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Benchmarking Study of Hospital Libraries 
 
Angela Spencer, MALS 
Assistant Professor, Health Sciences Reference Librarian  
Saint Louis University 
St. Louis, MO 
 

Elizabeth Mamo, MLS 
Library Director 
Regional Health 
Rochester, NY 
 

Brooke L. Billman, MLIS, AHIP 
Senior Manager, Governance Operations 
College of American Pathologists 
Northfield, IL 
 

 

ABSTRACT 
 

Objectives: To assess the current landscape of hospital libraries by collecting 

benchmarking data from hospital librarians in the U.S. and other countries. Since the 

last MLA benchmarking survey in 2002 hospital libraries have faced significant changes 

including downsizing, position and library elimination, and hospital mergers. This survey 

will provide information to inform the development and implementation of effective 

advocacy for hospital libraries. 
 

Methods: A web-based, anonymous survey was designed to collect information from 

hospital librarians representing stand-alone hospitals and hospital systems. The 57-

question survey was distributed via select listservs, targeting the US and Canada but 

open to any country. The topic areas covered hospital/health system, library, and library 

staff demographics; library characteristics and scope of service; interlibrary loan and 

document delivery; library funding; and library budget. Hospital library benchmarking 

surveys, including the previous MLA surveys, were reviewed and applicable questions 

were added. 
 

Results: There were a total of 180 respondents, but the total number of responses for 

each question varied. Select results are as follows: of the responding libraries, 67.2% 

were part of a hospital system; 24.4% had merged with or were bought by another 

hospital or health system and, of those, 77.1% had acquired 1-5 hospitals in the last 10 

years; 77.9% were not for profits; over half (55.2%) had <5,001 FTE in the organization; 

56.9% had one library; 47.7% had 1 FTE librarian, 34.9% had 2-5; 82.1% did not or 

were not able to use social media; 60.7% didn’t have strategic plans; 66.1% belonged to 

a consortium; 48.2% provided up to 250 search requests a year; 66.3% did not receive 

funding outside of their organization; 32.5% had budgets for print books totaling less 

than $1,000; 30.1% had budgets, excluding salaries, of less than $100,000 and 9.7% 

had budgets over $1M. 



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Conclusions: These findings contribute to the field’s knowledge of hospital library 

demographics as well as the services provided. The results suggest implications for 

hospital librarians regarding staffing levels and the depth of services within their unique 

settings, especially within the context of rapidly expanding health systems. 

 

INTRODUCTION 

In a time of increased health care system mergers and hospital library closures, 

library staff are looking for ways to advocate for the retention of services, resources, 

personnel, and, sometimes, the mere existence of the library. Compared to other 

libraries, those in hospitals face unique challenges in that they are evaluated based on 

their ability to generate revenue. Since hospital libraries are not usually revenue-

generating, they are often under scrutiny and the value of the library and its services are 

questioned. This is especially true when the hospital operating budget is cut or the 

organization is involved in a healthcare merger, either of which may lead to library 

closures. 

According to KaufmannHall, in 2017 alone there were 115 health system 

mergers and acquisitions in the United States [1]. Hospital libraries within health 

systems that have merged are faced with integrating library services and resources 

across multiple sites. This is a task that often requires more library staff and funding, not 

less [2]. As these hospitals grow in services and size, library operations don’t grow with 

them and physical space may be downsized [3] and library locations may close. 

Although there does not exist a single, comprehensive resource that tracks 

library closures, a review of the literature reveals a disturbing trend. Over a decade ago 

the MLA Vital Pathways project found a decline in the number of hospitals with libraries, 

from 44% in 1989 to 30% in 2006 [4]. A more recent attempt to determine the rate of 

closures was a study in which the DOCLINE membership database was queried and it 

was found that 613 NN/LM member libraries had closed from 2011-2015 [5]. Harrow et 

al compared the 2007 edition of the Library and Book Trade Almanac with the 2017 

edition and noted a 32.7% decrease in medical libraries, including hospital libraries, 

from 2,055 in 2007 to 1,384 in 2017 [6]. 

Previous hospital benchmarking studies are now outdated, especially with the 

increase in health care mergers and library closures. The aim of this study was to 

collect data about hospital library characteristics, services, populations served, and 

budgets. This information will provide library staff and hospital administrators with 

current data to inform their plans for library services. Library staff can also use this 

information when advocating for the needs of their libraries.   

 

 

 



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HISTORY OF HOSPITAL LIBRARY BENCHMARKING 

Hospital library benchmarking studies have been conducted since the early 

1960s, beginning with a survey by the American Hospital Association’s Division of 

Research which collected information from a sample of hospitals in their registry. Select 

data was analyzed and it was recommended that improvements were needed for 

libraries to function successfully [7].  

The American Medical Association, in partnership with Case Western Reserve 

University and the American Hospital Association, issued three surveys (1969,1973, 

1979) of health sciences libraries which resulted in the publication of the Directory of 

Health Science Libraries in the United States [8-10]. Each edition of the directory 

provided a listing of libraries by state and name. The directories contained a breakdown 

of libraries by sponsoring organizations and by number of staff. Crawford analyzed 

results of the three surveys to determine patterns, growth, or decline. Overall there was 

in increase in the number of libraries in hospitals in the 10-year period [11].   

By the 1980s, hospitals were experiencing an increase in health care costs and 

institutional mergers. Wos surveyed hospitals that were part of multi-site systems; data 

illustrated the impact of mergers on library collections, staffing, and budgets [12]. In 

1990, hospital libraries in Michigan provided survey responses for two time periods and 

it was concluded that these libraries were adversely affected by mergers with noted 

reductions in staff, hours, and resources [13]. The author called for the ongoing 

collection of hospital library data. Also in 1990, the American Hospital Association 

surveyed registered hospitals in the United States [14]. Two years later, Glitz conducted 

a survey of hospital libraries in the Pacific Southwest Medical Library region, comparing 

the data to the 1989 version of the same survey, noting decreases in libraries and staff 

[15].  

In the late 1990s MLA observed an increase in closures of hospital libraries and 

established the MLA Benchmarking Network. Dudden described the development of a 

task force to create a benchmarking tool, issue surveys, and share the results with MLA 

members [16]. Surveys were distributed in 2002 and 2004 and select data were 

presented in publications, conference proceedings, and made available on an 

interactive website. MLA members could select parameters applicable to their situation 

and obtain data to share with their administrators. For example, Bertolucci used the 

data to increase her library’s book budget [17] and Fama used the data to revise her 

library’s hours of operation [18]. The MLA Hospital Libraries Section Standards 

Committee used the data to develop and publish a formula for library staffing, which 

was included in the 2002 MLA Hospital Libraries standards [19]. 

Meanwhile, MLA’s support evolved into the task force on Vital Pathways for 

hospital libraries. The task force distributed a new survey in 2005. Thibodeau compared 

the results of the 2005 survey to the 1989 American Hospital Association survey results 

and noted a decrease in staffing [4]. Thibodeau also noted the need to track the status 



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of hospital libraries as there wasn’t a way to accurately quantify closures. Later that 

decade VanMoorsel distributed a survey of hospital library staffing and compared the 

results to the MLA standards for Hospital Libraries, finding a negative variance from the 

MLA standard [20]. Similarly, Ducas surveyed Canadian hospital libraries in 2012 and 

compared the results to the Canadian Hospital Library Association (CHLA) standards 

for library staffing and found that many libraries did not have a master’s prepared 

librarian, or adequate staffing levels according to the CHLA Standards [21].  

 

METHODS 

In August 2017 an online survey using SurveyMonkey was distributed in order to 

collect and assess hospital library benchmarking data. A three-member planning team 

developed and pilot-tested the survey instrument (Appendix A), consisting of 57 

questions with integrated skip logic. The survey was reviewed and determined to be 

exempt from human subject review by the Institutional Review Board at Rochester 

Regional Health on July 19, 2017. The call to participate in the survey was sent to 

various health science librarian online distribution lists including MEDLIB-L and the MLA 

Hospital Libraries Section on August 16, 2017 and the survey closed on September 15, 

2017. Reminders were sent during this period. Identifying information, such as IP 

address, respondent name, and organization name, was not collected. The survey 

indicated that just one library representative from each hospital or hospital system 

should fill out the survey. For open-ended questions the constant comparative method 

was used; two authors independently coded the responses and resolved discrepancies 

through discussion [22]. A total of 180 respondents participated in the survey.  

 

RESULTS 

Institutional characteristics 

Of the total responses, 91.6% were from the United States, 7.3% from Canada, 

and 1.1% from New Zealand. One-third (32.8%) of respondents indicated they were 

from a hospital that is not part of a health system while two-thirds (67.2%) were. About 

thirty percent (30.1%) were from a system with 2–5 hospitals, 12.5% with 6–10, 6.8% 

with 11–15, and 18.2% with more than 15. The majority of respondents (30.5%) 

indicated they were from hospitals/hospital systems that had 201–500 beds, while 

16.7% had 200 or fewer beds, 20.7% had 501–1,000, 14.4% had between 1,001-2,000 

beds, and 17.8% had more than 2,001 beds. Just 8.7% of hospitals/health systems had 

1,000 or fewer full time equivalent (FTE) employees while 46.5% had 1,001–5,000 FTE, 

16.9% had 5,001–10,000 FTE, 20.9% had 10.001–50,000, and 6.9% had over 50,001 

FTE. Most (91.0%) of the respondents were from teaching hospitals. Twenty-four 

percent (24.4%) of the respondents’ hospital or hospital systems had merged or been 

acquired by another organization in the last 10 years. Of the locations that have 



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acquired hospitals, 77.1% had acquired 1–5 sites, 10.8% acquired 6–10 sites, and 

12.1% had acquired 11 or more sites.  

 

Library characteristics 

Over half (56.9%) of all respondents had 1 library within their hospital/hospital 

system, 32.8% had 2–5 libraries, 5.2% had 6–10, and 5.2% had more than 10 libraries. 

Figure 1 is a cross tabulation of the number of libraries and the number of hospitals and 

Figure 2 is a cross tabulation of number of libraries and number of beds. Half (50.0%) of 

respondents indicated that their library supported 1 hospital while 31.2% supported 2–5 

hospitals, 9.4% supported 6–10, and 9.4% supported more than 10. The number of FTE 

librarians ranged from fewer than 1 to more than 15: 5.8% had fewer than 1 FTE, 50.6% 

had 1 FTE, 35.5% had 2–5, 2.9% had 6–10, and 4.6% had more than 10. One 

respondent (0.6%) was not an employee but a volunteer. Figure 3 is a cross tabulation 

of librarian FTE and number of sites supported. Half (52.0%) of libraries did not have 

support staff while 39.3% had 1–3, 6.9% had 4–7, and 1.7% had 8 or more staff. 

 

 



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The department(s) the library/libraries reported to included education (e.g., 

graduate medical education, nursing education) (44.1%), administration (41.3%), 



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information technology (6.1%), human resources (5.6%), research services (4.5%), and 

other departments (6.7%). The majority of libraries (60.7%) did not have a strategic plan 

and 78.8% did not have a formal marketing or communications plan. Almost all (97.1%) 

respondents had physical library space. 

Many (40.6%) respondents did not have a library website. Of the respondents 

who did, the following departments managed it: library (50.0%), marketing (29.0%), 

information technology (16.0%), public affairs (3.0%) and other (2.0%). Most (91.7%) of 

respondents had an internal library website or intranet. Of those respondents, the 

following departments managed it: library (66.2%), information technology (22.1%), and 

marketing (11.7%). Off-site access to electronic resources was provided by the hospital 

(39.2%), the library (34.5%), both the hospital and library (12.9%), 10.5% provided no 

access off-site, and 2.9% were unsure. Most (84.4%) libraries did not use social media. 

Most (80.7%) library staff did not have access to the electronic health record while 9.4% 

had full access and 9.9% had access only to the module that allows staff to provide 

links to resources (e.g., via the InfoButton feature.) 

 

Populations served 

Most health care professionals are served by the library with respondents 

indicating they serve nurses (94.6%), physicians, (94.0%), pharmacists (92.2%), allied 

health staff (89.8%), residents (78.3%), and other clinical staff not already categorized 

(88.6%). Others served include administration/management (92.2%), students (85.5%), 

researchers (76.5%), patients (61.4%), faculty (59.0%), visitors (56.6%), and other non-

clinical staff not already categorized (83.1%). 

Of the respondents who provided services to residents, 63.6% served up to 100 

residents, 31.0% served 101–500 residents, and 5.4% provided services to over 500 

residents. A cross tabulation of librarian FTE and number of residents served is 

available in Figure 4. Of the respondents who provided services to fellows, 89.4% 

served up to 100 fellows and 10.4% served over 100 fellows. 

 



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Library services 

Respondents selected services provided by their libraries. “Other” responses 

were coded and included in Table 1. 

 

Table 1. Services provided by respondents 

Services % 

Literature searching 100.0% 

Interlibrary loan 98.8% 

Teaching/instruction 87.4% 

Cataloging 85.0% 

Intranet/internet pages 72.0% 

Meeting space 60.5% 

Patient education 52.7% 

Consumer health 52.1% 



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Publishing support 45.5% 

Systematic reviews 32.3% 

LibGuides 30.5% 

CME 23.4% 

Clinical medical librarian program/patient care rounding 22.2% 

Media services 11.9% 

Data management 12.0% 

Internal Review Board 9.0% 

Social media 5.4% 

 

The number of search requests respondents received each year ranged from up 

to 100 (20.5%), 101–250 (27.7%), 251–500 (21.1%), 501–750 (10.2%), 751–1,000 

(10.2%), and more than 1,000 (10.2%). Figure 5 is a cross tabulation of the number of 

searches and hospital/system FTE and Figure 6 is a cross tabulation of the number of 

searches and bed count. Most (86.7%) of respondents received consumer health 

questions and, of those who did, 57.3% received up to 25 questions a year while 21.0% 

received 26–100 questions and 21.7% received over 100 questions a year. A third 

(34.1%) of respondents maintained the hospital/health system archives. 

 



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Respondents provided the following number of articles from their collection to 

those within their organization in one year: up to 250 (22.5%), 251–500 (6.9%), 501–

1,000 (18.1%), 1,001–2,500 (15.6%), 2,501–5,000 (11.9%), and over 5,000 (25.0%). 



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Figure 7 is a cross tabulation of document delivery requests and hospital/hospital 

system FTE. Articles requests filled each year via interlibrary loan (ILL) were as follows: 

up to 100 (21.3%), 101–250 (17.7%), 251–500 (20.1%), 501–1,000 (15.2%), 1,001–

2500 (13.4%), 2,501 or more (12.2%). Figure 8 is a cross tabulation of the number of 

ILL requests and hospital/hospital system FTE. 

 

 
 

 



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Two thirds of respondents (68.1%) spent up to $1,000 a year on article requests, 

excluding copyright fees, 24.1% spent between $1,001–$5,000, and 7.8% spent over 

$5,000. Most respondents (83.0%) spent up to $500 a year on copyright fees. The 

response to whether the library was a Loansome Doc provider was almost split with 

45.2% indicating they were. Almost half of the libraries (47.9%) borrowed up to 10 

physical books a year from other libraries, while 34.5% borrowed 11–50, and 17.6% 

borrowed more than 50 per year. Most respondents (71.7%) lent up to 10 books a year 

to other libraries. 

 

Library budgets 

Budgets, excluding staff salaries, varied greatly with 12.2% up to $50,000, 17.9% 

from $50,001–$100,000, 19.2% from $100,001–$200,000, 28.8% from $200,001–

$500,000, 12.1% from $500,001–$1,000,000, 5.8% from $1,000,001–$2,500,000, 2.6% 

from $$2,500,001–$5,000,000, and 1.3% over $5,000,000. Figure 9 is a cross 

tabulation of library budgets and hospital FTE. 

 



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For staff salaries, 11.5% of respondents had a total budget for staff salaries, 

excluding benefits, of up to $50,000 while 34.6% had budgets from $50,001–$100,000, 

33.3% from $100,001–$250,000, 13.5% from $250,001–$500,000, and 7.1% over 

$500,001. Figure 10 is a cross tabulation of library salary budget, excluding benefits, 

and hospital FTEs available. 

 

 



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Over a third (39.6%) of respondents had a journal budget of up to $50,000, 

22.0% from $50,001–100,000, 22.0% from $100,000–250,000, 8.2% from $250,001–

500,000, 5.1% from $500,001–$1,000,000, and 3.1% over $1,000,000.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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Figure 11 is a cross tabulation of journal budgets and hospital FTEs. 

 

 
 

For ebook budgets, 22.8% spent up to $500; 19.0%, $501–5,000; $18.4%, 

$5,001–20,000; 12.0%, $20,001–50,000; 16.5%, $50,001–100,000; and 11.4% were 

over $100,000. The majority (26.1%) of respondents spent $50,001–100,000 on 

database budgets (which excluded point of care tools) while 21.5% spent up to $10,000, 

16.4% spent $10,001–25,000, 15.0% spent $25,001–50,000, and 20.9% spent more 

than $100,000. Almost a third of respondents (32.5%) had a print book budget of up to 

$1,000, 30.7% had a budget of $1,001–5,000, 20.6% had a budget of $5,001–$10,000, 

and 16.3% had a budget of over $10,000. Most libraries (66.1%) belonged to a 

consortium and, of those, three-quarters (74.8%) allocate up to 25% of their budget to 

consortium purchased products while 14.4% allocate 26–40%, 8.1% allocate 41–60%, 

and 2.7% allocate more than 60%. Over a third of respondents (35.6%) did not have a 

point of care tool or did not pay for one. 

Most libraries (66.3%) do not receive funding outside of their organization. One 

quarter (26.3%) received donations, 18.1% generated funds from ILL, 16.9% received 

grants, 4.4% generated funds from non-systematic review mediated searches, and 

0.6% generated funds from a systematic review service. 

 

 



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DISCUSSION 

We were unable to calculate the survey sample size, and therefore response 

rate, as there is no source documenting the current number of hospital libraries in 

existence. We found we could not compare our response rates or survey results to 

Dudden [16] or Thibodeau [4] as we asked participants to coordinate one survey 

response for each organization (as compared to previous studies in which any library 

staff representative could participate). Requesting one respondent per organization was 

done in an attempt to minimize duplicate data. The inability to compare our data to 

previous studies is indeed problematic; this speaks to the difficulty in collecting data 

representative of the current landscape while minimizing the possibility of duplicative 

responses. 

  Related to organizational responses, we found that some hospital libraries, 

despite being a member of a health care system, do not work closely with others from 

the same system and don’t have information (e.g., library characteristics, budget, 

resources, search statistics) about the other locations. Respondents commented that 

health care systems have libraries with partially or entirely separate budgets and 

function autonomously. It is unclear if some responses reflect one or multiple hospitals. 

The landscape of hospital librarianship is changing so it was difficult to 

hypothesize what the survey data would reveal. We presumed there would be a steady 

increase in budgets as the size of the organization increased but this wasn’t indicated 

(see Figure 6). We also speculated there would be a correlation between the number of 

librarians and the number of hospitals supported. Results show that there are many solo 

librarians supporting single sites as well as multiple sites, in some cases a single 

librarian is supporting 10 or more sites (see Figure 3). This data reflects the results of 

the solo census study by McLaughlin et al [23]. The MLA Hospital Libraries Section 

Standards Committee published standards for hospital libraries in 2008 which included 

staffing [24]. In 2009, Van Moorsel studied a sample of hospitals and found that the 

majority did not comply with recommended staffing levels in their libraries [20]. Those 

standards have not been updated in over a decade and there are no current 

recommendations to provide guidance on the ratio of number of librarians to staff or 

hospitals supported. 

   It is of interest that very few libraries had a strategic plan (39.3%) and even fewer 

had a communications or marketing plan (21.2%). A surprisingly low percentage of 

libraries (59.4%) had a website and, of those who do, just 50.0% of library can manage 

it themselves. Most (91.7%) respondents had an internal library website or intranet 

presence but just two-thirds (66.2%) of the staff could manage it themselves. The data 

on marketing plans and web presence speaks to the barriers that hospital libraries face 

in promoting their services or interacting with populations served. Although it may be 

difficult to persuade hospital information services of the need for a web presence, the 

need to create strategic communications and marketing plans presents an opportunity 



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for educational resources and courses to be created to assist hospital librarians in 

understanding the benefit of and creating these plans. 

  It was surprising to discover that 35.6% of hospital librarians do not have or do 

not pay for a point of care tool, such as UpToDate or DynamedPlus. It may be that 

some librarians successfully eliminated costly point of care tools from their budgets or 

that another department pays for access to the tool. The authors speculate whether the 

respondents who pay for a point of care tool also pay for the majority of knowledge-

based resources at their organization, even resources unique to one department or 

those that may not be typically thought of as library resources. 

 

Limitations 

We identified limitations that resulted from the design of the questions. 

“Document delivery” and “interlibrary loan” were used to distinguish between articles 

supplied to users from one’s collection as compared to resources requested from other 

libraries’ collections, respectively. Respondents’ comments indicated confusion over the 

use of these terms.  

In the past, when collection formats were mostly print, there were distinct budget 

lines for journals and books. For the resource budget questions, it was difficult for 

respondents to provide accurate estimations on the total spend for resource types as 

some have a combination (e.g., journals, books, databases) within a single resource. 

Consequently, it is difficult to draw conclusions as to how much is spent on each type of 

resource. Related to resources, the question about point of care tools was worded so 

that one selection included both “does not have a point of care tool” and “does not pay 

for a point of care tool” whereas they should have been separate options. 

  Categorizing the open-ended responses for the question about library staff 

participation on committees was not possible as each organization has unique 

committee names. It was difficult to understand the scope or charge of the committees 

without having additional information. 

 

Future efforts 

The largest takeaway from this study is that there is a need for a concerted effort 

to understand baseline hospital library data in an era of increasing health care mergers 

and overall changes. Only once this data is collected can we begin to understand the 

current landscape and how to advocate for hospital libraries. Capturing data about 

these libraries will be challenging, as was demonstrated in this survey, and future 

iterations of the survey will need to address a way to collect data about health care 

system libraries, both those that work closely with one another and those that function 

independently. In order to do this, respondents may need to indicate which institutions 

they represent which is something not done in this survey in order to retain anonymity of 

respondents due to the sensitive nature of the data (especially regarding budgets). 



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Current efforts at data collection include MLA’s Hospital Libraries Section Census 

Task Force, which is charged with determining the number of hospital libraries presently 

in existence and the number that have closed since 2017. Once that information is 

collected, we suggest sending a benchmarking survey on a determined schedule (even 

creating a large-scale longitudinal study to set baseline data and track changes), 

making sure there is consistency in the questions and response choices. This will 

ensure we have comparable data, which should be readily available for use with 

administrators and for hospital library planning and advocacy. 

It would be helpful to understand other changes in the hospital library profession 

such as staffing number changes (e.g., reduction of professional staff, mergers, 

retirements with or without a rehire), and changes in service responsibilities (to help 

determine if librarians are doing more with less). It would also be of interest to explore 

whether closures have impacted services in other hospital libraries or even academic 

libraries. With limited budgets and varying access to resources, it’s possible some 

health systems are experiencing an environment of information inequity, or a gap in 

access to library resources [25]. Studies are needed that explore the short- and long-

term effects of closures and mergers and their impact not only on library resources, 

services and budgets but also on access to information for health care providers as well 

as any impact on patient care outcomes. To provide the most benefit, access to future 

survey data for institutional comparison, such as in an online platform in which hospital 

library staff can input their information to see how their organization compares, would be 

of great benefit. 

This paper presents selected results from our survey. Data associated with this 

article are available in the Open Science Framework 

at https://doi.org/10.17605/OSF.IO/5VA74. Note that identifying information, such as 

location within each country, has been removed. 

 

 

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	Angela Spencer, MALS
	Assistant Professor, Health Sciences Reference Librarian
	Saint Louis University

