Moving the Lausanne medical library to a new location : shaping spaces , tailoring services

Introduction In November 2019, the Lausanne medical library moved to a new location. The design and planning process was mainly dedicated to space analysis and configuration. However, the relocation project was also an opportunity to tackle other strategic dimensions. Would a change of physical venue have an impact on the library’s relations with the clinician users and the academic community it serves? How could we position the library in order to mitigate potential disruptions in professional connections and services? Our approach put an emphasis on the characteristics of three main roles a medical library plays to answer the varied users’ needs, while keeping up with the changing medical research landscape.


Introduction
In November 2019, the Lausanne medical library moved to a new location. The design and planning process was mainly dedicated to space analysis and configuration. However, the relocation project was also an opportunity to tackle other strategic dimensions. Would a change of physical venue have an impact on the library's relations with the clinician users and the academic community it serves? How could we position the library in order to mitigate potential disruptions in professional connections and services? Our approach put an emphasis on the characteristics of three main roles a medical library plays to answer the varied users' needs, while keeping up with the changing medical research landscape.

Background
For the last ten years, the Lausanne medical campus has been a constantly growing site and presently serves as a healthcare hub for a region of over one million inhabitants, 1/8 of Switzerland's total population. The site brings together in a rather compact area: • a university hospital, built in the mid-eighties, which now employs around 10'000 staff members in 16 clinical departments; • research centers in oncology, neuroscience, immunology; • the faculty of biology and medicine administration office; • educational facilities for 1100 students present on the medical campus from the second year onwards. These facilities encompass several lecture halls and lab rooms for training in physiology, biochemistry and microbiology.
The medical library was created 35 years ago on the ground floor of the main hospital building next to the lecture halls, the student association office and the staff cafeteria. Employing 9 full time equivalents and 5 student helpers, the library is open all year round 7 days a week from 8 am to 10 pm. The library serves medical and nursing students, clinical staff and researchers. With online access to information, use of the library spaces by clinical staff decreased over the last ten years. Students became the main on-site users, but the library turned out to be too small to accommodate a constantly increasing number of learners. In 2016, the hospital top management decided that the library should expand but could not develop within the Moving the Lausanne medical library walls of the hospital main building. It had to move out to new premises. This decision was based on a strategic principle that activities not connected with patient care had to be relocated outside the hospital central building. That very same year, the lecture halls already moved to the south part of the medical campus. No specific construction for the library was ever considered. New residential buildings with mixed commercial activities and facilities were planned close to the hospital. It was decided to rent part of these commercial properties, nearly twice the size of the initial location, to host the new medical library. Moving out of the hospital main building in November 2019 was quite a challenge for the library staff who felt driven out of the heart of the campus. However, the 35-year-old facilities had structural limits in terms of extension and adaptability. There was no raised floor for ground wiring and electrical outlets, some installations were out of date, the ventilation system was poor.

The new library planning and design
The new site has many interesting features, particularly in terms of accessibility and situation. Three hundred meters away from the main building, the new location remains well embedded in the healthcare campus. It faces the hospital metro station and the faculty's lecture halls are within walking distance. The new venue literally broadens horizons since it overlooks the lake surrounded by mountains. Nevertheless, as the premises were not planned specifically for a library, the initial space was given with its own constraints and characteristics. Making efficient and effective use of the space was a challenging task and requested the creation of a team with a variety of profiles: architects, engineers, designers, planners, main stakeholders: librarians, students and professors. This group of experts had to deal with 3 open floors of around 600 square meters each. It was easy to define the goals of each floor: the ground floor would be a high activity zone with functional services: reception, workstations and printers; the first floor would be a quiet zone with the collections; and the top floor would be the silent area. The difficulty was that 2 huge light wells spanning the library's entire height fragmented these 3 large open plans ( Figure 1). Many other features can also restrict the design of open spaces. After learning how to read and analyse architectural plans, the librarians discovered the structural importance of steps, doors, pillars, circulation areas, escape routes and security exits. Project methods were introduced to manage the planning process and facilitate teamwork and timeline at the different stages of the project: conception, construction, tenders, delivery and installation.
Planning a new library involves many quantitative evaluations concerning the users' areas, collections and activities. What is the initial situation? What would the ideal target be? The study places (258 seats) now represent 62% of the library surface against 42% (162 seats) in the former library. While the books and periodical compact shelving used to take up to 11.5% of the surface (1230 linear meters), they have been reduced after a drastic weeding to 6% of the surface in the new library (923 linear meters). Concerning the activities, it was decided to favour integrated, flexible and multi-purpose areas. The information desk was set at the entrance, close to a delimited social area around the coffee vending machine. The new premises also integrate the students' association and 3 laboratory training rooms on the ground floor. The lab rooms can be used as reading rooms when the laboratory training sessions are over, and after a full cleaning. These shared facilities create new synergies with students and educational staff but also need some practical and procedural adjustments. During the planning phase, the librarians involved in the project also conducted a literature search for recent case studies, standards and guidelines and organised focus groups interviews with Bachelor and Master medical students to collect their needs and wishes. Cécile Jaques, Isabelle de Kaenel and Alexia Trombert

Library as space provider
By asking the students what they liked and disliked in the old library and what they expected from a new library, we found out that they consider the library mainly as a valuable place to work and study. They appreciate the physical aspects, spatial qualities and the opportunity to work in a calm environment. To study they essentially use lecture notes, handouts and resources stored on the faculty Moodle platform.
Regarding the library space, the features they most value could be centered around three main dimensions: comfort, functionality and conviviality. Comfort combines all aspects concerning noise, temperature, light, ergonomics and design quality. The Lausanne medical students declared studying mostly independently rather than in groups. To concentrate to a maximum they favour quiet space. Quiet not only means good acoustics. Students look for a feeling of privacy, intimacy, even seclusion, while seating in a public space surrounded by a community sharing the same ambitions. For that reason, they requested to have individual study carrels, and as many seats facing walls or windows as possible. In that respect, the threestorey light wells conveniently offer some partition while providing abundant light and a sense of common space. Students also insisted on having comfortable chairs with casters and large tables with enough surface to spread out their study materials and private mobile devices. Regarding size, the chosen model is 100 cm wide and 80 cm deep. The distance between rows is on average 1.60 m. These values are not outstanding but represent a good compromise for space optimisation ( Figure 2).
Functionality includes such features as reliable Wi-Fi access, easy access to electrical outlets with sockets on all tables, spatial flexibility and movable partitions and furniture. However, some functions proved to be conflicting. For example, since every single table is plugged to an electric socket, it is difficult to quickly reconfigure the spaces. Even if power lines are mounted in accessible raised-floor channels and outlets slide quickly to new spots in each channel, it is better to refer to an electrician before you can change the position of the tables. Functionality is also a challenge in terms of logistics. All group study rooms are equipped with tables, chairs, whiteboards, network connections and a projection screen. « Ready to use » facilities generally require a lot of care and attention to keep them in a state of tidiness for collaborative work to take place. These types of caretaking maintenance services are often disregarded by library staff members. They tend to consider that lending whiteboard markers and adaptors from the front desk is not a rewarding task and could even harm their professional image and status. However, it does belong to a general package of basic services meant to facilitate study work and contribute to a more ambitious goal which is to convey a general supportive attitude. Conviviality is another dimension students seek after. Although medical students insisted during the focus group interviews that they were not in favour of relaxing furniture since they had little time to unwind, the reality proved slightly different. Every student working individually during long hours needs to take a break and socialise. A small student lounge on the top Moving the Lausanne medical library floor, offering an unsurpassed view over the city and the lake, was designed both to relax and to encourage social interaction ( Figure 3). However, the central point for breaks is the coffee machine on the ground floor. During the discussions, students mentioned that caffeinated drinks were necessary to help them deal with the heavy workload. They were expecting to find hot beverages right on the spot and estimated that the nearest cafeteria (300 meters away) was not close enough. The idea of having a coffee vending machine in the library entrance, near the welcome desk, was dismissed by staff members for a long time, but was finally accepted because of persistent claims from the students. The fact drinks and food go with social interactions was overseen. The library entrance is now considered by the students as a place to share and socialise during breaks. Access to food and drinks has become a critical issue. Drinks in covered containers are allowed in most areas, but food is another concern since the variety of snacks, foodstuffs and multiple packaging may cause more disturbances. The opportunity to share a hot drink and a snack apparently makes the experience of spending long study hours in the library more bearable. Informal and social exchanges among our local medical students are probably as important as formal collaborative work and group studying. While there is a high degree of self-control and autoregulation in study areas, the entrance of the library is often crowded with animated groups of students chatting, eating and having a drink. Due to the proximity with the front desk and public computers, this has become an issue. This need was underestimated in the project and the coffee area not sufficiently delimited and carefully planned. In the next few months a new approach and strategy will be discussed with the students.

Library as an online service provider
The planning of the new library required a lot of collection weeding. The medical library used to grant public access to print journal and book collections published after 2000. Before moving, printed journal archives not electronically accessible were sorted for local storage, and all issues available online thrown away. Thousands of bound volumes were sent to recycling. The medical library could take benefit from the national archives deal negotiated in 2017 by the Consortium of Swiss Academic Libraries. The aim of the project was to provide all Swiss universities, research centers and citizens with a nationwide supply of electronic journal archives from academic publishers such as Springer, de Gruyter, Oxford University Press, Cambridge University Press. Book loan statistics were also thoroughly examined in order to discard all copies not borrowed over the last 7 years. On the other hand, many textbooks were replaced since it appeared inappropriate to display worn-out items in a brand new environment (Figure 4).
Over the last 10 years, clinicians and researchers have increased their use of the electronic library. On average, over 1.5 million article requests are recorded annually, just for the top 5 commercial publishers (Lippincott, Springer, Wiley, Elsevier and Taylor & Francis). On the other hand, ebooks are not widely used by students. Use of core reading list titles available online is far below expectations. An explanation could be that the ebook collections are mainly in English while French is still the official teaching language at the Lausanne medical faculty. Furthermore, relations between the library and medical curriculum designers are not close. Library instruction is integrated into the curriculum but the library's repeated offers to collaborate on teaching resources selection and dissemination have never been fruitful. This is one dimension where cooperation has failed until now, while the library's participation in clinical and research activities have steadily developed.

Library as solution provider
Librarians considered that moving the library outside the hospital main building was a potential threat for close collaboration with the clinical and research units.

Fig. 4. Collections on the library first floor
Cécile Jaques, Isabelle de Kaenel and Alexia Trombert The former situation allowed busy clinicians to spontaneously pop in the library, which was next to the staff cafeteria. They used to ask questions, chat, inquire about services, as well as find a quiet place to work. These informal behaviours are now lost and need to be compensated. In fact, moving the library was an opportunity to promote the services in different ways. Construction progress and project evolutions were regularly advertised in meetings and interviews, on the hospital Intranet page and in the library itself. More significantly, months before moving, as the evidencebased approach spread in medicine and clinical research, new types of collaborations were progressively built with most of the institution's departments. The evidence-based movement is also closely connected with the trend towards Open Science. Both promote the need for robust methodologies, transparency and data sharing. Researchers can be supported by the library throughout the research and publication cycle, from the research project definition to post-publication evaluation. The Lausanne medical library was able to keep up with the changing medical research landscape in terms of expertise and labour. Over the last 4 years the library was able to dedicate 1/3 of its workforce to support systematic searching, academic publishing, data management and research metric analysis. 2 FTEs are in charge of mediated searches and assistance with development of specific search strategies, 0.5 FTE deal with data management and scholarly communication issues, and 0.5 FTE provide individual assistance for citation management tools and research metrics. All staff members committed to these specialised tasks have a first subject degree (nursing, pharmacy, computer science) and a qualification in Library and Information Science. These services require a high level of interaction with the users and a strong personal engagement from librarians who have to train extensively, constantly upgrade their expertise and go outside the library to meet the users in their working environment. With such an emphasis put on personal link, most of the requests come through recommendations. On average, the library deals with 130 mediated search requests annually. More than 50 are comprehensive searches for systematic reviews, guidelines development and doctoral theses. Clinicians and researchers who request these comprehensive searches expect services tailored to their own specific activities and no general answers or one-size-fits-all solutions. They acknowledge the librarians strengths for systematic searching as well as for scientific data and information management. To meet these expectations and strengthen their credibility, librarians need to be more than service providers. They are challenged to provide expert solutions for technical and methodological questions, which are distinct in each case. Background and general information can be targeted towards the users through web pages, LibGuides or flashcards. These kinds of tools are efficient to serve as a basis for training or for systematic search interviews, but they are not sufficient to position the library as solution provider. In order to develop a comprehensive, solution-oriented service package, the library is strengthening a wide range of activities: • development of customised training courses, small group workshops and even individual tutorials on different topics: data management plans, open access publication and search methodology. The courses usually take place in the library training room and thus draw participants to the new location. On demand, training sessions are organised in places more convenient for specific groups; • implementation of a "book a librarian" service with an open source web appointment scheduling system (Easy!Appointments). This program supports the planning of interviews and tutorials, either face-to-face or distant with the help of Webex, screen sharing technologies and desktop remote control; • flexibility in the meeting places for the interviews, either at users' workplace or in the library where two specific private spaces with computers equipped with large screens are dedicated to one-to-one discussions and consultations; • extension of the scope of the service: from systematic searches to full text delivery, including deduplication, consolidation of the Prisma Statement requirements and support on systematic review software; • enhanced intranet visibility, with regular publication of news about the library services on the hospital intranet homepage. All information posted on this homepage has a strong impact on the clinical community; • users' needs and satisfaction assessment. In 2019, 9 months before moving, the library conducted an online satisfaction survey among users who had received support for their literature searches in 2018. The response rate, close to 53%, was encouraging. More than 80% of participants mentioned that this service had greatly contributed to the success of their research project. More than 9 out of 10 recipients said they would definitely recommend the service. Suggestions were made concerning speed of processing, clarity of reporting and visibility of the service. These results were published on the hospital intranet so that we could promote how the library contribution can impact a research project. The aim was also to publicly acknowledge the participation of the survey respondents and draw the attention of non-users. Repeating this survey in the next months might give us an indication on the influence of the library relocation on this specialised service. Strong professional connections and long-term engagement work have helped the library to gain the user's appreciation and loyalty and these ties seem to withstand the relative geographical distance. To position the library as a solution provider is demanding and labour intensive. The balance between serving the community at large with prolonged opening hours and extensive electronic access and focusing on individual requests is hard to find. As we do not charge for this personalised collaboration, promotion of solutionoriented services has to be proportionate to the taskforce in order to avoid bottlenecks.

Conclusion
Moving the medical library to new premises that integrate educational facilities and laboratory training rooms confirmed the library's position as a "teaching and learning" instrument, establishing its role as a study place for medical students. Nevertheless, on top of space design and planning, the project was also about strengthening relations. To support the clinical and research community at large and to help now distant users, librarians need to prove a high level of engagement, expertise and flexibility. When it comes to research projects and clinical reviews, customised solutions are expected from the medical librarians.