hospital sector. Similarly, in 1995 we contacted colleagues in New South Wales to ascertain the pattern of Networking there to see if it might be applicable to our situation in Victoria. Our survey of the experience of academic libraries led us to believe that we could expect the larger institutions to take the commanding position in amalgamations, that there would be clashes of organizational culture, a decline in staff morale, and that economies of scale were often quoted as a rationalization for amalgamation but never proven nor questioned after the fact of amalgamation by administrators within the system. The only systematic published survey of aggregated library staff following an amalgamation in Western Australia in 1982 reported that library services were not perceived to have improved and that library staff morale had suffered significantly. Our colleagues in NSW reported in 1995 that there was no universal pattern of hospital library service in NSW following aggregation, as the governing bodies were given independence. Amongst the many permutations of library service in NSW were the following:

• Eastern Sydney: libraries continued to function separately but with a group coordinating librarian and none were closed.
• Liverpool: libraries operate separately with a rotating group library leader.
• Bathurst: regional librarian based in a university with reciprocal access to collections between the university and the hospitals.

In NSW there was general agreement that a high level of cooperation existed, and that smaller libraries had benefited greatly from their association with larger libraries in their networks. How does the historical experience of academic libraries and the NSW experience in hospital libraries compare with the situation in Victoria today?

Our 1998 and 1999 comprehensive surveys of twenty-one hospital libraries in all Melbourne metropolitan Networks confirm many of our early observations and the interstate experiences. Perhaps indicative of the pace of change and consequent 'future shock' amongst hospital library staff, most librarians we interviewed by phone were reluctant to have their libraries identified in the survey. Consequently, librarians' comments have been gathered into themes emerging from the networking process, and libraries are not named individually.

The networks - change and more change

From the original seven Networks there are now five survivors. No less than fourteen non-Networked hospitals exist within the Network areas, with two major amalgamations existing amongst these hospitals. Several hospitals have amalgamated and then disamalgamated, joined and left Networks, some within the space of twelve months! Four hospitals have been closed altogether and two libraries have closed their doors in hospitals which continue to operate. At one hospital, the library was closed as a cost-saving measure and the collection spread amongst the hospital departments. At another, the library was closed as management felt that it was not getting value due to the large amount of time spent by library staff supplying other hospitals with GRATIS requests! On the other side of the equation, Networking has meant the creation of two new libraries.

Going it alone

With the exception of two Networks, and two of the separate amalgamations, hospitals are Networked in name but not in practice. As appeared to be the case from our 1995 NSW survey, Hospitals and their libraries continue to operate autonomously with their own budgets, staffing, etc. with minimal interaction with other hospitals in the same network. Budgeting pressures in some Networks are actually forcing hospitals apart instead of together. In these Networks, administrators attempt to control costs within individual institutions rather than tackling expensive network projects. The benefits of sharing resources and expertise from the larger to the smaller hospitals and community-based services in these networks are limited or non-existent.

However, there are plenty of indications of a co-operative spirit amongst librarians. Library staff in all such Networks stress the value of regular library consortium meetings. Such meetings were inaurgurated in most Networks since the very onset of the networking process. All librarians value such meetings where schemes to rationalise resources are discussed including attempts to obtain better deals on journal subscriptions, mutual lending of material, the creation of library Network master plans, and projects of wider significance such as the current government-sponsored project to supply online acces to databases for all hospital libraries in Victoria. Consortium meetings obviously perform a valuable psychological support mechanism for library staff in a high-stress period, as even vehement detractors of Networking value the experience of gathering together regularly.

Networked library services

There are only two library services that have fully embraced the Network concept in our view. In addition, the two hospital site-based amalgamations have versions of Networked library services and, as cited above, other networks have various co-operative schemes. The two Networked library systems were established in 1996 and 1997 largely on the initiative of the two chief librarians . They operate in quite different ways to provide service to their clientele. In one, each of the two hospitals involved maintains its own library budget, but staff move across both libraries - especially the Chief Librarian who works three and two days between the two libraries. The other networked library service, includes five libraries and services six hospitals, several University research institutes and community-based services such as community health services and community-based psychiatric assessment and crisis teams. Centralised functions in this network library service include budgets, acquisition/purchasing, cataloguing with network access, and several administrative functions including a Network library committee structure. Both Networked services have Network Chief Librarians responsible for planning and development of services throughout their region.

The librarians of the Networked services cite many advantages to this arrangement including: better distribution of resources and expertise, better services especially to the patrons of the smaller libraries, staffing arrangements are more flexible in moving staff between campuses for leave relief etc., joint projects to share the 'information wealth' of the bigger libraries with the smaller are possible, eg. centralised catalogues, better access to databases and sharing of journal collections. Interestingly, the librarians of the smaller libraries who initially expressed fears of 'takeover' by larger libraries, now see the advantages of sharing resources and expertise from the larger libraries. The downside of Networked library service is expressed by the larger libraries experiencing greatly increased workload with the same or fewer staff, and extra demands on their collections and technology. One librarian of a hospital amalgamation said that workload had increased since amalgamation by a factor of four!

Co-operative arrangements abound

Health librarians in Victoria have a long and successful history of cooperation. TheVICGRATIS cooperative interlending scheme being the outstanding example. So it is no surprise that besides the hugely successful consortium meetings in all networks, several co-operative projects are underway. These include: the provision of co-operative access to the catalogues of major libraries, mutual exchange of borrowing rights for network members, consortium subscriptions to databases through the Health Communications Network, and access arrangements for those interested in the services of specialist libraries. A typical example of such a scheme was reported by a major teaching hospital library in April 1999. This library is currently upgrading its library managment system and will eventually cover all libraries in the network. Clinicians will have access from home and via the network's intranet to the catalogue and will be linked via OVID to a number of databases including MEDLINE, CINAHL and others, some including full text. Library services from this library will also be provided to several private hospitals within the network. Such agreements once instituted have an enduring existence as two Networks cite continuing co-operation even through several amalgamation and disamalgamation episodes.

Privatisation and a competitive philosophy

One of the stated objectives at the establishment of the networks was to make hospitals more efficient and competitive. This philosophy 'wears many hats' in the hospital Networks, from a new generation of highly-paid, business-oriented executives and Hospital Board members; the implementation of 'Compulsory Competitive Tendering' for formerly in-house activities; through to outright privatisation. Sections of some major hospitals have been converted to private hospitals within the umbrella of the public system. An outstanding example of this approach being one hospital system which recently opened a new library serving both a public and a private hospital and subcontracting its services to another private hospital! This hospital cited privatisation as an advantage in terms of opening new revenue streams and offering some measure of independence from government policy. Perhaps a pointer to things that may come for Victorian public hospitals which cannot manage their finances in this harsh age is the case of one major Melbourne teaching hospital. This hospital consumed all its extensive cash reserves attempting to maintain its high levels of service to the community. These reserves exhausted after two years, it became financially insolvent and the Victorian government installed a financial rescue package, a draconian new management team, and the hospital is currently being prepared for some measure of privatisation. This disturbing trend has also overtaken two major hospital groups in the countryside encouraging speculation that the Kennett government may favour privatisation of public health services by attrition.

In 1996, the Kennett government moved to impose its 'Competitive Neutrality' policy on Victoria's public hospitals by which 'non-core' operations were to be opened to tender to private business. Under this policy, some Networks have privatised their cleaning, security, engineering and food services. Allied Health functions are most likely next on the agenda with one major mental health library put out to tender this year and competitive tendering preliminary processes applied to one of the Networked hospital library services. Most Networks seem to have exempted libraries from the 'Competition Policy' or, more likely, are yet to apply the competition model to academic and teaching services.

Specialist hospitals

Two major specialist hospitals we contacted were negative in their opinions about the value of Networking with the exception of consortium meetings to share information. They said that discussions on rationalising collections were not relevant to specialist collections as specialised journals, although expensive, have an enduring value to their specialised clientele. They emphasised that they can negotiate discounts with journals' suppliers better on their own, as smaller hospital with generalist collections of cheaper journals have little bargaining power. The specialist hospitals see problems for themselves in a one-way traffic of interlibrary loans, and centralised budgets hold no attraction as they can generate far more income on their own from interlibrary loans and charging fees for access to their specialised collections. Where specialist interests transcend Network boundaries eg. mutual interest in aged-care materials, informal co-operative agreements, such as the circulation of journals, help specialists support one another.

Role of the universities

Since the beginning of Networking, the Universities have been involved in making submissions to the Metropolitan Hospitals Planning Board. In one Network, a senior university staff member was appointed to the original Network board for that region. Yet there was little concrete information ever published in the major planning documents on the role of the universites, and hospital librarians were early confused by how the University biomedical libraries would relate to the new Networks. Little surprise then that in 1998/99, co-operation with the universities was seldom mentioned by respondents to our surveys. Of the two major universities with teaching hospitals, one is notable for its substantial assistance to its teaching hospitals with grants for books, lodgement of journals in teaching hospital libraries, provision of staff, support with special projects and management advice. This university library system shares responsibility with a private company to operate the library service for a new private hospital system in the countryside. It is also currently co-operating with hospital authorities to create a major new medical library serving one of Melbourne's teaching hospitals. The other major university has a more limited approach in its financial support and seems to have little interest in, or ongoing commitment to, the future of co-operative support for its teaching hospitals outside supporting the project to make online databases available to all hospital libraries via a government grant. This conservative attitude is hardly surprising as both Universities have to contend with serious financial restrictions on their home campuses inflicted by Federal government cutbacks since 1996.

Impact on morale

OK - now for the big question - what does all this mean for people who work in Melbourne's hospital libraries? Our impression from the various telephone surveys over the years, is that morale has taken a major plunge since the Networks were established. The rapid pace of change, particularly changes in the membership of various Networks, have tended to cause some confusion, feelings of uncertainty and dissatisfaction very similar to the attitudes expressed in the 1982 survey of amalgamated academic libraries in Western Australia. In some cases a great deal of effort has been put into rationalising and improving resources between libraries, however, changes in Network membership meant that these could no longer be pursued, became irrelevant or that finances would not be made available. Workloads have increased substantially for the downsized staff of some hospitals, and uncertainty about future job prospects are rife, particularly for those hospitals facing privatisation.

On the other hand, a few respondents pointed to the many advantages for library staff under Networks including the ability to work across several libraries instead of being 'stuck' in the same old familiar environment, the improvement of smaller libraries' service by having access to the collections and expertise of larger libraries in the Network has definitely lifted the spirits of some sole librarians of smaller libraries, and finally, the atmosphere of change has allowed previously undreamt-of projects to become reality eg. the building of new libraries and creation of entirely new services drawing on Network services eg. services to Community Health Centres.

Conclusion

The creation of hospital Networks in Victoria has projected all Melbourne hospital libraries - "Strait to the Future" - a future of dramatic change and adjustment. In short hospital Networking is a typical 1990s exercise in organisational restructuring with all its manifold consequences for people at the workface. A wise friend always used to say: "The answer is always Yes and No!" There is plenty of evidence of the truth of this statement arising from our surveys. It is easy to become overwhelmed with negatives during a time of rapid change and high stress. Most Australian health sciences librarians appreciate from first-hand experience that there are enormous challenges out there in today's public health jungle. The challenge remains for us to be positive and make these changes work for our clients and us - to flow with the "Yes" side of the answer when we can!

Some further reading:

Allen, Geoffrey. 'Staff attitudes to library amalgamation: the Western Australian College of Advanced Education: a case study.' Australasian College Libraries Vol. 7 (2) June 1989: 51-54.

Rooke, A and Clark, A. 'Preparing for hospital aggregations' Health Inform Vol. 4 (3): 1-3 Sept. 1995

Rooke, A. Clark, A. and Cawthorn, S. 'Hospital aggregations Part 2: an interim report' Health Inform Vol. 4 (4): 5-6 Dec. 1995

Rooke, A. and Cawthorn, S. 'Hospital networks and libraries: three years on' Health Inform Vol. 7(4) Dec.1998 Supplement.

Rooke, A. 'Escaping contracting-out' Health Inform Vol. 7 (2): 1-3 June 1998

Victoria. Dept. of Health and Community Services. Victoria's health to 2050: developing Melbourne's hospital Network Melbourne: VGPO, 1995

Metropolitan Hospitals Planning Board. Developing Melbourne's hospital network: Phase 1 report Melbourne: The Board, 1995

Metropolitan Hospitals Planning Board. Taking Melbourne's health care networks into the 21st century: phase 2 report Melbourne: The Board, 1995

Metropolitan Hospitals Planning Board. A healthier future: a plan for metropolitan health care services Melbourne: Dept of Human Services, 1996

Libraries surveyed by telephone in October 1998 and April 1999

Women and Children's Healthcare Network: Library Service;
Southern Health Care Network: Library Service;
Inner and Eastern Health Care Network: PMCI Central Cancer Library, Box Hill Hospital Library, Caulfield General Medical Centre Library, Royal Victorian Eye and Ear Hospital conjoint library with the Royal Australasian College of Ophthalmologists;
North-Western Health Care Network: Western Hospital Footscray, Sunshine Hospital, Bundoora Extended Care Centre, North-West Hospital, Royal Melbourne Hospital, Northern Hospital;
Peninsula Network: Mornington Peninsula Hospital;
Other hospitals: Royal Talbot Rehabilitation Centre, Mercy Hospital for Women, St. Vincent's Hospital.

A special thank you to all librarians who took the time and trouble to respond to our surveys.

Authors

Andrew Rooke: Currently Network Chief Librarian of the Southern Health Care Network Library Service. Has worked in academic libraries in Australia, Zambia, the USA, and in hospital libraries in Melbourne since the 1970s. Holds BA(Hons), M.Lib, and Dip.Lib.

Sue Cawthorn: Currently Library Manager of the Moorabbin and Dandenong campuses of the Southern Health Care Network Library Service. Has worked as a librarian and social worker in Papua New Guinea and Australia and in medical libraries around Melbourne since the 1970s. Holds BA, Dip. Social Studies, Dip. Lib.