If you are a surgeon and the patient dies, well the operation clearly wasn’t a success. The key item here is it is easy to measure the percentage of patients that died. Now, just because the patient died doesn’t mean that the surgeon did a poor job. Some operations are riskier than others, some patients are sicker than others, and sometimes the patient may not follow post-operative advice. Still, having a clear measurement (death / no death) allows for interesting types of research to occur. For example, it appears that patients are more likely to die if surgical teams have poor teamwork. That’s just one easily measurable outcome. Does anyone doubt that poor teamwork leads to worse outcomes, even for the patients that survive their operation?
Now, fortunately, most BCBAs don’t work under conditions that are life-and-death. The outcomes are measurable, but unless the service is terrible, it is almost always difficult to assess performance. If a child makes “some” progress, it is hard to determine how much they could have made with a great team. Thus, BCBAs don’t get the type of feedback that surgeons receive, and there isn’t much comparative research on different well-designed procedures.
Since we don’t have much of our own literature on these types of topics, I believe that we can learn a lot from the experiences of others. Anyone who has been part of a great team knows the importance of relationship-building, generating new ideas, communicating critical information, covering during illness, emergencies, or vacations, problem-solving when things don’t go well, ensuring safety, and a host of other possibilities that are difficult to measure. All these things dramatically impact the performance of our clients. That doesn’t even include other non-clinical team members like human resources, billing professionals, and schedulers that can have a huge impact on teams.
Do we do this well in applied behavior analysis? Sometimes. Unfortunately, in some organizations, staff are considered interchangeable parts. There isn’t a lot of thought given to ensuring we have good teamwork. BCBAs love numbers and graphs. It is difficult to measure these types of behaviors, thus it is rarely done. Just because it is difficult to measure doesn’t mean it isn’t extremely important.