Monday, January 25, 2010

Librarians and checklists -- do they make sense?

With the recent release of Atul Gawande's The Checklist Manifesto www.nytimes.com/2009/12/24/books/24book.html the idea of applying checklists as failure prevention mechanisms, I would imagine, has crossed the minds of many in health care that typically wouldn't be considering them.

Take librarians, for example.

I would submit that most of the functions that librarians deliver in the course of their work in hospitals are NOT complex -- but the world they function in is. (I would love to have that discussion with my peers in this forum -- if they are game. But I digress ) The notion of when a tool like a checklist is needed and **should** be used is an important question. It certainly isn't useful to pile more paperwork and process into the daily work of anyone - especially if it doesn't really improve anything and ends up resulting in workarounds that provide additional opportunites for failure.

For sake of discussion here, I do think there may be some applicability of a checklist in some areas of the domain, such as in the reference review process (in an emergent situation) or clinical informationist in context www.ncbi.nlm.nih.gov/pmc/articles/PMC64757/ rounding participation. Seems to me I saw I study a while back (gaps in the reference interview that happen due to communication failures, etc) that might provide some insights into ways to make that element of a librarians skill set more reliable via structured communication tools and/or a checklist.

I do also wonder if the checklist idea would be useful in a broader sense. Let's face it: librarians aren't the only ones doing lit reviews in hospitals and, as demonstrated by the gap in the lit reivew process www.ncbi.nlm.nih.gov/pubmed/11530164 at Hopkins that contributed to the research volunteer death some years back, we know it can result in failure if not completed effectively. Perhaps a tool that would enable more reliable searching no matter **who** does the work, would have multidisciplinary impact.

I would say thou, that the examples of IRB participation, systematic review support and similar "project and task flow" examples may be "complicated" (ie "building the space shuttle") rather than "complex" (ie performing surgery, raising children) if we consider complexity theory in all of this.

Its important for librarians, and the clinicians that require the best evidence to do their work in complex situations, to explore how a checklist could be enabled to affect patient safety in this intersection of professions. I wonder what -- if anything can be drawn from existing safety tools and processes in place in other high-risk domains such as aviation and nuclear power plants-- to help enlighten a discussion around how the information identification, acquisition and dissemination process in hospitals become "highly reliable" through the use of checklists.


Some additional food for thought:
http://www.springerlink.com/content/6x37w435wp32203t/fulltext.pdf

1 comment:

marry said...

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