I think the success of any sort of "honor system" depends on how personally that library's users feel about the collection. A small collection, in a department or a smaller hospital, is likely to have much better success than a larger collection in a larger institution. 

Any sort of key-card entry, or sign-in sheet, only tells you who went in/out -- not who came with them, and not what they were carrying.  Unless you can do an inventory every morning before anyone else comes in, it's hard to have evidence enough to really go after someone -- and if what walks isn't a high-visibility item, it may be days or weeks before you'd know it's gone.

I agree that most of the "theft" probably isn't the "I want to take this book for my own and keep it forever" variety, but the "I'm too busy/tired to read it now -- I'll just take it home/to the floor and bring it back later" variety. But, gone is gone, and both patrons and staff can lose a lot of time looking for things the next time someone needs them. (lost? just elsewhere in the library?)

In our old library, we had doors that locked with a key; Security would let in any employee with a regular badge (but not visiting students or temporary employees), sign them in, and lock them in. There was a fire escape. When the patrons finished, they called Security again, who signed them out, had them walk through the security system (supposedly), and let them out the door.  That worked fairly well -- mostly as a mechanism to discourage really-casual use and to assure people we cared about keeping things -- but we still lost stuff.

In our new library, with clock-controlled magnetic locks, this wasn't an option. Much debate. By then we had many things available electronically throughout the institution -- MDConsult, Stat!-Ref, UpToDate, plus Ovid Medline with journals -- so actual access to the library wasn't necessary to get the emergency sort of information usually needed. In an extreme emergency, users can page the librarian-on-call (usually me, oh joy), for access; these instructions are on our door (and on our intranet page). That combination -- the electronic resources and the librarian-on-call -- satisfy "24 hour access" requirements for JCAHO and residencies. (By the way, in 15 month of operation, we've had about 5 such pages -- none resulting in actual access. People have left things in the library, didn't know about the electronic access, etc.)  More details upon request.

Of course we all want our patrons to have access to what they need, when they need it. But keeping materials as available as possible to as many people as possible does mean that there will be some times when people can't get at things they want. It's always a balancing act...
Gretchen Hallerberg
Cleveland Clinic Alumni Library
9500 Euclid Avenue  NA 30
Cleveland, OH 44195
phone: 216/445-7333
fax: 216/444-0271
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