Atul Gawande’s premise seems too simple: modern professions have become so complex and varied and specialized that they cannot be managed without written checklists. The author is a surgeon and uses lots of examples from his profession- highly skilled, highly trained, nerves of steel doctors who forget to wash their hands leading to infection and possibly death following an otherwise successful procedure.
He researches and compares checklists that are used successfully in other professions; construction, restaurants, and most effectively: airline pilots. In the forties, planes were being built that were simply too complex to fly. There was a tradition of macho pilots operating on skill and experience alone. However, in order to fly the B17 without dying, that attitude had to be dropped and a simple checklist of tasks executed every time. Done this way, flying is supremely safe. Relying on one person’s skill and attention and relationship with the rest of the crew on a given day is not. The author argues that freed from being omniscient most professionals improve results and give themselves room for creative thought when it counts.
He presents jawdropping statistics on the effectiveness of a simple checklist in the operating room. (boy, surgery is dangerous!) A big part of this is empowering the nurses, anesthesiologists, and other people on the surgical team to speak up if they know something that could effect the surgery or if they see the surgeon inadvertently contaminate the surgical area. It allows for dialog in an historically hierarchical and gendered realm where the surgeon was treated as king.
And of course this is why people hate the checklists. They feel professionally threatened by the suggestion that their judgment and years of experience and schooling can be subverted to piece of paper held by someone else. Gawande finds that even in finance, where checklists have been proven to make their users much more money, people don’t want to use them- preferring to rely on their gut instinct or the firmness of their new partner’s handshake.
Libraries are not life and death like surgery or flight. Nor do we work with massive sums of money or huge masses of steel. However, librarians cling to the idea of our professional identity and we fail to standardize practices, preferring finesse and faulty memory. We let emotional reactions to patrons tamper with the service they receive. We fail to answer questions or determine what the questions are because of inattention. We take things personally.
I realized, listening to this book, that at my library we do not have a circulation manual (that I’ve seen). Whenever I show my pages how to check in a book or override an irrelevant message in our circulation system, I’m relying on the memory of a sixteen year old combined with my own flawed delivery of the information (that was delivered verbally to me, by another librarian). If they forget, they have to ask again. And they probably won’t ask me, but maybe will get up the courage to ask one of the other pages, if they remember.
As information professionals we should be masters of the checklist, the steps needed for a search, the process of a reference query. Instead we hide behind the desk and our years of college and grad school, knowing that if the patrons don’t get what they want, they’ll likely be too cowed to tell us.
I’m going to work up a couple checklists and a simple satisfaction survey for patrons this week. I’ll let you know how it goes.
