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Whooo Says

Whoo Says Owl Mascot

Dear Whooo,

I’ve been reading your column for the last few years, and it has sparked some thoughts about how I and other librarians perform our work. I am a solo librarian in a hospital with little opportunity to get together with librarian colleagues, so I’d like to ask you my question.

I’m becoming concerned that I may not be providing the highest quality service to my users. I have taken several searching classes and feel pretty confident, but I’m never quite positive of the completeness and accuracy of my search results. This has made me start to evaluate the other services and materials I provide, and I wonder how this is impacting patient care in my hospital. Do you have any ideas for me?

Thanks for your help,


Dear Wondering,

I’m so pleased that you read this column and you are expanding your thinking about how you practice. The concept you’re describing is called reliability. Reliability has been defined as “the capability of a process, procedure or health service to perform its intended function in the required time under existing conditions.”1 This science has only recently been applied to healthcare; it developed out of high-risk industries such as aviation and nuclear engineering, which have great need for highly reliable operations to protect the public.

As health sciences librarians we work in an industry that is very concerned with quality of patient care. Delivering high quality of care includes worrying about developing reliable processes to eliminate problems or errors in the workflow. In a project conducted by leaders at IHI (Institute for Healthcare Improvement) and Cedars-Sinai, those leaders found that “good people, working hard, repeatedly don’t register the problems that surface in their daily work as defects related to patient care.”2 More often, they are considered normal occurrences, and few if any staff members asked questions leading to solving or eliminating the problems.

As librarians, we should ask what our contribution to high quality care is, and what can we do to raise our level of performance? Basically what we need to do is make sure that discipline is incorporated in our performance.The following tactics will help us look at our systems and make necessary adjustments to improve the quality of what we do so that we can minimize the errors we inadvertently commit.

  1. Standardize your approach; create a well-defined process for each activity you perform.
  2. Build decision aids and reminders into your systems. Use checklists, flow sheets, and any other tools that will remind you to use your determined standardized approach.
  3. Examine your existing habits and patterns to make sure they are effective and efficient.  If possible, take advantage of those pre-existing habits and patterns. Using already established patterns and behaviors will be more effective and reduce the need for re-training.
  4. Make the desired action the default rather than the exception.
  5. Create redundancy. If you use redundancy strategically, you have created a filter that will decrease errors.
  6. Bundle related tasks.
  7. Encourage teamwork, feedback and training.

After we take a look at our systems and redesign our procedures, we need to identify mistakes as they occur. We are all human, and will make errors because of many things including fatigue, competing responsibilities, distractions, or poor task design. Identifying the error promptly, locating the cause, and making corrections without blame are crucial to creating a well-functioning system.

I hope this helps, Wondering. I think reliability is critical to the information and evidence processes we use to serve our healthcare colleagues. I hope you will consider using these steps to evaluate and restructure your practice. Please let me know what difficulties you encounter and what differences your changes bring.




1Resar R. Reliability. Presented at the Institute for Health Care Improvement’s Beyond Impact Conference Call; May 19, 2004.
2Luther K, Resar RK. Tapping front-line knowledge. Healthcare Executive. 2013 Jan/Feb;28(1):84-87.

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