|Positive Deviance and Spiritual Care Research|
|Saturday, 02 March 2013 09:18|
When I met with my surgical oncologist in October one of the things he said to me was, “Whatever you are doing, keep doing it. It is working.” He went on to add that a number of people that share my particular type of cancer, live well and much longer than expected without other medical interventions. So what are they doing that is different? Inquiring minds want to know. I want to know.
In 2010, I discovered the work and research of Jerry and Monique Sternin along with Richard Pascale as they tackled some difficult challenges ranging from childhood malnutrition in Vietnamese villages to hospital infections in the United States to reintegrating outcast girl soldiers in Uganda. Their book, The Power of Positive Deviance: How Unlikely Innovators Solve the World’s Toughest Problems, was published that year by Harvard Business Press.
Jerry Sternin, along with his wife Monquie, spent most of his life working with programs to address hunger and starvation in the world. While directing a Save the Children program working with malnutrition in poor Vietnamese villages, the program itself became starved of sufficient funding to continue as usual. So they started looking for another approach. What they did was go to the villagers and ask their help in identifying the best-nourished children in the village. They sought out the positive deviants from the norm and then started asking questions about what made the difference for them. What were they or their families doing that was different from what others were doing? What they discovered changed their approach to both researching these tough challenges and engaging them.
What emerged as they talked with the families of these positive deviants were narratives that revealed a common pattern: the parents were breaking local customs regarding when children were allowed to eat and what they were being fed. This included a group of greens that were considered to be beneath human consumption. With these insights they were able to coax a few more parents to try these approaches. They periodically brought these children together to weigh them as a way to share how this was an approach that could make a difference for the health of their children.
As they continued to observe and work with other challenging problems around the world, they kept evolving Positive Deviance as a change tool, and approach to working with some of these very challenging concerns. What emerged for this approach were the following premises: (1) the recognition that solutions already existed, (2) that the solutions were discovered by some in the community already, and (3) that these positive deviants were succeeding given the same constraints, conditions, and resources everyone else had (Sternin, Sternin, and Pascale, 2010, loc. 116).
What does this mean for research in health care, and especially for spiritual care? Primarily, it brings us back to the value of qualitative and contextual research in a field that has become mired in quantitative research. Atul Gawande points us in the right direction in his Forward to the Power of Positive Deviance. He makes a point of identifying the United States as the village facing malnutrition and starvation in the area of health care because of the expense. He notes how the U.S. spends twice as much per capita as any other developed country while not showing evidence of measurably better overall health. As a surgeon he notes how this provides us with an approach that parallels what they do toward improving their practice; they note the emergence of positive deviants—those showing unusually good results—and they go observe what they do, listen to the stories of their experience, and copy their techniques and approaches. Dr. Gawande’s encouragement us to look at the positive deviants within the health care system; those who are providing high quality at low cost to see what they are doing differently.
As a cancer patient, I immediately start asking what this research approach might mean for me. What are cancer patients who are doing well living with their cancer—people who continue to adapt and thrive in spite of illness—doing differently from those who are not doing as well? The reason that I ask is because I want to do what they are doing.
Yes, I have read the quantitative studies regarding my particular type of cancer. I know what the projected life expectancy range is. I know the average and I know the mean ages on the statistical curve. It is information that leaves me feeling depressed and helpless. But I also know that there is a positive deviance group; a group that survives significantly longer than the statistical mean. What I want to know is what are they doing that is different. It apparently involves more than just medical treatment and intervention. This is information that needs to be teased out contextually through observation and conversation in the same way that the Sternins teased out what was making a difference for the positive deviants among the children in the Vietnamese village. This is why we need qualitative research as well as quantitative.
While quantitative research does well in confirming our hunches and observations within controlled contexts, qualitative research in its various forms provides us a methodological approach for discovering things people are doing in the real world that make a difference.
Since my particular area of interest relates to spiritual care, I start asking questions about what this means for research around the provision of spiritual care. Is spiritual care part of the holistic mix making a difference for the positive deviance group? Potentially. I know it is part of the mix in my case in my quest to be among that group for my type of cancer.
The big thing this means, however, is that as we ask questions about whether spiritual care makes a difference in a person’s recovery from illness, injury, or trauma and ongoing quality of life, one place we want to focus our research is on the positive deviants. We want to start by identifying those groups of patients that exceed our expectations for quality of life and adapting well to the consequences of illness or injury. We want to identify those in our congregations that exceed our expectations in coping with crises. What are they doing that is different that might be making the difference? What role is their faith, spiritual practices, or spiritual community playing in how they are doing? What spiritual care approaches are involved? This is all contextual research that involves conversations and observations of patients and families in their communities watching for common patterns to emerge. It is contextual research that seeks to tease out deeper layers of story and meaning in pursuit of awareness and understanding. It is the kind of qualitative research that needs to precede any quantitative research regarding the contributions that spiritual care may be making to adapting and living well, and perhaps even longer, with illness and injury. But it is the kind of research that will clue us in on how we might help more people in the community to be part of those who exceed our expectations for living well with illness, injury, or trauma as a result of spiritual care we provide.
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