CANADIAN STANDARDS

FOR
HOSPITAL LIBRARIES
These Canadian Standards for
been accepted by:

Hospital

Libraries have

Health Sciences Section

CASLIS Division
Canadian Library Association
Canadian Regional Group
Medical Library Association
Committee on Medical Library Services
Ontario Medical Association

Board of Directors
Ontario Medical Association
Board of Directors
Canadian Medical Association
Associate Committee on Libraries
Association of Canadian Medical

Colleges

December, 1974
STANDARDS FOR HOSPITAL LIBRARIES*
Introduction
The lack of standards for Health Libraries in Canada
has been acutely felt for a long time. Many different
drafts have been written and guidelines indicated by a
number of bodies and individuals, but no one document
has been accepted by the various associations concerned
with Health Libraries in institutions in Canada. This new
document is an attempt to produce minimum standards
which will meet the need. It is obvious that some libraries,
particularly in teaching hospitals, should already have
surpassed these standards, which apply to personnel as
well as materials.
It is not, indeed, an original piece of work, since it is
based on many others. Acknowledgement must be made to:
Library Association: Recommended Standards for
Libraries in Hospitals. London, 1972.
Association of Hospital and Institutional Libraries. Hos
pital Library Standards Committee. Standards for
Library Services in Health Care Institutions. Chicago,
American Library Association, 1970.
Great Britain. Dept. of Health and Social Security.
Welsh Office. Library Services in Hospitals. April,
1970. H.M.(70)23.
Association Canadienne des Bibliothecaires de la Lan
gue Francaise. Project for the Establishment of Stand
ards of Library Service in Canadian Hospital Librar
ies. 1966/67.
Bunch, Antonia J. & Cumming, Eileen A. Libraries in
Hospitals; a review of services in Scotland. Edinburgh,
Scottish Hospital Centre, February 1969.
United States. Health Services and Mental Health Ad
ministration. Administrative Services and Facilities
for Hospitals: a planning guide. Washington, U.S.
Govt. Print. Off., 1972.
The format adopted is modelled on the Canadian docu
ment GUIDE TO HOSPITAL ACCREDITATION, pub
lished by the Canadian Council on Hospital Accredita
tion in 1972. The chapter on "Staff Library Services" in
this publication gives a straightforward and simple prin
ciple but does not detail graduated standards sufficiently.
These have been expanded and added to in an attempt
to round off the description of requirements in a manner
which conforms to the other chapters of the GUIDE.

As in the Standards of the Association of Hospitals and

Institutional Libraries of the ALA, no attempt was made
to give definitive figures in the body of the recommenda
tions, but Appendices have been added detailing minimum
figures and measurements.
Members of the Working Party which drafted the
Standards were:
Mrs. Muriel A. Flower, Librarian,
Ontario Medical Association.
Mrs. Beatrix H. Robinow, Associate Committee on
Medical School Libraries, Association of Canadian
Medical Colleges, Health Sciences Librarian, Mc
Master University.
Mrs. Sheila Swanson, Chairman, Health Sciences Divi
sion of the Canadian Association of Special Libraries
and Information Services, Librarian, Academy of
Medicine, Toronto.
Miss Jane Wachna, Librarian,
Canadian Hospital Association.
The task was undertaken in response to requests from
the Associate Committee of the ACMC and from the
CASLIS Health Sciences Division (Canadian Library As
sociation), following decisions taken at meetings in 1971
and 1972.
Patient libraries have not been discussed at all. Usually
the provision of library services to patients in general
Auxiliary
hospitals has been undertaken by the Women's the
local
of the individual hospitals, often helped by
Public Library. In a very few cases, patient libraries may
be supervised jointly with the staff libraries, but the gen
eral principles governing such libraries would be those
of a public library system. In psychiatric hospitals where
bibliotherapy may be more actively undertaken, the serv
ices would still relate basically to the local public and
school library systems.
Although the title of this document names Hospital
Libraries, it is felt that the same standards would apply
to Community Health Centres and to other health re
lated facilities visualized in federal and provincial plan
ning. Physicians and other Health personnel in such
centres would need information and material in exactly
the same way as personnel attached to community hos
pitals, or teaching, psychiatric or chronic tohospitals.
establish a
In these standards we have attempted
pragmatic minimum which we know to be demonstrably

?Prepared by the Ontario Medical Association in co-operation with other health agencies and approved (1975) by the Canadian Medical Association.

CMA JOURNAL/MAY 17, 1975/VOL. 112 1271

higher than the level of service offered in many institu

across Canada. It is a directional goal which we
hope will encourage many hospitals to improve their
libraries. On the other hand, some libraries in teaching
hospitals in Quebec have advanced well beyond the stand
ards suggested and therefore find them to fail short of
the personnel and collections needed to support their
tions

programs.

STANDARDS FOR LIBRARIES IN

CANADIAN HOSPITALS

Principle
provide library

The hospital shall

service appropriate
the professional, technical, educational and adminis
trative needs of the medical and other hospital staff.
Standards
Standard I
Objectives, organization and
administration
Standard II
Staffing and Personnel Qualifications
Standard III
Nature and scope of Services
Standard IV
Facilities and Equipment
Standard I
The Health Sciences Library shall be organized as a
department of the hospital to provide for the information
needs of the other departments of the hospital.
to

Interpretation
The library should be organized to give active support
to the philosophy and day-to-day activities of the hos
pital. The rapid advance in medical and scientific research
has produced an enormous quantity of literature in medi
cine and related subjects and hospital staffs should have
the same ease of access to information as they do other
diagnostic and therapeutic services.
To accomplish this objective, all hospital libraries
should be capable of providing information:
1) in support of patient care
2) in support of the educational and continuing educa
tion programmes of medical and other hospital staff
3) to keep personnel aware of new developments in
their own fields
4) in support of any special function of the institution
5) in addition, certain hospital libraries should be
capable of providing information in support of

clinical research.
The extent and scope of library service will vary with
the size and responsibilities of the hospital, and must be
considered in relation to other local, community and re
gional resource libraries.
The library should be conceived as a line department
of the hospital, directly responsible to the administration.
It should have its own independent budget funded by the
hospital. All library services, including budget preparation
should be combined under the administrative control of
the librarian.
An advisory committee should be established to aid the
librarian. Its members should include representatives from
clinical, research, technical and administrative depart
ments, and over a period of time should represent all
levels of hospital personnel. This committee should fulfil
two roles. As an advisory body it should help to formulate and evaluate the policies for library services and
should find ways to solve problems of interaction and
finance.
In many cases the Education Committee of the hospital
could act as its Library Committee. As an interdisciplinary

1272 CMA JOURNAL/MAY 17, 1975/VOL. 112

body it should assist in maintaining liaison between the

library and its users. The committee should meet regularly and frequently.
Standard II
All library

personnel should be prepared for their

responsibilities through appropriate training, or through
in-service training and educational programmes.
Interpretation
The quality of the library staff is the single most im
portant factor in the effectiveness of library activities. The
purpose of the librarian is not to act as custodian of this
collection, but to use technical knowledge and training
to exploit the book stock to the full and to provide an
information service. Personal qualities include good
judgement, flexibility, tact, poise, initiative and a primary
interest in serving the information needs of hospital work
ers. The numbers and types of library workers appropriate
to various levels of services are discussed in Appendix I.
Wherever possible, a qualified professional librarian
with experience in a health sciences library should be in
charge. Where this is not possible, professional supervi
sion in setting up and maintaining the service should be
sought through co-operation with other hospitals in the
area or through a regional service.
Support should be provided for library staff members
to attend workshops, library technicians' courses, profes
sional association meetings, or to enlist any other method
of increasing their competence which may become avail
able.
Standard III
The library shall provide books, journals and nonprint
materials with adequate bibliographic sources and indexes
to provide information and reference service in support
of its objectives. It shall provide a document delivery
service: that is, provide books and periodical articles,
either from the library's own collection or by borrowing
from other sources.

Interpretation
Services and supporting technical functions of the
library should include:
the selection, acquisition and organization of books,
journals, reports, audiovisual and nonprint material
the provision of reference and bibliographic ma
terials and indexes and the ability to provide from
these, citations and answers to questions
the development of relationships with other libraries,
both local and regional, for their mutual benefit and
to establish a system of interlibrary borrowing and
lending.
The quality of the collection of books, journals and
other materials is more important than the quantity, al
though it must be recognized that a small collection will
have only limited use. There should be available current
and basic texts reflecting the interests of the hospital with
emphasis on any special service, such as bibliotherapy in
a psychiatric hospital, or regional service, such as dialysis
units, poison centres, ete.
Journal titles, both general and special should be ap
propriate to the size and function of the hospital. They
should provide information well beyond immediate pa
tient care requirements. Indexes to the journal literature
are of utmost importance and should include those to the
medical, nursing and hospital administration material.
Numbers of books and journals appropriate to the func
tion of the hospital and a bibliography of basic book and
journal lists may be found in Appendix IL
.

Standard IV

Adequate physical facilities shall

be made available for

the library.

Interpretation
The library should be conveniently located and readily
accessible to all potential users. The area should be
reserved for library purposes.
Space is required for:
1) users, with suitable seating and writing tables, and
areas for using nonprint material.
2) collection according to kind: books, journals, refer
ence books, indexes and audiovisual aids.
3) work space for library staff.
It is essential to recognize that work space is necessary
for library functions such as acquisition, cataloguing, typ
ing, filing, processing new material and preparation of
volumes for binding.
In planning library quarters, consideration should be
given to potential growth for several years. Physical con
ditions such as lighting and heating must be adequate.
Library materials must be protected against loss or dam
age.
Some formulae for space requirements are to be found
in Appendix III.
APPENDIXES

Appendixes are guides only, to be used as start

ing points for the design of library and information serv
ices. As minimum standards they should be expanded and
improved upon as far as possible. It must be understood
that where teaching hospitals are concerned, local arrangements have to be made between each Medical School
and its affiliated hospitals. Since these are minimum
standards, they should be expanded and improved upon
These

in order to serve the best interests of teachers and stu

dents across the country.
APPENDIX I
Personnel
The number and kind of personnel required and the
functions of the library have a direct relationship to the
kind of institution and its scope. "Number of Beds" has
often been used as a determination of the requirements
of the library service and the size of the library, but this
can only be a rough estimate. There are now many insti
tutions with a large out-patient population and a busy pro
fessional staff which are in no way measured by the
small number of in-patient beds. The number of profes
sionals might be a better guide: this includes physicians,
dentists, nurses, pharmacists, technicians and therapists
of all kinds, with a further consideration of number of
specialties and of teaching and research programmes. The
ACBLF standards specify categories of hospitals rather
than bed size. They have been modified as follows:
Category 1 has the following characteristics:
a) The hospital is affiliated with a Faculty of Medicine
of a University.
b) It is accredited for internship and residency in vari
ous

specialties.

c) It maintains research projects.

d) It has a medical staff of at least 200 physicians,
residents and interns, and appropriate supporting
staff.

Category

a) The hospital has two of the characteristics a, b or

c,

of Category 1.
a medical staff of at least 100 persons, and
appropriate supporting staff.

b) It has

Category 3
a) The hospital does

not qualify for Category 1 or 2,

but has 300-499 beds.
Category 4
a) The hospital does not qualify for Categories 1, 2
or 3, but has 100-299 beds.
Category 5
a) The hospital does not qualify for Categories 1, 2,
3 or 4, and has less than 100 beds.

Category

1
1 Librarian
1 Library Tech.
2 Clerk/Typists

Category

2
1 Librarian
1 Library Asst.
1 Clerk/Typist
Category 4
1 Library Asst.

Category

3
1 Librarian
1 Clerk/Typist

Category 5
part-time
or Technician
Library Asst.
The Librarian in charge should be a fully qualified
professional librarian with an academic and a professional
degree, preferably Medical Library Association certifica
tion, as well as experience in health sciences libraries. A
library technician can be a graduate of a Community Col
lege; Library Technician's course, or in some cases a
Library Assistant who has had three or four years of
health sciences library experience supervised by profes
sional librarians.
Although it is not likely that the very small hospitals
can afford to hire a full-time professional librarian, every
effort must be made to have a full-time assistant who has
at least a year's experience in a health sciences library,
and who can be supervised and directed by a professional
librarian. This supervising librarian may be employed
jointly by a group of libraries or by a provincial body.
Even when only one assistant is looking after the library,
some arrangement should be made for help in keeping
the library open and supervised during lunch and coffee
breaks.
A part-time library assistant in a very small hospital
should also be supervised by a professional librarian.
"Part-time" should mean regular hours for library duties,
A

fifteen hours per week.

APPENDIX II
Books and Journals
The following suggested figures for each category of
hospital should be recognized as minimal. New titles
should continue to be added annually and new editions
acquired as they appear. The disposal of out-dated ma
terial should be a regular part of the selection process.
Journals should be kept for five years or longer, ac
cording to local resources and circumstances.
Periodical subscriptions should absorb from 60-75%
of all the acquisition budget.
at least

Hospital Category
Current book titles

4
312
5
1000

Journals
Medical

Nursing

Administrative (Hospital)
Other Allied

750

500

200

50

2000+ 75

35
5
5
5

20
3
3
3

15
3
2
2

20
10
15

10
10
10

Reference Works
In addition the following reference works should be
available to every hospital library:
1. a current standard dictionary
CMA JOURNAL/MAY 17, 1975/VOL. 112 1273

2. a current medical dictionary

3. Index Medicus for categories

Abridged

Index Medicus for

International

Nursing

Index

1, 2 and 3

categories

or

4 and 5
Cumulative Index to

Nursing Literature
Hospital Literature Index

4. Canadian Medical Directory (Toronto; Seccombe

House. Annual)
5. Canadian Hospital Directory (Toronto, Canadian
Hosp. Assoc. Annual)
6. CPS
Canadian Pharmaceuticals and Specialties

(Toronto, Canadian Pharmaceutical Assn.)

7. Location of journals indexed in Index Medicus in
Canada (Ottawa, National Science Library)
8. Guide for Canadian Health Sciences Libraries
(Ottawa, Canadian Library Assn. In Press)
9. Ontario Council of Health, Monograph no. 3 Audiovisual Systems, Toronto, Ontario Queen's Printer,
1971.
Pamphlet Material
There are many publications of value to the library
which come in pamphlet or unbound form; some of this
is obtainable free from drug companies of Health Asso
ciations. Further, legal documents such as Hospital Acts
should be available in the library and anything published
by the Hospital itself should be kept as archives. Serial
publications of this sort should be treated as periodicals
and other pamphlets kept in files.
Lists of recommended material
There are many lists of recommended books and
journals; the so-called 'core' libraries. Of the following
list the first three are Canadian examples. All are updated
at regular intervals.
1. Division of Continuing Medical Education,
University of Saskatchewan, Saskatoon.
Guide for developing a basic 'core' library for
physicians in Saskatchewan. #1, 2 and 3.
no reference works, no nursing or adminis
tration
obtainable from the Division
2. Ontario Medical Association. Committee on Medical
Library Services.
Suggested basic book list.
Additional suggestions
obtainable from O.M.A., 240 St. George St.,
Toronto, Ontario.
3. Les Bibliotheques des Hopitaux d'Enseignement Affilies a l'Universite Laval. Rapport d'Enquete
1971. Annexes III, IV, V
(Lists for French collections.)
4. Stearns, N.S. and Ratcliff, W.W.
Health-science core library for physicians, nurses
and allied health practitioners.
New Eng J Med 283;1489-98, 1970.
5. Brandon, A.N.
Selected list of books and journals for the small
medical library, 5th revision.
Bull Med Lib Assoc 61:179-200, Apr. 1973.
6. Duncan, H.F.
Selected reference aids for small medical libraries.
Bull Med Lib Assoc 58: 134-158, 1970.
APPENDIX III
Facilities
and
Planning Premises
have been the result of an
libraries
Too many hospital
is being planned or
new
a
When
hospital
afterthought.
an existing one improved, it is essential that consultation
take place between the hospital planning authority, the
architects, an experienced qualified librarian and the
library committee or a panel of users.
.

1274 CMA JOURNAL/MAY 17, 1975/VOL. 112

Different minimum standards have been laid down in

different publications, but the final decisions must be made
according to the kind of institution and its special need.
Certain basic elements will be found in all libraries:
Location of the library should be central and convenient.
It should be easily supervised. While extended hours are
important for maximum service, it is not necessary for the
premises to be open day and night. Arrangements should
be made for staff members to gain access in cases of
genuine emergency.
Library area for users: estimated on one-sixth of potential
users of all kinds. Space for users should be 25-30 sq. ft.
per reader, which includes table, chair and aisle space.
The minimum size of the area should be 500 sq. ft., and
one seat in eight should be in the form of a single study
carrel, normally 35 sq. ft. There should be a bulletin
board in that area, and a display shelf for new books and
other material.
Shelf space for material: a ready rule of thumb is 10 books
per sq. ft. of stack area, or 85 medical books per stack
unit of 7 shelves, 3 ft. in length. A depth of 8 inches is
sufficient if there are no backs to the shelves, otherwise
10 inches with backs. Ranges of shelves should have
aisles a minimum of 34 inches wide. Provision should be
made for the display of current periodicals and the use of
indexes on a suitable index table. Floors must meet weightbearing standards.
Space for library staff: a single librarian requires 125 sq ft.
for her desk and working equipment, which should be
situated near the entrance/exit of the library. From this
position both reference and circulation services can be
provided. In multi-staffed libraries these two functions
could be separated, and the space increased to accommodate the number of workers on duty together.
Workroom and preparation area: for packing, unpacking
and processing of library materials, recording periodicals,
ete, working space is calculated at a minimum of 100
sq. ft. per library staff member. In many small libraries
a glass division makes it possible for the assistant on
duty to supervise the library, even when not at the desk
near the door. The library should contain a telephone, a
typewriter and cupboards for stationery. There should
also be easy access to a photocopier.
Facilities for special materials: even where the library does
not possess audiovisual material, thought must be given
to the future development in this area and provision made
for housing and using play-back equipment of various
kinds. White walls can be used for projection screens and
earphones may be necessary for individual study. If the
hospital maintains a separate audiovisual production de
partment, the AV technician may help to service the
library equipment. Audiovisual software should be regarded as library material.
Discussion study rooms: a separate room adjacent to the
library can be a great asset. It can be used for group dis
cussions, journal club and other meetings, viewing films
and videotapes, or as additional reading space.
Storage: provision should be made for storage of duplicate
and older material which is to be kept for a while or to
be disposed of. Such storage can be in a less centralized
area of the hospital, but only the librarian should have
access to it.
Maintenance: must be adequate. Wall and floor finishes
should contribute to light diffusion, noise control and
elimination of glare. Heating and ventilation should conform to the standards of the hospital. Suitable housekeeping services must be provided.