Building projects: redefining hospital libraries

Editor’s note: With this issue, we begin a new annual column devoted to describing notable features of health sciences library building projects. The column, to run each July, supersedes previous periodic surveys of the health sciences building landscape. It will be accompanied by a website, as described below, with more information on building projects and tools for those who are under taking renovations or new construction.


Introduction
Just what is a library these days? With the shift from print to electronic resources, librarians the world over have been given the opportunity to reenvision their libraries' appearances, structural needs, and purposes. As Frieda O. Weise, FMLA, stated in her Janet Doe Lecture given at the 103rd annual Medical Library Association meeting, ''The physical library can and does convey its mission. Libraries are today, and have been for the last century, certainly more than storehouses; they are service organizations that embody the mission and vision of their institutions'' [1]. Is this still true? The Welch Medical Library at the Johns Hopkins University Medical Center was scheduled to close its physical building December 31, 2011. When students and faculty recognized this pending change, the university administration appointed a task force to further review the need for the building to remain as a place of browsing and study [2]. When the Spencer S. Eccles Health Sciences Library at the University of Utah closed in December 2009 for nine months for a remodel of its ceiling, the School of Medicine received numerous student concerns and consequently, built a temporary study place. So while our users want desktop delivery of information, they still want ''a place'' to go to for reflection and to concentrate their focus on learning.
The focus of this first column is hospital library projects that are illustrative of the dramatic changes that are taking place as these libraries are transformed from traditional models to dynamic environments, responding to the needs of their users and institutions.
Future columns, to be published on an annual basis, will feature new libraries as well as those that have recently undergone additions or remodels of existing space and new space assignments for specific purposes in libraries. The building project columns will each have a type of library or purpose as its theme. Future columns will cover: & projects in libraries of a particular type (hospital, academic, consumer health, pharmaceutical companies, associations, special, etc.) & projects centered on particular improvements (energy efficiency, sustainability, fire protection, mechanical, electrical, lighting, landscaping, etc.) & projects to improve special spaces (history of medicine, galleries, testing centers, classrooms, Clinical and Translational Science Award centers, cafés, compact shelving installations, study areas, new furnishings, staff areas, information commons, technology and multimedia laboratories, offices, meeting spaces, exhibits, student headquarters, etc.) To accompany these annual columns, a new website, Library Construction and Renovation ,www. buildings.mlanet.org. is being created for sharing information about various aspects of renovations and building construction.
In addition, a comprehensive survey of building projects will be conducted, updating the one published in the Journal of the Medical Library Association (JMLA) in 2010 [3]. A database of these projects will be created and made available via the new construction website.
As Weise challenged us during her Janet Doe Lecture, ''I believe it is the responsibility of librarians to guide the design of the library; we must advocate strongly the role for the library beyond the 'storage facility' and even the 'access facility,' and focus attention on the many other place-centered activities and services that the library can support'' [1]. Please consider sharing your building guidance and experiences, lessons learned, plans, and achievements with your colleagues! access computers. This was the last improvement made to DML.
As the print journal collection diminished, fewer patrons visited the library and usage of the DML began to change. Remote electronic usage and requests via email increased. DML was becoming a place to check email, relax with a newspaper, and meet with a small group.
In 2010, the education department moved into PSLMC, losing much of its classroom space in the process. The house staff was squeezed into a tiny, antiquated lounge for morning report. Space for meetings on the campus was at a premium. Compliance with Americans with Disabilities Acts standards became an issue, necessitating more space between the stacks, wheelchair-accessible computers, and a lower counter at the reference desk.
Opportunities were explored for DML to position itself to better serve its users. Stepping away from its role as a traditional medical library, DML looked to a new mission as a multipurpose education and research center. While the project may have been developed to conserve space and monetary resources, it was conceived with imagination. Final plans included a classroom for morning report, two meeting rooms seating ten each, and a redesigned computer area. The classroom took the space formerly occupied by the FHL, which was integrated back into the main library. It is now located next to all-glass windows where the FHL is easily spotted and accessible to the public ( Figure 1).
With the opening of RMHC in the fall of 2010, DML increased patient, family, and public access with the addition of a Family Resource Center. This colorful space features an art room, sitting area, computers, children's books, games, and consumer-oriented pediatric medical books. DML oversees this area that is staffed by volunteers.
To gain the space needed for a new public computer area, six and a half rows of dual-sided book stacks needed to be eliminated. This was the biggest challenge of the remodel. Losing the shelving was necessary to open up the room and make the computers more visible to the librarians. Utilization of open access journals, electronic archives, and journal aggregators meant the library could continue to provide access to procedure-oriented, unique, and classic titles that residents needed.
The computer area is now in view of the reference desk and the outside hallway, making it easier to observe when users have questions. Two public computers were eliminated in the new design. Original plans called for a freestanding circular computer area housing four workstations, but that was dropped due to costs. We are already planning to add computers in the future.
The results of the renovation have been favorable with a visible increase in use by hospital staff and other users. Compliments are frequent. DML has been revitalized with its new look and function. Rearranging trafficked areas and consolidating those areas close to the reference desk has increased staff visibility and assistance.
This will be a year of growth and challenge for DML with its new physical presence and increased foot traffic. This is a time of opportunity to demonstrate the value of the library as an integral compo-nent of education and research for both PSLMC and RMHC.
Jean Burrows Medical Library and Resource Center, Deaconess Hospital, Oklahoma City, Oklahoma

Submitted by Emily McEwen, MLIS
Deaconess Hospital, which began as a home for unwed mothers in 1900, is a 273-bed faith-based facility located in northwest Oklahoma City. The hospital's major service areas include a certified chest pain center, cancer center, center for reproductive health, wound care center, and behavioral health, which includes a senior diagnostic center. The hospital also offers the only robotic bariatric surgery in the metropolitan area.
The medical library, founded in 1972, has a long and rich history. The library serves physicians and staff and provides consumer health information to both hospital patients and the surrounding community. It is a participating DOCLINE library and an active member of the National Network of Libraries of Medicine and South Central Chapter of the Medical Library Association. However, the library was allowed to become dangerously Building projects in health sciences libraries outdated with no medical texts newer than ten years, only eight current subscriptions, and thirty years of archived journal holdings.
Following a complete inventory, the library staff developed recommendations that were presented to the chief executive officer: close the library as a legal liability or move forward with an investment in the future. It was agreed that the loss of the library would create many difficulties: providing access to current medical information, meeting Joint Commission requirements, and recruiting new physicians. It was recommended that the library be renovated for broader educational use and that the library resources be upgraded and entirely converted to e-journals and e-books.
Knowing that holding down costs would be paramount to the success of this renovation, the redesign used original building material as much as possible. The other key to success was partnering with the hospital's talented internal departments. Facilities management dismantled the modular office unit sections, cut them down, and made a computer table holding three stations. There is room for an additional two computers later. The copier and color printer were consolidated into one central workstation, creating better workflow and lending a more professional appearance. Because the library was going ''electronic,'' the area was opened by removing several bookshelves. A wooden carrel was moved to the back of the room, allowing more privacy for studying.
An adjoining journal room experienced the biggest change. The vision was a conference room that would serve as an educational training space and would substantially increase library traffic. Thousands of old journals were recycled and the movable shelving sold. Titles that supported the hospital's service lines or had the most use in the last year were replaced with electronic subscriptions. Once the room was empty, lighting was reconfigured and new carpeting installed. A beautiful conference table was purchased through Craig's List, and gently used chairs were found in storage. Information technology (IT) utilized recycled computer and conferencing equipment, including a big screen television relocated from the emergency room. Finally, interesting and whimsical artwork was installed, creating an interesting place to visit (Figure 2).
The new meeting room is now a space that hosts webinars and online conferencing, reducing the hospital's need to fund expensive travel to meetings. With the foot traffic from the conference room and the interest generated by the renovation, the library's usage has more than doubled in six months. Hospital staff and physicians are excited about the new resources, and the library has become a part of the institutional fabric once again.

Submitted by Lois Culler, MSLS
The Inova Fairfax Hospital recently celebrated its fiftieth anniversary and initiated Vision2015, an ambitious building plan. As has been the case numerous times over the hospital's history, the Zylman Health Sciences Library has adapted its space to serve a growing number of service lines and programs. What started as a small community hospital in a fairly unpopulated area of Fairfax County, Virginia, has grown to a large teaching hospital serving the county's diverse population of more than one million residents and is part of the largest health care provider in northern Virginia.
In 2005, the hospital became a branch campus for the Virginia Commonwealth University School of Medicine, currently hosting more than 60 medical students for their clinical rotations. Graduate medical education activities support about 100 Inova Fairfax-based residents, with a complement of visiting residents and fellows numbering over 500. Inova Fairfax has a growing commitment to research: The campus includes the Betty and Guy Beatty Center for Integrated Research as well as the Inova Translational Medicine Institute.
To meet the demands of a transforming environment, the size and location of the Zylman Health Sciences Library has changed. From a small room near the medical staff offices in the hospital's original building, to a temporary modular structure outside the main hospital buildings, to its current location in the heart of the hospital, the growth of the library's physical space has been linked to overall expansion on the hospital campus. Each move has more than doubled the previous space. The library's current central location provides visibility and room to accommodate new library programs and users ( Figure 3). The library director worked directly with the design team prior to construction of the current 4,500square-foot space. Side-by-side service desks were placed for ease of staff communication and efficiency in customer service. Seating for 28 users at a combination of individual carrels and tables provides an inviting place for study. The single public computer in the library's previous temporary space has increased to 16 to accommodate growing user numbers. The repurposing of a photocopy room and storage area has created space for 3 conference rooms that provide a place for learning and collaboration.
Over the years, service to health care consumers has resulted in changes to the library's physical space. What started as a small number of consumer health books has blossomed into the Consumer Health Resource Center, a dedicat-ed space just inside the library. The most recent addition to this area is the Joanne G. Crantz, MD Geriatric Resource Center, developed collaboratively with the staff of the Inova Fairfax Hospital Elder Life Program. The center provides specialized resources related to geriatric health issues and caregiver support, a low-vision adapted computer workstation, other assistive technology to support reading and hearing for hands-on demonstrations, and monthly geriatric community educational programming. Easily accessible physical space and a centralized location make this addition possible.
The Zylman Health Sciences Library at Inova Fairfax Hospital is well positioned to support the evolving needs of Inova as it works to fulfill its vision to optimize the health and well-being of each individual served.   This decision was unpopular among many alumni and donors. Since that time, there has been talk of reopening the school of nursing. The CNE had a vision of bringing evidence-based practice to the hospital, along with a center for nursing research and a school of nursing.
The CNE assembled a committee of representatives from various partners including the librarian. Not surprisingly, the partners all had very different ideas for how the new facility should look. Meetings were lively and controversial. The group went through several project managers and 2 architects and was downsized to its final size of 42,750 square feet. The downsizing was due to 2 reasons: (1) the community's very strict building and zoning laws, such as the required certain percentage of green space on the campus, as well as many other zoning issues, and (2) money. The original desired features were over budget, so the entire building size shrank and interior features were altered. Interior designers, art specialists, and move managers were involved, as were specialists in computers, audiovisuals, simulation, and educa-tion. Planning for the center started in 2009, with it opening 2 years later. Total cost for the new center was $12.6 million. Funding for every room in the building was provided by individuals. The new facility includes state-of-the-art classrooms, computer labs, and simulation areas (Figure 4).
In this new center, the library is separated from the administrative area by the classroom and simulation areas. It is near the student lounge, computer labs, and study areas. The final library is 784 square feet and includes an office, copier/printer, 6 computer workstations, and compact shelving of 864 linear feet. As the building shrank from its original size, all areas became smaller, so the reduction in space meant a study table was forfeited. The other items were deemed to be of more importance, because the student study area is right outside the library door. Many lessons were learned through this building project experience.