It's not a topic as glamorous as Medicare and Medicaid budget battles or Columbia/HCA Healthcare Corp.'s dealmaking.
But the American Hospital Association's library is one of the few remaining threads linking virtually every hospital, hospital association and hospital executive, past and present. It's the resting place for hospital histories and the papers of administrators who hope to be remembered by their successors.
But the AHA is shaving that thread by limiting public access to the library, dumping the bulk of its contents and replacing it with a slimmed-down model.
"A lot of people don't know what's happening to the AHA library," said Robert Sigmond, scholar in residence at Temple University in Philadelphia.
Sigmond was the first person to raise the library issue publicly, when he questioned AHA board members during an open forum at last summer's AHA convention in San Francisco.
"To me, the AHA always had a soul, and the soul is basically the library," Sigmond said. "I don't feel enough attention is being given to the soul beyond the short-term objectives of serving members and keeping costs down."
The effort, word of which was leaked last summer, stirred the ire of a handful of health services researchers and scholars. But their effort to generate widespread opposition to the AHA's plans fell on mostly deaf ears, and they failed to persuade the AHA to keep the library intact.
Ironically, the AHA is convening a special forum next week at its annual Washington meeting to discuss the future of health services libraries.
MODERN HEALTHCARE submitted a list of written questions to the AHA about its library plans and requested an interview with Christine McEntee, the AHA's executive vice president in Chicago who's leading the library restructuring effort. However, the AHA declined to respond to the written questions or participate in an interview.
"We'll share our decision on the resource center and library after they've been made," the AHA said.
But the decision appears to have been made long ago, shortly after the AHA moved into its new headquarters building in Chicago's Loop in September 1994. Space was allocated in the new building for the resource center, but questions arose about the ability of the floor to support the weight of the books and periodicals.
A spokeswoman for VOA Associates, a Chicago-based interior design firm that styled the AHA's new digs, said in July of last year the company was working to resolve the "structural integrity issue."
But in an Aug. 11, 1995, memorandum to the executive committee of the AHA's board, McEntee outlined plans to "refocus" the resource center.
The resource center is open in the AHA's new Chicago headquarters, but the bulk of the center's books and periodicals still are at the association's old headquarters building. Stacks of unassembled movable bookshelves clutter the floor at the new site.
On Jan. 8, a resource center librarian told MODERN HEALTHCARE that the structural improvements had yet to be made because of cost concerns.
To date, the AHA has made no public announcement of its library restructuring plans. But internal AHA documents obtained by MODERN HEALTHCARE reveal the association's plans and chronicle how the AHA addressed criticism of its plans.
For example, the AHA convened a six-member task force last September in response to questions from the field and to review the "intellectual integrity" of the library plans. But the AHA didn't give non-AHA members of the task force any written materials to consider before the meeting. The task force, after a brief meeting, unanimously supported the AHA's plans. It added the caveat that the book collection not be dismantled or sold.
David Sniff, a task force member and senior vice president at Memorial Health System in Springfield, Ill., said not having advance information wasn't a problem because the material at the meeting was "easy" to evaluate.
"It didn't require hours of study," he said. "Today, a journal that's a year old is ancient history."
"This was (an AHA) board committee chaired by a member of the board's executive committee," said Thomas Dolan, president of the American College of Healthcare Executives and a task force member. "If the group didn't like the direction the AHA was taking, it could have changed things."
Fred Brown, president and chief executive officer of BJC Health System in St. Louis and a member of the AHA board, chaired the task force. He didn't respond to an interview request.
The AHA's library is formally titled the American Hospital Association Resource Center. The resource center consists of the Asa S. Bacon Memorial Library and the Center for Hospital and Healthcare Administration History.
The AHA library, created in 1920, was dedicated in 1940 to Asa Bacon, who, absent a one-year stint as AHA president in 1923, served as AHA treasurer for 33 years starting in 1906. The AHA and the ACHE created the historical center in 1984. The AHA's own promotional material says the resource center "houses the nation's most comprehensive collection of both current and historical hospital and health services administration literature" (See chart).
The center's1994 operating budget was about $1.5 million. That year, the AHA's revenues were about $83.5 million. But according to President Richard Davidson, the association no longer has the resources to operate a full-service public library.
In an Aug. 30, 1995, letter to Emily Friedman, a health policy analyst and critic of the AHA's library plans, Davidson said: "The day is past when the AHA can possibly hope to collect and have everything of importance that our members may need. The amount and movement of information simply is too great."
Friedman rebutted the contention that money is the issue, pointing to the fact that the AHA is shopping around for as many as four companies to buy with $40 million in cash (Jan. 1, p. 2).
"I no longer believe that the choices the AHA has made were really about cost," she said. "I think this was about a failure to recognize that history, intellectual effort and knowledge have a role in the lives of healthcare providers, their executives and their associations."
The AHA is doing the following:
Disposing of its 63,000-volume book collection. The AHA is dangling it before several universities, including Northwestern University and the University of Michigan.
Cutting its periodical subscriptions to about 30 from more than 1,000 and giving or selling its back stock of periodicals to an "external commercial document vendor."
Keeping the historical collection and providing on-site access to the materials for AHA members.
The AHA insists that it's not discarding or dismantling its library but rather is refocusing it to make it more useful to AHA members, association documents and correspondence say.
According to a slide presentation by McEntee to the September task force, a copy of which was obtained by MODERN HEALTHCARE, the new resource center will have six "service lines": a factual information and referral service; a document delivery service; an information and data retrieval service; selected readings service; two literature index services; and the historical materials center.
"When I heard the AHA was thinking about selling or closing its library, I got concerned because the library's services are particularly useful to smaller state hospital associations that don't have the same resources," said Richard Meiers, president of the Healthcare Association of Hawaii. "But I've been assured by the AHA that the same services will be available to me as a state executive."
The new services essentially are the same that were available from the old resource center with two important differences: Members will pay for some of the new services, and the services will be available primarily to members only, not the general public, according to an internal September AHA memo.
Nonmembers who want to use the resource center will be referred to the AHA's membership office to see if they want to join. Inquiries for information about AHA products or services will be referred to the appropriate AHA department. But if an inquiry is for virtually anything else, the nonmember must pay for it or go elsewhere.
All calls from the media will be referred to the AHA's media relations office in Washington, and requests from congressional staffers will be referred to the association's federal relations division.
"Our emphasis will be on the services most frequently used by the members," Davidson said in his Aug. 30 letter. "It will also mean we must limit our services to nonmembers."
According to Sniff, McEntee told the task force that use of the resource center by nonmembers was "nominal."
Gail Warden, president and CEO of Henry Ford Health System in Detroit and last year's AHA board chairman, didn't respond to an interview request. However, in one piece of AHA correspondence, Warden said the board was "comfortable" with the plans.
John Griffith, a health management professor at the University of Michigan, confirmed that the university is interested in getting a piece of the AHA library. But Griffith is only interested in what he called "a package solution" involving not just the book collection but historical documents and the periodical collection as well.
"The books are the least valuable of what's available because we have duplicates in our own library," he said. That means if Griffith gets his way, the AHA's book and historical collection could be dismantled.
Griffith said he's been dealing with Sigmond about the contents of the library. Since Sigmond publicly questioned the AHA's library plans, he was appointed to the special library task force, is negotiating on behalf of the AHA regarding the disposition of the library collection and is working with the AHA on next week's forum on the future of health services libraries.
The AHA and the ACHE also are helping him develop a $100,000 grant proposal to study the feasibility of creating a new national health services library.
As for the library's crown jewel-a book by Benjamin Franklin about the nation's first hospital, Pennsylvania Hospital, which he founded-it's been moved to the AHA's Washington office. The AHA said it will be put on public display in the near future.