Applied behavior analysis (ABA) service delivery, similar to other healthcare, educational, coaching, or professional services, operates within an economy. In that economy, our science is our asset. Improving the patient care paradigm and changing public perception of ABA without watering down the science, is as important now as ever before for the evolution of our field.
Behavior analysis is distinct in that it treats behavior as a subject matter in its own right. This concept is sometimes misunderstood to mean that thoughts, emotions, or feelings, and reports or other collateral measures thereof, are not only off limits, but that any reference thereto dilutes our science. The purpose of this article is not to discuss the inclusion of emotions or other private events in the context of experimental or contingency analyses (see Friman, 1998), but instead, in the context of a consumer analysis.
Caregiver feedback is a very important component in evaluating customer satisfaction, but it is distinct from patient feedback, which is paramount. Patient centered measures may include measures of experience and satisfaction (Larson et al., 2019), and are a meaningful part of a thoughtful consumer analysis. Again, consumer and experimental analyses are distinct, but pertinent and interrelated components of our service deliver paradigm and process.
Following from Prakash (2010), measures of patient satisfaction can be valuable in improving outcomes, retention/ongoing treatment, malpractice claims or [ethics violations, and even public perception of ABA]. In fact, “research shows that high [consumer] satisfaction leads to greater customer retention, higher lifetime value, and a stronger brand reputation” (Zendesk). And, branding is relevant.
Considering patient preferences in treatment decisions and outcomes is being increasingly recognized as an important part of healthcare service delivery and medical decision making (Van Hoorn, 2016). Although this concept is not entirely foreign to applied behavior analysis (Hanley, 2010), we have not even begun to provide this sufficient attention.
More research is needed to better understand how patient satisfaction reports impact clinical outcomes and quality of care in ABA and healthcare more broadly. Person centered measures (i.e. patient experience and satisfaction) should be used in addition to, not in replacement of, observable and objective data. It will be important to expand procedures for evaluating patient satisfaction and treatment preferences for people with limited communication repertoires and who can’t as easily self-advocate (see Hanley, 2010). Additionally, for all people we serve, it’s important to be sensitive to power dynamics in evaluating this topic.
Evolutionary ethics and value changes are as pertinent in applied behavior analysis as they are in medicine (see Calman, 2004). This is a concept worth understanding and embracing. I am not convinced there is a need for a rebranding of our science (i.e. “the new ABA”), although I suppose time will tell. Regardless, we need to intensify focus on learning from the people we serve and improving the patient care paradigm in applied behavior analysis. Doing so will only benefit the profession, and people we serve.
What do you think? Share in the comments.
References
Calman KC. Evolutionary ethics: can values change. Journal of Medical Ethics 2004;30:366-370. https://jme.bmj.com/content/30/4/366
Franklin, Alaina. “What is customer satisfaction? Definition + importance.” Zendesk. January 23, 2023. https://www.zendesk.com/blog/3-steps-achieving-customer-satisfaction-loyalty/
Friman PC, Hayes SC, Wilson KG. Why behavior analysts should study emotion: the example of anxiety. J Appl Behav Anal. 1998 Spring;31(1):137-56. doi: 10.1901/jaba.1998.31-137. PMID: 9532758; PMCID: PMC1284106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1284106/
Hanley, G. P. (2010). Toward effective and preferred programming: A case for the objective measurement of social validity with recipients of behavior-change programs. Behavior Analysis in Practice, 3(1), 13-21. Retrieved from https://www.proquest.com/scholarly-journals/toward-effective-preferred-programming-case/docview/851234519/se-2
Larson E, Sharma J, Bohren MA, Tunçalp Ö. When the patient is the expert: measuring patient experience and satisfaction with care. Bull World Health Organ. 2019 Aug 1;97(8):563-569. doi: 10.2471/BLT.18.225201. Epub 2019 May 28. PMID: 31384074; PMCID: PMC6653815. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6653815/
Prakash B. Patient satisfaction. J Cutan Aesthet Surg. 2010 Sep;3(3):151-5. doi: 10.4103/0974-2077.74491. PMID: 21430827; PMCID: PMC3047732. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047732/
Van Hoorn, R., Kievit, W., Booth, A. et al. The development of PubMed search strategies for patient preferences for treatment outcomes. BMC Med Res Methodol 16, 88 (2016). https://doi.org/10.1186/s12874-016-0192-5
Brandon Herscovitch, Ph.D., LABA, BCBA-D
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