Feeling the Big Squeeze? Remember that even a squeeze box can make a pretty song.
There’s a billboard across the street from my office building, promoting the hospital that’s affiliated with the medical school where I work. It features a friendly looking young woman with the words above her head, “I want it all.” The implication, of course, is that the medical center can meet all of the health needs of this person, indeed of anyone who uses the hospital and its network of health care providers.
This isn’t a criticism of their advertising campaign, but more just a few thoughts that come to my mind every time that I drive past that sign. Wanting it all is pretty much the American dream, is it not? Maybe it’s the dream of all people, everywhere. We all want whatever it is that we want, whether we necessarily need it or not. You may not subscribe to this belief personally, but you have to admit that it’s an awfully loud societal message.
From the perspective of a provider, be one a provider of health care services or a provider of information services, we want it all, too. We want to say that we can provide anything and everything to anyone and everyone who comes through our doors. Libraries, especially, have this idea deeply ingrained in their DNA. They exist for everyone.
But as we have become such a specialized world, I think we’d do well to face the facts that our ability to meet that mission anymore is dwindling, if not altogether extinct. I’ve been working on an evaluation of one of the research cores for the CCTS and in talking to those involved with it, I can’t help but notice they speak many of the same concerns that I long heard in my former home in the library; a handful of people simply cannot meet the needs and demands of everyone.
This imbalance causes us to rethink much of what we do, how we measure our success, and how we plan for the future. The reality of health care is that you really cannot have it all. A few weeks back, I was feeling really miserable and went to the walk-in clinic of the hospital next door only to learn that it’s really not a walk-in clinic, but rather a place for patients who see a certain group of doctors there. These patients can walk in for a last-minute appointment. If one is available. My doctor is a doctor within the same system, but while he has an office a few floors above the very clinic where I was seeking treatment, his clinical office is in another location, thus I wasn’t able to use the services provided there. Again, not a criticism of the provider network (though I am a big critic of the messed-up system that dictates these type decisions), but I share the story as an example of how claiming all can be provided to everyone ought to be a statement with an asterisk after it. Some restrictions DO apply.
One of the reasons that I chose to leave the library and work for the CCTS is that I felt the expectations in this new role were somewhat more realistic. Here was a defined group of programs and research cores for me to evaluate. It’s a lot, but still seems a manageable number. It allows me the ability to focus more, to feel less scattered, to feel less pulled, to feel less like I’m always falling short of meeting my goals, not because I’m not trying hard or working hard, but because I am only one person and trying to give time to everyone feels like a losing proposition. To me.
Sustainability is a key issue as we continue to work in institutions and businesses and governments that are constantly under the pressures of too little resources to meet all of the required needs. We are limited in people, certainly. Positions are cut or people leave posts and are never replaced. Everyone feels overworked as we try to fill holes and do more.
But we’re also limited by our current service models. Yesterday, I was able to attend the annual eScience Symposium hosted by the NN/LM NER. The afternoon session featured two speakers from different universities who described their particular programs for data services. Regarding their data repositories, one school allows self-deposit while the other offers a mediated service, i.e. researchers send their data to the library and then staff their deposit on their behalf, adding all of the proper metadata, annotation, etc. necessary in order for people to search and find the data sets in the said repository. During the Q&A, I asked the speakers about the differences between their models. I asked them some of the same questions that are asked in the process of evaluating research cores and programs:
How did you decide which path to follow? How did you decide which aspect of your repository to sacrifice; the quality of the content (enhanced by the mediation) or the ability to be a bigger service (because you’re not limited by the time/efforts of staff in the library)?
As one speaker said, “It’s a balancing act.” Indeed. And it’s also a clear example of how believing we can be all for all is misguided. It’s just not possible. We have to set priorities and make choices.
For good and bad, though, these are the realities of academic institutions, health care providers, research centers, and libraries. The one thing that we all really do have is the challenge to face these limitations, all the while trying to come up with the solutions for providing the best of whatever we can offer to as many as possible. Whether it’s what we really want or not, THAT is the “all” that we have.
A Librarian by Any Other Name 
Ugh. This: “to feel less like I’m always falling short of meeting my goals, not because I’m not trying hard or working hard, but because I am only one person and trying to give time to everyone feels like a losing proposition.” feels like a constant mental refrain lately. We keep talking about how medical libraries (hospital libraries in the conversations I’m having) are specializing and more and more becoming whatever the host organization needs them to be. And I think this is a good thing, but I also think my hospital needs me to be a lot. Or, perhaps rather, there’s a lot I could do that could really help them, but I have to figure out where I want to spend my energy, because there’s no way I really can do it all and still be effective. But that makes me sad, because I like it all and I’m interested in it all – patient ed, informatics, research, population health, etc. It’s all fascinating, and valuable. And so I keep holding out on making a directional decision, hoping that maybe I’ll find or be inspried to create something that will pull all my disparate interests together into a cohesive strategic plan. And in the meantime, I always just feel a little ragged.