How does the organizational structure of an academic health sciences library (AHSL) impact its provision of services? While once AHSLs were established as separate entities, many are now consolidated under a larger university library. Their roles are expanding, particularly in the areas of research support, data management, bioinformatics, systematic reviews, assessment of research impact, and community outreach. In order to explore the impact and consequences of reporting structures, we held interviews with individuals from twenty-eight academic health science libraries. The purpose of the report published today is to synthesize our findings on key success factors, risks, positive and negative outcomes, and opportunities associated with maintaining the AHSL as a separate entity versus integrating them as a part of university library administrative structures. 

AHSLs are mission-driven organizations that thrive by aligning their programs and services with the new and emerging needs of the programs they serve. Because AHSLs serve a myriad of campus constituents including health care service providers, the directors made a case for having sufficient autonomy to harmonize services and procedures based on their user communities. It is important to establish and maintain close ties with diverse user communities in order to be effective, responsive, and visible. 

Regardless of organizational configuration, there is tremendous pressure on AHSLs to do more with less–save money, be efficient, and keep up with emerging or expanding service areas such as research data and bioinformatics support. Although we focus on AHSLs, we believe that some of the insights gained through this study will apply to other types of specialized libraries as they share similar challenges in meeting the information needs of contemporary researchers and learners. As libraries continue to explore different service models in support of expanding their services and containing costs, one of the outstanding questions is how they will strike a balance between maintaining cohesiveness as a library system and attending to the needs of specific user communities. We hope that the findings will inform institutions that are considering or planning various kinds of reorganizations in the future and facilitate further reflections on such critical questions. 

We express our great gratitude to forty-eight colleagues who contributed to the study in various ways by serving on the project advisory board, participating in the interviews, reviewing a draft version of this report. We thank the Association of Academic Health Sciences Libraries (AAHSL) and Elsevier for their sponsorship as well as colleagues at the Association of Research Libraries (ARL) for their advice and support.