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Expert-recommended tasks for hospital librarians during a healthcare system merger or acquisition: an e-Delphi consensus statement

Authors

DOI:

https://doi.org/10.5195/jmla.2026.2031

Keywords:

Delphi Method, Mergers, acquisitions, hospital libraries, hospital librarianship, hospital librarians, M&A, mergers and acquisitions, Consensus, leadership, management, administration, change management, Organizational Change

Abstract

Objective: Limited empirical research is available to guide hospital librarians through a healthcare system merger or acquisition. To address this knowledge gap, an e-Delphi research study was used to develop recommended tasks that librarians should consider when consolidating the delivery of library services to a newly merged, geographically distributed healthcare system.

Methods: This e-Delphi study was conducted and reported according to the Guidance on Conducting and REporting DElphi Studies (CREDES). The expert panel, composed of 29 hospital librarians, responded to four rounds of questionnaires during April to December 2022. In Round 1, the panelists’ qualitative responses were collected and analyzed via thematic analysis to identify potential recommended tasks. In Rounds 2 through 4, tasks were eliminated or prioritized based upon the panelists’ rating of each task using a seven-point Likert scale. Those tasks rated as 5, 6, or 7 by ≥75% of the panelists were included in the final consensus statement.

Results: The consensus statement identifies 330 recommended tasks. Highly prioritized tasks involve cultivating beneficial relationships with others throughout the merger, particularly newly blended library teams, finance and administrative leadership, information technology/services, and vendors. Marketing and outreach activities and physical library space management tasks were not prioritized. The panelists emphasized understanding organizational context and culture throughout any merger.

Conclusions: The recommended tasks can be used by hospital librarians to create an action plan for consolidating and delivering library services in the event of a healthcare system merger or acquisition. Future research on the utility of the recommendations is anticipated.

Author Biographies

Stacy Posillico, AHIP, Northwell, New Hyde Park, NY and Office of Academic Affairs, New Hyde Park, NY

Stacy F. Posillico, MLS, JD, AHIP-D is the Senior Librarian for the Eastern Region Hospitals of Northwell Health within the system's Office of Academic Affairs. She is an accomplished information science professional and educator with over eleven years’ experience in special and academic libraries. She received her M.L.S. with a Certificate of Academic Excellence from St. John’s University. She also earned her J.D. and received outstanding evaluations from Northeastern University School of Law, and she received her B.A. summa cum laude with University Honors in Political Science and Justice from American University. Stacy is responsible for collaborating with various graduate medical education and hospital specialties to develop and execute educational programs that meet the strategic goals and initiatives of the program and ACGME. She also provides research support services to residents, faculty, researchers, and administration in the form of literature searching, bibliographic management, and scholarly activities. Her research interests include advancing the writing and dissemination skills of trainee clinicians and clinical faculty, promoting the voices of new and diverse clinical authors and citations to their work, and innovation in hospital library organization. Stacy is also a leader in several library professional organizations and regularly presents at professional conferences. She is a distinguished member of the Academy of Health Information Professionals and is an active member of the National Medical Library Association, as well as the Liberty Chapter of the MLA, and the Long Island Library Resources Council. 

Jaclyn Morales, Northwell, New Hyde Park, NY and North Shore University Hospital, Manhasset, NY

Jaclyn Morales has been a medical librarian for over 10 years and is currently the senior librarian at North Shore University Hospital. She is responsible for collaborating with various clinical and allied health programs and hospital specialties to develop and execute educational programs that meet the strategic goals and initiatives of the program and ACGME. She also provides research support services to residents, researchers, and administration in the form of literature searching, bibliographic management, and scholarly activities. As part of the Northwell librarians’ team, she assists with technical questions regarding mobile applications and access to the electronic resources and chairs their Marketing and Outreach committee. Jaclyn is also an active contributor on several systematic reviews. Jaclyn is a distinguished member of the Academy of Health Information Professionals and is an active member of the National Medical Library Association and is the current chair of the Liberty Chapter of the Medical Library Association.

Saori Wendy Herman, Northwell, New Hyde Park, NY and Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY

Assistant Dean of Library Services, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
Corporate Director of Libraries, Northwell Health, New Hyde Park, NY

References

1. Harnegie MP. Branching out and becoming a hospital library system. J Hosp Librariansh. 2019;19(2):173-81. https://doi.org/10.1080/15323269.2019.1586292.

2. Barnes J. First you cry: The Lansing General Hospital/Ingham Medical Center merger experience. J Hosp Librariansh. 2003;3(3):39-51. https://doi.org/10.1300/J186v03n03_04.

3. Harrow A, Marks LA, Schneider D, Lyubechansky A, Aaronson E, Kysh L, Harrington M. Hospital library closures and consolidations: a case series. J Med Libr Assoc. 2019;107(2):129-36. https://doi.org/10.5195/jmla.2019.520.

4. Martin HJ. How to merge libraries in an era of hospital mergers [Internet]. 2018 Feb 16 [cited 2024 Jul 11]. Available from: https://digitalcommons.providence.org/publications/502/

5. Spencer A, Mamo E, Billman BL. Benchmarking study of hospital libraries. Hypothesis (Macon). 2019;31(1). https://doi.org/10.18060/23805.

6. Rhue DJ. Hospital libraries: past, present and future. Med Ref Serv Q. 2022;41(3):296-303. https://doi.org/10.1080/02763869.2022.2097850.

7. Martin HJ, Delawska-Elliott B. Combining resources, combining forces: regionalizing hospital library services in a large statewide health system. J Med Libr Assoc. 2015;103(1):44-8. https://doi.org/10.3163/1536-5050.103.1.009.

8. Regenberg PB, Joyce MK, Moeller K, Ratner J. Surviving a merger: how four hospital libraries created a unified system. J Med Libr Assoc. 2002;90(1):98-100.

9. Hobbs J, Martin HJ, Matucheski M, Schwartz L, Kraft M, Tucker A. Strategies for library mergers and centralizing library services. Presented at: MLA’19; Chicago, IL; May 7, 2019.

10. Rodriguez J, Kanungo C, Macias A. Appraising the community of practice at a hospital library system using a critical librarianship lens. Med Ref Serv Q. 2020;39(3):269-79. https://doi.org/10.1080/02763869.2020.1769423.

11. Delawska-Elliott B, Grinstead C, Martin HJ. Developing a marketing orientation in hospital library services: a case report. Med Ref Serv Q. 2015;34(4):481-9. https://doi.org/10.1080/02763869.2015.1082390.

12. Kraft M. Hospital acquisitions: problem with libraries [Internet]. 5 December 2019. [cited 2024 Jul 11]. Available from: http://www.kraftylibrarian.com/hospital-acquistions-problem-with-libraries/.

13. Kenefick C, DeVito JA. Five realities of hospital library mergers. J Hosp Librariansh. 2015;15(3):334-40. https://doi.org/10.1080/15323269.2015.1049093.

14. Schwing L. Clinical support: hospital librarians participate in mergers and acquisitions [Internet]. Chicago, IL: Medical Library Association. 2020 Feb 6 [cited 2024 Jul 11]. Available from: https://www.mlanet.org/article/clinical-support-hospital-librarians-participate-in-mergers-and-acquisitions/.

15. Huffman I. Preparing a library for a hospital merger [Internet]. Chicago, IL; Medical Library Association. 2017 Feb 16 [cited 2024 Jul 11]. Available from: https://www.mlanet.org/article/hospital-librarianship-preparing-a-library-for-a-hospital-merger/.

16. Daly A, Harrison S, Reed A, Yates D. Integrating e-collections following the merger of two specialist hospital libraries: a case study. Health Info Libr J. 2021 Mar;38(1):32-38. https://doi.org/10.1111/hir.12305.

17. Devereaux MJ, Robishaw S, Ulmer T, Asbury E. Merger mosaic: impact of mergers among health care institutions on their medical libraries: proven practice merging libraries. Presented at: MLA’16-CHLA/ABSC-ICLC International Conference; Toronto, Canada; May 13-18, 2016.

18. Smith JI. Circuit librarian serves five hospitals in shared program. Hospitals. 1976;50(8):83-5.

19. Singh A. 2022 M&A in review: regaining momentum [Internet]. Chicago, IL: Kaufman Hall; 2023 Jan 12 [cited 2024 Jul 11]. Available from: https://www.kaufmanhall.com/insights/research-report/2022-ma-review-regaining-momentum

20. Kacik A. Hospital M&A volume reaches decade-plus low. Mod Healthc. 2023.

21. M&A quarterly activity report: Q3 2023 [Internet]. Chicago, IL: Kaufman Hall; 2023 Oct 12. Available from: https://www.kaufmanhall.com/insights/research-report/ma-quarterly-activity-report-q3-2023

22. Kacik A. Hospital merger activity to increase in 2024. Mod Healthc. 2023.

23. Dowling MJ, Kenney C. Health care reboot: megatrends energizing American medicine. Charleston, SC: Forbes Books; 2018. 220 p.

24. Falvey A. 100 of the largest hospitals and health systems in America. Becker's Hospital Review. 2023 Feb 28.

25. Kacik A. Health systems increasingly seek cross-market merger partners. Mod Healthc. 2022 Nov 7.

26. Kacik A. Proposed merger guidelines may limit cross-market hospital deals. Mod Healthc. 2023 Oct 6.

27. Fulton BD, Arnold DR, King JS, Montague AD, Greaney TL, Scheffler RM. The rise of cross-market hospital systems and their market power in the us. Health Aff (Millwood). 2022;41(11):1652-60. https://doi.org/10.1377/hlthaff.2022.00337.

28. Knapp C, Peterson J, Gundling R, Mulvany C, Gerhardt W. Hospital M&A: when done well, M&A can achieve valuable outcomes. Washington, DC: Deloitte Center for Health Solutions Healthcare Financial Management Association.

29. Caroline Hudson AK. CEOs sound off on mergers, healthcare disruptors. Mod Healthc. 2023 Jun 5.

30. Diaz N. Hospital mergers becoming 'immune' to antitrust enforcement. Becker's Hospital Review. 2023 Sept 8.

31. Condon A. CEOs pinpoint 'where-to-win' growth opportunities. Becker's Hospital Review. 2023 Aug 8.

32. American Hospital Association. Fact sheet: hospital mergers and acquisitions can expand and preserve access to care [Internet]. 2023 Mar [cited 2024 Jul 11]. Available from: https://www.aha.org/system/files/media/file/2023/03/FS-mergers-and-acquisitions.pdf.

33. Raising and communicating your strategic value to clinicians: a panel discussion with and for hospital librarians [Internet]. [place unknown]: Wolters Kluwer; 2022 [cited 2024 Jul 11]. Available from: https://www.wolterskluwer.com/en/expert-insights/medical-librarians-speak-out-on-costs-creativity-and-their-changing-roles#video.

34. Tarabula J, Gibson DS, Jivanelli B, Lindsay JM, Macias A, McGowan S, Mills L, McLaughlin L. Standards of practice for hospital libraries and librarians, 2022: Medical Library Association Hospital Libraries Caucus Standards Task Force. J Med Libr Assoc. 2022 Oct 1;110(4):399-408. https://doi.org/10.5195/jmla.2022.1590.

35. Shannon C, Freeman J, Maceachern M, Rana G, Smith C, Smith J, Song J. The impact of libraries and informationists on patient and population care: a mixed-methods study. J Med Libr Assoc. 2024;112(1):5-12. https://doi.org/10.5195/jmla.2024.1520.

36. Bridges J. Marketing the hospital library. Med Ref Serv Q. 2005;24(3):81-92.

37. Walker P, Laferriere H, Walden RL, Ivey C. The never-ending evolutionary saga of assessing and demonstrating the value of information services in a biomedical library. Med Ref Serv Q. 2021;40(4):369-82. https://doi.org/10.1080/02763869.2021.1987775.

38. Kacik A. Healthcare deals may slow under FTC proposal. Mod Healthc. 2023 Jun 27.

39. Fulton BD, King JS, Arnold DR, Montague AD, Chang SM, Greaney TL, Scheffler RM. States' merger review authority is associated with states challenging hospital mergers, but prices continue to increase. Health Aff (Millwood). 2021;40(12):1836-45. https://doi.org/10.1377/hlthaff.2021.00781.

40. Berryman L. Healthcare industry divided over draft merger guidelines. Mod Healthc. 2023 Sept 20.

41. Jünger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on conducting and reporting delphi studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliat Med. 2017;31(8):684-706. https://doi.org.10.1177/0269216317690685.

42. Lund BD. Review of the delphi method in library and information science research. J Doc. 2020;76(4):929-60. https://doi.org/10.1108/JD-09-2019-0178.

43. Hasson F, Keeney S. Enhancing rigour in the delphi technique research. Technol Forecast Soc Change. 2011;78(9):1695-704. https://doi.org.10.1016/j.techfore.2011.04.005.

44. Veugelers R, Gaakeer MI, Patka P, Huijsman R. Improving design choices in delphi studies in medicine: the case of an exemplary physician multi-round panel study with 100% response. BMC Med Res Methodol. 2020;20(1):156. https://doi.org/10.1186/s12874-020-01029-4.

45. Eldredge JD, Harris MR, Ascher MT. Defining the medical library association research agenda: methodology and final results from a consensus process. J Med Libr Assoc. 2009;97(3):178-85. https://doi.org.10.3163/1536-5050.97.3.006.

46. Cukier S, Lalu M, Bryson GL, Cobey KD, Grudniewicz A, Moher D. Defining predatory journals and responding to the threat they pose: a modified delphi consensus process. BMJ Open. 2020;10(2):e035561. https://doi.org.10.1136/bmjopen-2019-035561.

47. Iqbal S, Pipon-Young L. The delphi method. Psychologist. 2009;22(7):598-601.

48. Fletcher AJ, Marchildon GP. Using the delphi method for qualitative, participatory action research in health leadership. Int J Qual Method. 2014;13(1):1-18. https://doi.org.10.1177/160940691401300101.

49. Harer JB, Cole BR. The importance of the stakeholder in performance measurement: critical processes and performance measures for assessing and improving academic library services and programs. Coll Res Libr. 2005;66(2):149-70.

50. Lund BD, Wang T. An analysis of research methods utilized in five top, practitioner-oriented LIS journals from 1980 to 2019. J Doc. 2021;77(5):1196-208. https://doi.org.10.1108/JD-10-2020-0171.

51. Eldredge JD, Ascher MT, Holmes HN, Harris MR. The new medical library association research agenda: final results from a three-phase delphi study. J Med Libr Assoc. 2012;100(3):214-8.

52. Ludwig L, Starr S. Library as place: results of a delphi study. J Med Libr Assoc. 2005 Jul;93(3):315-26.

53. Geist MR. Using the delphi method to engage stakeholders: a comparison of two studies. Eval Program Plann. 2010;33(2):147-54. https://doi.org/10.1016/j.evalprogplan.2009.06.006.

54. Ashrafi-Rizi H, Kazempour Z, Sheikhshoaei F, Ghazavi Z. Designing a model of professional ethics excellence for clinical librarians. J Med Libr Assoc. 2020;108(4):574-83. https://doi.org.10.5195/jmla.2020.893.

55. Artino AR Jr, La Rochelle JS, Dezee KJ, Gehlbach H. Developing questionnaires for educational research: AMEE guide no. 87. Med Teach. 2014;36(6):463-74. https://doi.org/10.3109/0142159x.2014.889814.

56. Ayre S, Brettle A, Gilroy D, Knock D, Mitchelmore R, Pattison S, Smith S, Turner J. Developing a generic tool to routinely measure the impact of health libraries. Health Info Libr J. 2018;35(3):227-45. https://doi.org/10.1111/hir.12223.

57. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN. The redcap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. https://doi.org/10.1016/j.jbi.2019.103208.

58. Braun V, Clarke V. Thematic analysis: a practical guide. London: SAGE; 2022.

59. Nicholson J, Plovnick C, van der Vleuten C, de Bruin ABH, Kalet A. Librarian-led assessment of medical students' evidence-based medicine competency: facilitators and barriers. Perspect Med Educ. 2024;13(1):160-8. https://doi.org.10.5334/pme.1145.

60. NNLM regions map [Internet]. [cited 2024 Jul 11]. Available from: https://www.nnlm.gov/about/regions.

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2026-04-13

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Vol. 114 No. 2 (2026): April 2026

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Original Investigation

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Copyright (c) 2025 Stacy Posillico, Jaclyn Morales, Saori Wendy Herman

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