What do Sigmund Freud and some in the field of improvement have in common? No, this is not the beginning of a Woody Allen joke and I hope the answer is a simple “nothing”. But sometimes when I hear those immersed in improvement say that our work is too complex and nuanced for randomized trials or other rigorous research methodologies, it reminds me of the famous cigar-smoking psychoanalyst.
Freud claimed that the psychoanalytic theories he invented could not be scientifically evaluated because doing so was simply too complicated and not suited for such study. However, in the more than 100 years that have followed, many researchers have done the difficult work in the field of psychology and found that many of Freud’s theories and the therapies generated by them are simply wrong and unhelpful.
Of course, this is not to dismiss the whole field of psychoanalysis but the Freudian form of it has taken a hammering from those using science to see how well it works. I think this points out that we can never rely on the “it’s too hard” excuse to say that we can’t provide the robust studies to support (or otherwise) the work we do.
Doing the research on improving health services and systems is indeed very difficult and complicated and many settings we work in do not lend themselves to conducting randomized controlled trials. But we must do the best science that the circumstances allow to guide us as we try to make health care better. Without it, we risk irrelevancy.
And if you don’t like what I’m saying, blame my mother…..