Are you positively deviant?

What are you doing to help pediatric psychology achieve its full potential to improve children’s health care? How can we mobilize the exceptional human resources within our organization?

By Tim Wysocki, PhD

I’ve always known that pediatric psychologists are extremely intelligent and highly motivated people, but it wasn’t until I became President-Elect last year that this really came home to me. I have met so many wonderful representatives of our profession and seen many examples of their creativity and energy. What a phenomenal resource we have in our membership! In my year as President, I look forward to meeting more of you, learning more about what you’re doing, and perhaps mobilizing some of you to contemplate how your particular career path can contribute to carrying our profession forward. What are you doing to help pediatric psychology achieve its full potential to improve children’s health care? Beyond your delivery of excellent clinical care, teaching or research, and past the boundaries of your particular institution, what can you do to further the profession of pediatric psychology? How can we mobilize the exceptional human resources within our organization?

I’m going to date myself by using this term, but my “main man” with reference to our broader responsibilities to our profession is Atul Gawande, a Harvard surgeon, accomplished author, and keen observer of health care. Dr. Gawande has achieved international acclaim for his three books, “Complications: A Surgeon’s Notes on an Imperfect Science” (2002), “Better: A Surgeon’s Notes on Performance” (2007) and “The Checklist Manifesto: How to Get Things Right” (2009). He’s been a New York Times columnist, acclaimed speaker and member of the Institute of Medicine. Anyone working in our health care system can benefit from reading his works.

Dr. Gawande acknowledges that errors in human judgment and decision making and imperfect performance of sophisticated skills are unavoidable and that health professionals, and the systems in which they work, must develop and implement methods that account for these facts to achieve the best possible quality and safety of care. His analyses of these points draw from many corners of scientific inquiry, but what most interests me for my purposes here is the afterword of his book “Better”, which he entitled “Suggestions for Becoming a Positive Deviant”. He shares his perspectives on beginning his life as a surgeon when he realized that he needed more from his career than satisfaction from helping many individuals reach a better level of health and quality of life. He needed to leverage the training, expertise and credentials he had obtained to also face bigger and broader challenges affecting his profession and the larger society. It amazes me what he has achieved in the 11 years since he completed his training and the influence that his work has had, not only on surgery, but on the entire movement toward reduction of health care errors and optimization of the quality and safety of care. In closing his book, he exhorts health professionals to become “positive deviants”, people who make a difference in the nature of their professions, and he offers five suggestions for doing this. With apologies to Dr. Gawande, I’ll borrow his points and apply them to pediatric psychology:

  • Ask an unscripted question. Gawande argues that the helping professions tend to move forward most notably when its experts raise questions that are “outside the box”, that question conventional wisdom and that challenge one’s colleagues to re-examine business as usual. The emerging evolution of our health care system will reward those who are able to envision and prepare for new or adapted roles rather than focusing exclusively on the demands placed on them by today’s environment.
  • Don’t complain. Anyone working in the health care system can find valid reasons to bemoan the sorry state of affairs surrounding our work lives. Gawande implores us to resist this temptation. Complaining is boring, resolves nothing and can discourage you and your colleagues. Instead, devote the time you might have spent complaining to finding a creative solution to the problem you identified or to reframing the problem in a way that doesn’t lead to more angst.
  • Count something. Whether you’re a clinician, teacher or researcher, find things you would like to improve about your performance, and systematically measure and analyze variables that may affect your outcomes.
  • Write something. All of us have good ideas that can benefit others, all of which are helpful only if they are shared. Whether you standardize a clinical protocol, prepare a parenting curriculum, develop a resource for a professional organization, submit a poster to a scientific conference or prepare a major research grant, get your ideas out there to be scrutinized, refined and utilized by your peers.
  • Change. Recognize the shortcomings of our evidence base and be an “early adopter” of promising new practices that at the same time challenge your established beliefs while offering the potential for growth and improvement.

Does every pediatric psychologist need to be a positive deviant? Perhaps not. But remember that nobody can do everything but everybody can do something.