Associate Director

Library Operations

National Library of Medicine

There is a Spanish proverb: He who does not look ahead remains behind. Most successful professionals spend considerable time looking ahead, thinking about what will occur in the future. Even sports figures like Wayne Gretsky, possibly the greatest hockey player of all time, make statements about the future. He is reported to have said, I skate where the puck is going to be, not where it has been. Think about soccer. Picture in your mind what kind of a game it would be if the players all ran to where the ball had been. Successful players play the game based on where the ball is going to be. Most of you are at this conference because you are looking ahead; in your professional life you want to be running to where the ball is going to be.

This is easier to say than to do. Unsuccessful players do not know where to position themselves to get the ball. The best soccer players correctly anticipate where the ball is going to be, know where other players will be, and have the skills to score with the ball. Soccer players however have three advantages. The game last a finite time; there are rules for playing; and there is a prescribed playing field. Planning for health sciences librarianship enjoys none of these advantages. My assignment today is to talk about strategies for health sciences librarians for the future. What are the skills you need to be successful in handling health sciences information and anticipating where the profession, libraries, and the people to whom we provide information will be? My talk is divided into two parts. First, I will talk about some general skills which I believe are important both today and in the future. Some of these may seem self-evident to many of you. I believe they are very important and I often see people who are not applying them. Second, I will suggest some special skills that I believe are increasingly important for the future. First, the general skills which will help you now and in the future.

Although there is no known written language for the pre-Columbian tribes, a rich tradition of myths, legends, and folklore was passed on from one generation to the next. In some tribes certain members were entrusted with the knowledge of the past which they committed to memory and taught to the next generation. In others stories or poems of the past history were taught to the children and then to their children. The Incas had an interesting process of passing on knowledge. Quipus were used to record numbers, using many strings of different colors the Incas kept an accurate count of many things such as supplies, census, etc. It has also been reported that when a noble died the wise men of the tribe came together to decide the facts of the noble's life which should become part of the official Inca history. The quipu, consisting of a series of knots on strings, was used as a memory aid. The color, size, and way in which each knot was tied indicated something to the quiposcamayo, the quipu reader. You can see quipus in museums and a search of the Internet yields more than thirty possible sites using the term.

My career in health sciences librarianship has lasted more than three decades. As a professional I have witnessed and participated in two revolutions, one in computers and the other in telecommunications. Both revolutions have significantly changed and continue to change the way in which libraries and librarians function. Peter Drucker said in Managing for Results, We know only two things about the future: It cannot be known. It will be different from what exists now and from what we now expect. [1] How can you develop strategies for what cannot be known? Using the Inca model, you each can make a quipu as a memory aid for the four general strategies I have found to be the most important.

The first knot is for performance. The best strategy for anyone is to develop a reputation for getting things done. By done I mean producing a high quality product, on time and without irritating or alienating people. Peter Drucker in his book Managing for the Future: the 1990=s and Beyond has a chapter on leadership. He reports that seminars on leadership are the rage just now. He is often asked to conduct seminars on leadership which one human resources vice president described as Acharisma. Drucker decries the perception that every CEO has to be made to look like a dashing caballero, a boardroom pop star like Elvis Presley, or a stand up comic. Leadership, he says, does matter, of course. But, alas, it is something different from what is now touted under this label. It has little to do with >leadership qualities and even less to do with >charisma. It is mundane, unromantic and boring. Its essence is performance. [2] He goes on to assess some of the world's greatest leaders, some in unflattering terms, and describes effective leadership. Effective leadership, according to Drucker, is thinking through the organizations mission, defining it and establishing it, clearly and visibly. The leader sets the goals, sets the priorities and sets and maintains the standards. [3] Drucker also points out that the effective leader makes compromises with what he calls the constraints of reality. He also points out that leadership involves responsibility, not privilege, and requires strong and talented associates and subordinates. Ultimately the leader must earn the trust of those he or she works for and those who work with and for him or her. The first knot on your quipu is for performance. Your best strategy for the future is to demonstrate the ability to define a job that needs to be done and organize the people and other resources to do the job well and on time. This strategy is an enduring one, irrespective of the changes occurring around you.

The second knot is for life long learning, continued professional development. Morris Weeks has said that more is needed than mastery of subject matter; mastery of learning is essential. Life long learning is a phrase currently in vogue. Administrators and managers are beginning to understand that the rapidly changing technology means that a professionals education is out-of-date the minute after graduation; however, they often don't understand that this means a commitment of the time and money to support learning opportunities. It is essential that you keep up-to-date. A meeting such as this is a good way to learn about new trends and obtain new skills, but it is not always possible to attend meetings. If you live in a city where there are other health sciences librarians or information specialists, you might try meeting with them a few times a year to discuss issues or new technologies. Each person in the group can take a turn at planning the agenda. You can also pursue life long learning on your own because an ever increasing amount of information is available on the Internet. You must however allocate time to explore the Internet world and to revisit some sites regularly to see what is new. Think of the Internet as your library and read some of the available materials. Think of yourself as an explorer and sail through unknown seas of information remembering to mark in your log book how you got to them so you can easily return.

Several institutions and associations are experimenting with distance learning, some through the Internet. National Library of Medicine (NLM) has issued challenge grants to a small number of institutions involved in the education and training of health sciences librarians. These grants are to explore new ways to teach individuals the skills necessary for health sciences librarianship. One of these institutions is Johns Hopkins University which is experimenting with distance learning. You might want to visit their site at [http://www.welch.jhu.edu/cthsl/]. Distance learning is something for BIREME or PAHO to consider testing.

I would be remiss if I didn't mention the NLM home page [http://www.nlm.nih.gov] as a site worth visiting regularly to keep up with changes in NLM, its services and its databases including MEDLINE, and the toxicology and biotechnology databases. Learning throughout your life is represented by the second knot.

The third knot is to remind you to try new things or try to improve services or programs. Be flexible; be an adopter of new technology. Be interested in improving programs, services, and processes in your library. Change is a fact of life. You must continue to change in order to live. Look for new projects which others are trying or that you read about in the literature. Investigate projects supported by your institution, professional association, your government or PAHO. What is the computer department in your institution doing? Is there a role for you and your library? Will this role provide important information to your institution? Seek and welcome change; it offers you new opportunities. Of course, it may be uncomfortable at first but so was learning to walk many years ago. Learning a new skill or role involves a period of discomfort.

What are some things to consider? If you do not already do it, teach users to do some of their own searches. You will demonstrate your knowledge and you will encourage your users to seek information more frequently. Many users hesitate to ask a librarian but will search on their own. Sometimes health professionals have time to search when the librarian is not available. Data collected at the National Library of Medicine show that 50% of health care providers search most often from home and almost 80% of the scientists search primarily from their offices. Develop a home page for your institution and offer to maintain it with the help of an advisory committee including some influential people. Offer to help an editor of a journal check the references in manuscripts before they are published to ensure that the bibliographic citations are correct. A large percentage are not. Find out from the administrator of your hospital or clinical facility the diseases for which individuals are most often admitted or the surgical procedures most often performed and searched the literature to identify the most recent high quality reviews, clinical trials, clinical practice guidelines for these disorders or procedures and distribute the citations or post the articles. Obtain the software to enable you to obtain documents electronically so you can provide a fast service.

The fourth knot is to remind you to be aware of what is going on in the rest of your institution, in your profession and throughout the world. Drucker calls this walking around-outside. What are your users thinking? What are they doing? What is your administration thinking and doing? I don't know who said it, but the following is certainly meaningful. A frog can relax in a pot of hot water and not notice the temperature rise. Many managers relax and ignore changes occurring in their environment. By the time they wake up they, like the frog, are boiled. In a speech years ago I told the story of a tribe of people who lived by fishing and farming. They caught enough fish and grew enough vegetables and fruits to feed their people. They taught their children fishing and farming. They were happy and never left the village and the near by land. Many miles upstream another tribe was busy building a dam. One day the stream the tribe depended on for its fish and to irrigate its lands was no more. The dam ended the flow of almost all the water. Don't be like the downstream tribe. Become aware of what is happening in your environment that may affect you and what you do. You need to know in order to develop survival skills or to work with the other tribe to ensure that enough water remains available to support your activities. Visit the chief of the departments in your institution. Find out what their information needs are, how they obtain information now, and how you can help them in the future. You will find this a good opportunity to describe some of the new services of your library and how these services might help the people who work in that department. It will not surprise many of you to discover that some of the chiefs will not know what information services are available or what you could do for them. That is why you want to start by asking them what their information needs are. If they can't tell you, try asking them to describe some of the activities in which they are involved. You can think of many ways to help them if they are involved in research, clinical care, teaching, and publishing. Even administrators can be helped, although often not as easily. As an example, look to see if there is a disaster preparedness committee in your institution. You can provide information from the DESINDEX database on the LILACS CD-ROM. Copies of the articles and other documents are provided by the Regional Disaster Documentation Center in Costa Rica.

You should now have four knots in your quipu to help you remember the four general strategies for the future: performance, life-long learning, flexibility, and maintaining an awareness of what is happening in your environment. I would now like to mention three specific strategies necessary for the future. In this instance the future is defined as the next five years.

First, since technology will continue to play an increasingly important role in our profession, it is, therefore, essential that you develop and continually update your technical skills to understand and to use computer hardware and software and the telecommunications technologies. You need not know how to do object-oriented programming or be able to select the specific routers to be used in a local area network. You do need to know enough to understand if the technical people have developed a plan that is workable and which employs the most tried and true modern capabilities. You need to keep track of the cutting edge technologies, their shortcomings, who is using them, and where these technologies are successful. Currently you need to understand what the Internet is, what a browser like Netscape does, how to use common application software such as word processing and spreadsheets, etc. You need to understand the strengths and limitations of various technologies, such as CD-ROMS, BITNET, E-mail, etc. You need to understand the significance of common protocols and platforms. It is important to keep your technical skills up-to-date. Technology is changing so rapidly that maintaining some level of current proficiency is very difficult.

The question is how to keep current. I have the following advice for those who want to try. First allocate time to keeping up-to-date as part of your life long learning. Second, if you are in an institution which has a technical department, go see them, ask how they keep current, and see if you can avail yourself of some of their methods or research. Third, find sites on the Internet on which current information is being exchanged. Fourth, find a couple of newspapers or magazines that review current technical advances and read them. It helps to discuss the articles you read with others to reinforce what you have read. Fifth, help others keep their technical skills up-to-date. When you have that responsibility, you will seek out the new technologies and you learn by teaching and answering others questions. Talk to people at this conference and see how they keep up-to-date. The most important thing is, however, to allocate the time to doing this. Remember it takes a lot of work to keep up-to-date.

Because technology is advancing so rapidly, experts are needed in every field. It is impossible for everyone to know everything. This means that people in leadership positions will spend much of their lives working in groups composed of individuals from other fields. This brings me to the second strategy, the ability to work successfully in groups of people from other disciplines. The first challenge in working in groups is to understand the group's mission and authority. What is the group expected to do? By when is the task to be done? What resources are available to the group? There are, however, skills necessary to work within such a group that you should cultivate. These skills include the ability to listen, for everyone has something to contribute. David Schwartz in The Magic of Thinking Big wrote Big people monopolize the listening; small people monopolize the talking. [4] It is important in groups to help everyone contribute to the best of their ability. Value each member for his or her contribution and help each to feel like a valuable member . Everyone wants to feel that they have contributed something of value. I learned this many years ago in a hospital working group in a training seminar. The group included a number of administrators and a Cuban immigrant woman from the housekeeping department. The group's task was to draw a pictorial representation of leadership. The woman, who spoke little English, sat without saying a word while the five others in the group discussed the project and ideas for 15 minutes virtually ignoring her. I guess we expected her to interrupt and voice her ideas. She did not. When time was almost up and the rest of the group had agreed on the idea they were going to use in the drawing, someone turned to the woman and asked her what she thought of the idea. She said she thought leaders needed followers, an aspect of leadership completely missing from what was being proposed. The group's idea was redone and she was asked for her input regularly during the revision process. The result was 100% better than it would have been without her idea. The members of the group learned an important lesson - everyone can contribute but not everyone will interrupt or be assertive about expressing their thoughts.

Another skill to develop is the ability to express your opinion or contribute the relevant information you have clearly, factually and succinctly. Know the point you want to make and state it using words the group will understand. An additional useful skill in such situations is the ability to listen for and articulate areas of perceived consensus. It is important in groups of diverse experts to build the group's consensus. A consensus forms the foundation from which the group can explore ideas and action plans about which there may be some difference of opinion.

One of the Grimms fairy tales is the story of a motley group of four animals who managed to form a successful group The story starts with a donkey who after many years of faithful service had become too old carry the heavy sacks of grain. The farmer felt that he could no longer afford to feed the donkey because the animal could no longer work effectively. Fearing the worst, that he would become donkey sausage for the farmers breakfast, the donkey ran away. Deciding that he had a good baritone bray, he resolved to go into town and join a band of street musicians. On the road to town he saw an old hunting dog lying by the road uttering an occasional bass bark. The dog had also run away from his master, a hunter, because he had arthritic joints and could no longer quickly retrieve the fowl the hunter shot. The donkey invited the dog to join him and they both went slowly down the road. Soon they met a sad looking cat. The cats story was similar. She was no longer able to catch mice and her mistress was threatening to drown her. Join us, the dog and donkey said. Your alto meow would be welcome. Further down the road the three encountered a bedraggled rooster crowing so loudly they stopped. The rooster was soon to become chicken soup and to avoid that, he too joined the fleeing animals as a falsetto soprano. Toward nightfall the four found a small forest where they began to settle for the night, although they were getting hungry. As it became darker they could see a light through the trees and went to investigate. They found a cottage and through a window they could see a table piled high with wonderful things including lots of food. Seated around the table were five robbers. After some discussion the animals decided on a plan to scare the robbers away and have the cottage to themselves. At the donkey's signal, they all made noise as loudly as possible. The donkey brayed, the dog barked, the cat shrieked and the rooster crowed. In the midst of this noise all four plunged through the window. The robbers were frightened and thinking that demons were attacking, they fled, screaming into the woods never to return. The four animals made themselves at home, feasted and settled for the night. The next day they decided to stay in the cottage, make it their home, and make music together. They became known as the Bremen-town musicians, a somewhat unlikely group of experts.

What is the significance of this story for you and me? Those were four animals who were thought to have outlived their usefulness. They weren't valued experts. The idea of the four of them living in that cottage for long and making music is ludicrous. Why did I tell this story? Well, there may be better stories illustrating group participation. I couldn't think of one and since I first heard this story as a child I was skeptical of this unlikely group of animals living together and making music. Although recently while stopped at a traffic light, I heard a tape playing in a car next to mine which I think they might have made. If so, they become a commercial success.

Individuals from diverse backgrounds can work together pursuing a common goal with each member of the group making a valuable contribution. Often the success of each individual's participation, or participation of the group as a whole, is a function of the group's charge, how the group is led, and the dynamics among the members. There are skills you can develop as a junior or mid level health sciences librarian working in groups, especially groups composed of professionals from other disciplines. Help the members clarify what is meant. Practice your listening skills. Listen for words that may have different meanings between professionals in different disciplines. Practice your participation skills. Practice your consensus building skills. Get experience with good group leaders. These are skills you will need for the future.

The third and last strategy specifically for the future is to improve productivity in the information service area. Many libraries are funded with public money. Services funded with public or tax moneys are being reduced in many parts of the world in order to reduce governmental deficits. Many Libraries supported by public money will be facing shrinking budgets in the future, if we aren't already. Peter Drucker says that, in knowledge and service work, improved productivity can only be accomplished by working smarter. He points out that working smarter is not working harder. Working smarter emphasizes performance, both the quality and quantity of the results. He says that in order to work smarter we need to ask ourselves three questions. What is the task? What are we trying to accomplish; that is, what is the real goal? Why do it at all? He points out that the greatest increases in productivity often come from redefining the task and when possible eliminating work or continuing to do a better job of what we already do well.

Let's look at one example. When computer searching was first used to retrieve citations to prepare a bibliography for a patron, reference librarians saved the request and a copy of the retrieval in case the question was asked again. The idea was if the same question were asked the reference librarian would pull the search formulation and the retrieval from the file and just update the search results. What was the task? The task was to prepare a bibliography using the computer to search an index to the literature. The goal was providing the citations to the user. Why save these searches? Well, the librarians thought it would save them time in the future. Also if they had formulated a good search, they could use that formulation and be assured of good search results in the future. Thus in many medical school libraries librarians were photocopying formulations and results and filing them. How often did the librarians look at the file to see if a user had made the same request earlier? Almost never! How often did users come in with the same request, even months later? Very seldom! This would be a good process to eliminate and thus save the librarian's time which can be spent on a new service or some activity which is more productive. I am certain if you think about it, you can find processes in your library which do not contribute to the staff's productivity. Eliminate them! Use your resources for productive work.

Thus the strategies for the future are: technical competence, ability to work in groups of people from diverse fields, and an emphasis on productivity.

Charles Wilson, president of General Electric, was asked how his experience as president of a large company could apply to the presidents of small companies. Wilson answered that when he was just a boy he worked for a dairy filling milk bottles. The bottles were different sizes. Some were pints, quarts, half-gallons, and others gallons. Working in the dairy he learned that no matter what the size of the bottle, the cream always came to the top. No matter what size library you work in, you can work to be the cream and rise to the top. Earn a reputation for performance, continue to learn throughout your life, be open to new ideas and be aware of what is going on in the world which will affect you. Add to that technical competence, the ability to work in groups of people from diverse fields, and emphasize productivity. You will rise to the top.