View from the 5th – November 2010


The Best of Times, The Worst of Times

Image of Carol Jenkins

As the director of the HSL for nearly 25 years, it has been an honor to lead one of the few libraries in the nation to serve five schools (Dental, Medical, Nursing, Pharmacy and Public Health), as well as a large healthcare system and the general public. The changing “View from the 5th” floor of our library is testament to the expansion of learning, teaching, research and patient care in the health sciences at Carolina. As I write, the Dental School’s new addition is rising up impressively in the shadows of our library.

As our users have grown, we have grown. As their needs changed, we changed to meet them. But our current situation brings to mind the famous opening line of A Tale of Two Cities: “It was the best of times, it was the worst of times.” As “Helping UNC Health Care Implement Performance Improvement and Best Practices” illustrates, the HSL has implemented innovative new ways to serve our constituents better.

But we also face pressures from reduced state funding, rapidly changing technology, and skyrocketing cost of scientific journals. “Economic Environment Puts Pressure on Library-Publisher Negotiations and Journal Renewals” provides an interesting insight into how we and other similar libraries are handling some of those pressures. Two other stories (“Honoring the Legacy of Dr. Wilcox: HSL to Rename Historical Collection Reading Room” and “Special Collections Receives Digitization Grant“) illustrate how significant gifts and grants can help us continue to be innovative.

If your generosity has already been directed toward our library this year (2010-2011), thank you. If you would like to make a gift, you can do so quickly and securely via our online giving page, or by contacting Dwain Teague (919-962-3437 or for more information.

Thank you for your interest in what we do to support the vital teaching, learning, research and patient care that takes place every day at UNC Chapel Hill.


Carol Jenkins, Director
Health Sciences Library

In this Issue:

Behind the Scenes

Helping UNC Health Care Implement Performance Improvement and Best Practices


Image of Jean Blackwell

When UNC Health Care made the headlines for reducing bloodstream infection by 85 percent over the last decade, very few people would have thought about the UNC Health Sciences Library (HSL)’s role behind the headline. But “behind the scenes” is often where you’ll find HSL and the institution’s librarians.

As the Director of Performance Improvement at UNC Healthcare, Larry Mandelkehr leads a team that oversees and/or assists with 30-40 ongoing quality improvement activities, clinical and operational, large and small scale. Each one influences the way UNC Healthcare operates and treats patients. So when Mandelkehr says, “I tell everyone I know about Jean Blackwell,” it’s worth finding out more about what Jean Blackwell does.

Blackwell is the HSL’s UNC Health Care Administration liaison*. In that capacity, she provides knowledge-based information to hospital managers involved in patient safety, quality improvement, risk management, and operational decision making.

Looking to the future, Mandelkehr sees a direct correlation between the future economic health of the UNC Health Care and the information that the HSL provides via Blackwell, as well as other valuable HSL resources he and his team have access to. For instance, Mandelkehr says the day is rapidly coming, if it hasn’t already, when hospitals won’t be paid for Medicare and Medicaid services if the hospital hasn’t implemented and adhered to established best practices. Since this represents a significant portion of UNC Healthcare’s revenue, any threat of nonpayment is taken very seriously. He also describes how Blue Cross Blue Shield and other health insurers are pressuring hospitals to be on the cutting edge of patient safety or they will reduce the amount the hospital is reimbursed for its services. This pay-per-performance or repayment-driven-by-performance model can have a dramatic negative effect on a hospital’s bottom line if it doesn’t have access to the information they need.

“The only way we’re going to succeed in the future is by keeping ahead of the game and keeping on top of best practices,” says Mandelkehr. “In large part we’re going to learn that by working with the folks at HSL, and having access to the vital resources they maintain and manage on our behalf.”

Even though Mandelkehr says he used to live in the HSL but now lives in the library’s virtual presence, if you spend a short time with him you quickly realize how much he values the HSL’s resources, particularly utilizing the E-journals in the HSL’s collection. But it’s also the service he and his team receive from Blackwell that he values.

Proving that the liaison program turns the old model of library services offered only to those who visit in person on its head, Mandelkehr describes Blackwell as welcome addition to a variety of meetings. She is a regular at the monthly Quality Council meetings, during which Mandelkehr, his staff, other administrators, doctors and nurses discuss the wide variety of issues they face related to quality improvement. Indeed as much of Blackwell’s time is spent wandering the halls of UNC Hospitals as it is in the HSL.

“A trained librarian who invests in (my team) is invaluable. We, like our clinicians, are really busy and don’t have the time to filter all the information,” says Mandelkehr.“ Google doesn’t filter the information so we get to what we really need. Nor does is continue to provide information after the fact.”

Opening his email inbox, Mandelkehr quickly finds numerous examples of reactive and proactive emails he has received over the years from Blackwell that are relevant to his and his group’s needs. He also describes how she doesn’t inundate him with information that clutters up his already very busy days.

“(Jean) asks the right questions and understands what it is we need. She narrows down and helps us find what we need,” says Mandelkehr.

Kathleen Lowell, a Quality Manager with Mandelkehr’s team, agrees with her manager’s assessment of Blackwell’s help and support. For three years, Lowell worked with the Commitment to Caring Communication team at UNC Hospitals, a group of people who held daily huddles throughout the hospital to increase staff awareness on a variety of topics. Somehow, Lowell wrote in an email, “Jean was aware that hand washing would be an upcoming huddle topic and she sent an article on hand washing behaviors and motivations.” In another instance, Lowell was working with physicians, nurses and administrators on a quality and improvement team that focuses on obstetrics and newborn care. The team asked Lowell to find more information about a particular quality indicator and Blackwell helped locate articles related to their inquiry.

Furthermore, whenever Lowell begins a new improvement project, she uses the HSL’s online resources to perform a literature search; and it was Blackwell who taught her how to use the online resources. Most recently she was part of the Readmission Task Force, a hospital wide initiative to reduce Heart Failure, AMI and Pneumonia readmissions. The initiative is included as one of UNC Hospital’s incentive goals for the year, and will have reimbursement ramifications in the not too distant future. Lowell says she was able to find more than 20 articles that she shared with the task force members, and that the articles were “a jumping off point for determining the direction our team wanted to go in to improve our readmission rates.”

So, while it is quietly and behind the scenes, it is clear that a strong and supportive HSL is critical to the ongoing and future performance improvements efforts of UNC Health Care. Perhaps Mandelkehr sums up it up best when he says, “We would not be as successful as we have been and/or need to be without the support of Jean Blackwell and the HSL.”

*About the HSL’s Liaison Program

The UNC Health Sciences Library provides outreach to the health affairs schools and to several departments at UNC Hospitals. HSL librarians work with schools or departments on a variety of projects based on their needs and the librarian’s background and experience. Through this work, librarians develop a deeper understanding of the information needs and resources in a field. Their accumulated knowledge directly benefits the schools and departments through high quality customized library services provided to students, faculty, clinicians, researchers, and staff.

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UNC Health Sciences Honors Legacy of Dr. Wilcox

Image of Dr. Benson Wilcox

The UNC Health Sciences Library (HSL) is pleased to announce that its Historical Collections Reading Room will be renamed “The Benson Reid Wilcox Historical Collections Reading Room” in recognition of Dr. Benson Wilcox. The renaming was approved by the University of North Carolina at Chapel Hill (UNC-CH) Board of Trustees during their July 22, 2010 meeting.

Dr. Wilcox, a 1957 graduate of the UNC School of Medicine and a retired heart surgeon who served 29 years as chief of the Division of Cardiothoracic Surgery at UNC-CH, died May 11, 2010, after a courageous battle with brain cancer. He was 77. The director of the HSL Carol Jenkins had told Dr. Wilcox and his family about the library’s intention to rename the room prior to his passing.

In addition to his generous financial support of the HSL, including a $225,000 bequest and $140,000 of in-kind gifts of rare books, Dr. Wilcox had been an active member of the library’s Board of Visitors since 1995. He was also a longtime member of The Friends of the Health Sciences Library, a group whose annual financial support is vital to the daily operations of the HSL.

Starting in 1984, Dr. Wilcox shared his love of rare books with his students by donating a rare book each year to the HSL in honor of one graduating surgical resident. In return, recipients of this honor have given $25,250 in gifts to the HSL’s Benson Reid Wilcox Rare Books Fund, which allows the library to continue to add rare books to its collection.

“I will always remember Dr. Wilcox’s enthusiasm when talking to medical students about how he became a book collector, and how much fun it was,” said Jenkins. “With the renaming of our historical collections reading room, visitors to our library will always be reminded of a wonderful man who recognized and supported the HSL’s central role in the mission of medical education, the pursuit of knowledge, the relationships of early discoveries to current practice, and the passage of wisdom from one generation to another.”

Dr. Wilcox loved history, especially medical history. As a medical student at UNC-CH, he helped found the Bullitt Club for the study of the history of medicine. When he became a faculty member, he began collecting old and rare books about the history of medicine, particularly books about thoracic surgery and the specialties that preceded it. Then, in 1998 and 1999, he donated most of his medical book collection to the HSL. Since then, the Benson Reid Wilcox Collection, cataloged and housed physically and virtually ( by the HSL on the UNC-CH campus, has grown to more than 1,400 books, journals, reprints and other items.

To learn more about Dr. Wilcox’ remarkable medical career, service to others and professional accomplishments, visit

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Economic Environment Puts Pressure on Library-Publisher Negotiations and Journal Renewals

Image of journals

National coverage of this summer’s public dispute (see below for details) between the University of California (UC) and the Nature Publishing Group (NPG) put the challenges that the UNC Health Sciences Library (HSL) faces when negotiating with publishers of academic journals and publications squarely in the spotlight.

The HSL is under enormous pressure to continue providing the very best services for its users, in spite of the adverse economic environment and publishers continuously raising the cost of journals. In recent years, the annual increase in cost for all journals to which HSL subscribes has been 7-10 percent. Sometimes a particular publisher will raise prices considerably more than that. For example, the average cost for each of the 78 NPG titles that UNC-Chapel Hill subscribes to rose 38 percent between 2008 and 2009, a similar kind of raise that caused the UC-NPG tension.

HSL spent nearly $2,260,000 to renew over 5,400 journals for calendar year 2010. Renewing licenses is a lengthy and complicated process, and the HSL carefully examines its subscriptions to journals, both digital and printed, on an annual basis. Recently the HSL conducted a Journal Collections Review to help prepare for reductions to the FY 2010/2011 acquisitions budget. Librarians compiled the list based on a number of criteria, including an in depth analysis of the cost-per-use for each journal. HSL librarians also actively solicited and listened to users’ feedback on the wide range of journals included on the review list. The result of the review was a cut of a little over $100,000 in journal expenses that had as little impact on users as possible.

Cost savings efforts are not only found by looking inward. HSL staff search high and low to find the very best prices for the journals users need, and sometimes the best prices can be found by looking beyond the campus and participating in several consortia that act as “buying clubs”. For example, in contrast to the increase that sparked the UC-NPG skirmish, in 2010 UNC-CH incurred a very small increase per NPG title by renewing via a proposal negotiated by a consortium that the university belongs to. In other cases costs can be controlled by committing to a multi-year contract that offers a deeper discount and smaller price increases over the term of the contract.

Bottom line, HSL librarians, more than ever, are using their experience and skills to manage and maintain an inventory of journals and publications that students, faculty and physicians need. And with budget cuts for next year expected to be significant, those skills will be needed once again to ensure that the HSL continues to support the high level of teaching, learning, research and patient care at Carolina.

The UC vs. NPG Dispute in a Nutshell

According to California Digital Library (CDL), which negotiates the University of California system’s deals with publishers and the University Committee on Library and Scholarly Communication, the Nature Publishing Group (NPG) proposed to raise the cost of California’s license for its journals by 400 percent. In a letter to UC faculty, CDL said that if the publisher wouldn’t negotiate, the system might have to take “more drastic actions” with the help of the faculty. Those actions could include suspending subscriptions to all of the Nature Group journals the California system buys access to—67 in all. NPG responded with a statement questioning the version of events and the facts presented by CDL. NPG’s statement also claimed that CDL had been receiving such a sweetheart NPG deal before that it came at the expense of others. The incident made headlines in multiple media outlets, not least The Chronicle of Higher Education, which published the following stories:

A few months removed from the initial announcement(s), UC and NPG negotiations are ongoing. While this incident caught public attention, it also illustrates the constant challenges that libraries face, particularly during challenging economic times, as they strive to provide users with the resources they need.

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HSL Director Receives Prestigious Professional Award

Image of Carol Jenkins

The Association of Academic Health Sciences Libraries (AAHSL) recently named Carol Jenkins, director of the University of North Carolina at Chapel Hill (UNC-CH) Health Sciences Library (HSL), as the 2010 recipient of the organization’s prestigious Cornerstone Award. The annual award is given to a person whose career has assisted the AAHSL in achieving its mission* and/or had a significant impact on the profession of academic health sciences librarianship.

In a letter, AAHSL President Connie Poole mentioned that Jenkins’ nominators drew particular attention to her leadership role with the AAHSL Future Leadership Committee, a group she co-chaired for six years (2003-2009) and twice served as a mentor for at the HSL. The program, which has been co-sponsored by the National Library of Medicine since its inception, has had a notable impact on the recruitment of talented new directors into leadership positions in academic health sciences libraries. Since 2002, 38 scholarships and 40 fellowships have been awarded to aspiring directors. Over half of the fellows have been promoted to greater leadership roles.

“Carol is an outstanding example of a leader at Carolina who has made a significant impact on our campus, our state and on her profession as a whole,” said UNC Chapel Hill Executive Vice Chancellor and Provost Bruce Carney. “This award is a tremendous honor for her, and it brings great distinction to Carolina.”

Jenkins has directed the HSL for nearly 25 years. Her leadership has coincided with an unprecedented period of growth and change for the HSL and academic health sciences libraries as whole. As a result of the nationally and internationally respected services and programming overseen by Jenkins, the HSL has helped keep the five schools (UNC Schools of Dentistry, Medicine, Nursing, Pharmacy and Public Health) it serves and UNC Hospitals on the cutting edge of health sciences learning, teaching, research and patient care.

As part of the flagship institution within a UNC system that is committed to serving North Carolina, the HSL also plays a critical role in delivering health-related information to the general public and healthcare professionals throughout the state. For example, the HSL maintains NC Health Info, an online guide ( to web sites of quality health and medical information and local health services throughout North Carolina designed to meet the needs and interests of North Carolinians. Additionally, HSL hosts and maintains the North Carolina Area Health Education Centers Digital Library (ADL), an online service ( for healthcare professionals focused on clinical care and continuing education.

Along with her role at the HSL, Jenkins is also an adjunct associate professor with the UNC School of Information and Library Science. Her publications, consulting, and professional presentations are in the areas of information outreach, changes in scholarly publication, new library buildings and preparing health sciences librarians for future roles.

Immediately prior to coming to Chapel Hill, Jenkins was the executive director of the Southeastern/Atlantic Regional Medical Library Services (National Network of Libraries of Medicine) at University of Maryland Health Sciences Library. Prior to that, she held librarian positions at the University of Virginia’s Claude Moore Health Sciences Library and the University of Oregon Health Sciences Center.

Jenkins received the award during the Association of American Medical College’s 2010 Annual Meeting in Washington, DC, on Nov. 8.

*More information about AAHSL’s work and purpose can be found at

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Special Collections Receives Digitization Grant

Front cover of the Health Bulletin of NC

Special Collections at UNC Health Sciences Library (HSL) was awarded $42,675 for year two of a three-year NC ECHO (Exploring Cultural Heritage Online) digitization grant project for the creation of the North Carolina History of Health Digital Collection. Funded by the State Library of North Carolina through the Library Services and Technology Act (LSTA), the 2010-11 awards were announced June 10, 2010 and totaled $4.9 million.

Work on the North Carolina History of Health Digital Collection commenced with a pilot project over two years ago, and through year-one of the grant project (FY 09-10), over 130,000 pages of core journals and books in medicine, public health, dentistry, pharmacy, and nursing from 1849 to the present have been digitized. The digital collection will eventually grow to over 800 volumes and approximately 300,000 pages. This material thoroughly documents the development of health care and the health professions within North Carolina and is thus a significant part of the state’s cultural heritage and history.

While digitized content is also being made available via the Internet Archive, the project is actively developing an integrated web site that will provide consolidated online access and advanced searching functionalities. Moreover, the digital collection will provide historical context for the resources in the various health disciplines and K-12 educational materials for selected content.

HSL Special Collections encompass a wide variety of materials, numbering several thousand items from the 1500s to the present day. Among the collections are many significant works in the history of medicine, dentistry, pharmacy, nursing, public health, and the allied medical sciences. The history of the health sciences in North Carolina is also strongly represented. Just a few noteworthy items among many are letters by Florence Nightingale, Vesalius’ 1543 anatomical classic, De Humani Corporis Fabrica [On the Fabric of the Human Body], Edward Jenner’s 1798 work on smallpox, An Inquiry into the Causes and Effects of the Variolae Vaccinae, and The Confederate States Medical and Surgical Journal.

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Last modified: 01/19/21