Friday, March 13, 2015

Evidence seeking and checklists: does it make sense?

Atul Gawande's The Checklist Manefesto placed the use of checklists as failure prevention mechanisms in the laps of health care professionals and management worldwide, Since the book came out in 2009, checklists have now been planted in the minds of many in healthcare as tools to improve patient safety that typically wouldn't have considered them. 

Take librarians, for example. "My work is too messy", they say, "to use a checklist."

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 ... ). This isn't and shouldn't be taken as a insult--and I apologize up front if its received in that light. The notion of when a tool like a checklist is needed and **should** be used is an important question--and determining the type of process its being applied to is important. 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--or to do so for a process that is complex vs complicated. or even simple, for that matter.

For sake of discussion, I do think there may be applicability of a checklist in some areas of the clinical librarian / Informationist domain, such as in the reference review process. For instance, gaps that happen due to communication failures, cognitive biases and production pressures should cause us to think about ways to make the reference interview process more reliable via structured communication tools and/or a checklist. Especially in an emergent situation.

I do also wonder if the checklist idea would be useful in an organizational.system sense. Let's face it: librarians aren't the only ones doing lit reviews in hospitals and, as demonstrated by the gaps in the lit review process at Hopkins that contributed to the research volunteer death some years back that are discussed here, 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.

One example of a review tool that may serve as the model for a checklist to help examine the robustness and reliability of the search activities at the sharp end is the CADTH Peer Review Checklist for Search Strategies.

I would say IRB activity, systematic review support and similar "project and task flow" examples of evidence and information seeking 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, the CADTH tool (complicated task review) would probably benefit from the application of "local context" to help us all understand how to apply it in real time to shore up the effectiveness of search that frontline info seekers--librarians or others--undertake to inform info seeking actions that take place in a more complex context--in the midst of clinical decision making. 

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

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