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I had just sent the final draft of an article titled “The Real World is a Messy Place”, which chronicled a 4 year project to assess the effectiveness of various technologies to aid in the delivery of care to individuals with developmental disabilities and severe mental illness, to my co-authors, when I realized that this was the 20th anniversary of deciding to conduct research with non-academics.
ANTHROPOLOGY Open Journal Commentary Ceding Control, and Gaining Freedom: * *Corresponding author Anthropological Research in the Real Anthony P. Glascock, PhD Emeritus Professor World Department of Anthropology Drexel University Philadelphia, PA, USA * E-mail: glascock@drexel.edu Anthony P. Glascock, PhD* Volume 2 : Issue 1 Department of Anthropology, Drexel University, Philadelphia, PA, USA Article Ref. #: 1000ANTPOJ2107 Article History I had just sent the final draft of an article titled “The Real World is a Messy Place”,1 th Received: October 12th, 2016 which chronicled a 4 year project to assess the effectiveness of various technologies to aid in th Accepted: October 28th, 2016 the delivery of care to individuals with developmental disabilities and severe mental illness, th th Published: October 28th, 2016 to my co-authors, when I realized that this was the 20th anniversary of deciding to conduct research with non-academics. It was in 1996, when I ignored the advice given by Chef in Fran- cis Ford Coppola’s film, Apocalypse Now, to “don’t get off the boat” and began to undertake Citation ethnographic research exclusively with non-academics in the real world of care provision. At Glascock AP. Ceding control, and gaining freedom: Anthropologi- the time, the decision appeared to make sense since, as an anthropologist, I had conducted cal research in the real world. An- fieldwork in a variety of communities around the world, so it was easy for me to rationalize thropol Open J. 2016; 2(1): 10-14.
that this first foray into the real world of care provision was just another field site that I would doi: 10.17140/ANTPOJ-2-107 leave at some point. But this didn’t happen as I soon lost sight of the boat, then of the river and eventually got so far into the jungle of the real world that there was no longer a path back to the comfortable and safe world of academic research. I had gone native, it just took 20 years for me to realize it.
During these 20 years I’ve conducted anthropological research in over 30 different entities in 5 countries—the United States, the United Kingdom, Ireland, Canada and the Neth- erlands—with over a dozen different care organizations, both not-for-profit and for-profit, and numerous care models including: assistive living; dementia care; care management; visiting nursing; naturally occurring retirement communities; congregate living communities; adult training facilities; discharge planning; integrated comprehensive home health care; locked- down units for sexual predators; and outpatient clinics. I have also researched a wide range of populations including: cognitively impaired older people; human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) patients; at-risk elderly liv- ing in the community, individuals with developmental disabilities; elderly living in assisted liv- ing facilities; older hospitalized cardiac patients; severely mentally ill individuals; community dwelling healthy elderly; and sexual predators. I have published numerous articles and book chapters on this research, along with 2 books and presented over 75 keynotes, invited lectures, papers and posters in the United States and abroad, and consulted for over half-a-dozen com- panies and organizations, ranging from Honeywell and General Electric to a local county care facility. I even sat on the Board of Directors of a start-up company that attempted to develop and market a product to at-risk older people living in their own residences. CONSEQUENCES OF GETTING OFF THE BOAT Copyright Prior to deciding to work directly with non-academics, I had built a fairly conventional aca- ©2016 Glascock AP. This is an demic career. I had obtained funding from National Health Service (NHS), National Service open access article distributed un- Framework (NSF), National Investigation Agency (NIA), United States Agency for Interna- der the Creative Commons Attribu- tional Development (USAID), World Health Organization (WHO) to conduct anthropological tion 4.0 International License (CC research and collaborated on research and published books and articles with established anthro- BY 4.0), which permits unrestricted use, distribution, and reproduction pologists. Even when I first got off the boat, I thought that I would stay close to the shore and in any medium, provided the origi- very quickly get back on board, but I didn’t. Instead, I wandered further and further afield, to nal work is properly cited.
the point where I actually lost interest in even trying to find the boat, let alone getting on board. This is not to say that my journey was always easy and that I pared for analysis. This plan was summarily rejected because the didn’t experience a degree of culture shock, but it was never dull personnel did not want to change how they did their jobs, which and I learned some useful lessons along the way.
included filling out paper forms that remained in the residences of the individuals receiving the care. When I pointed out that if ANTHROPOLOGICAL RESEARCH VS. “ANTHROPOLOGICAL the information was in homes to which I did not have access, I RESEARCH” would not have the data I needed to evaluate the effectiveness of the care and services being delivered, I was informed that my When I began working with non-academics, I assumed that con- “research” was not worth disrupting the normal way things were ducting research would be little different in the real world as it done and that I would just have to find another way of collecting was in academia. I was wrong, oh so wrong. Perhaps I was naive the information.
or maybe it was my inexperience, but I quickly realized that I had entered a vastly different culture in which a different set of Even when my research had been successful to the point rules applied and that this culture was not going to change and where there were findings that could be presented at meetings that, if I wanted to work in this culture, I was the one who had and published, I could not proceed as if I was in control. More to change.
than once, there was a request from one or more members of the care organization to be included as co-authors or co-presenters, One of the first things I had to change was my expecta- even though there was no pretense that any of them were going tion that I would be in control of the research process. When I to be doing any of the writing. On more than one occasion, it was conducted conventional ethnographic research I was in control. my co-author who presented my PowerPoint at a meeting, even Yes, I had to conform to what the granting agencies wanted and though she had not contributed more than a few editorial sugges- compromise with my co-PIs, but to a great extent I was in com- tions, usually concerning acceptable and unacceptable nouns to plete control. I developed the timeline, chose the population, describe the individuals participating in the studies. selected the sampling design, created the data gathering instru- ments, picked the appropriate data analytical tools and decided UNEXPECTED BUT TANGIBLE BENEFITS when I believed I was ready to publish the findings. I could present other examples of how I had to cede control when Once I started conducting anthropological research undertaking ethnographic research, but this would be overkill with non-academics, I lost control over almost every aspect of and it would detract from the discussion of the benefits that I the research endeavor. I could make suggestions, but the final derived from working with non-academics, because there were say was in the hands of people at the organization or company. definite benefits. The 2 most striking and unexpected benefits They decided when the research began and ended, who would were that I no longer had to seek funding for the research nor be included in the study, the data gathering instruments and de- did I have to worry about my university’s institutional review. termined if the findings were to be published and even if their When I was first asked to conduct research in a non-academic decision was positive, had final say on what could be included site, I really didn’t even ask where the money came from to ac- or not, even extending to the words used to describe the research tually conduct the research, I just pitched in and did what came process. Three brief examples illustrate what can happen when naturally. After several months, I asked where the money came control is ceded. In one study, I was prepared to use standard from and was told that the research was self-funded. The direc- ethnographic methods—participant observation, and both struc- tor of the organization believed that she needed to enhance the tured and open-ended interviewing—to assess the use of a moni- way care was being delivered and needed to track the changes toring device used by a visiting nurse organization to track the to determine if the change in care models benefited the orga- well-being of at-risk elderly living in their own residences. Less nization’s clients and was cost-effective. As a result, not only than 2 weeks before the study was to begin, I was informed that was money made available to pay, for example, my time, but for the elderly population was to be replaced by individuals with equipment and other resources. In addition, staff was expected to end-stage HIV/AIDS. When I asked why the change had been contribute time to the project and to recruit clients to participate. made, the director of the organization just stated that they were It was nice to not have to worry about paying research assistants, at greater risk than the elderly population. When I responded recruiting subjects or even filling out forms so I could spend that, since I was a gerontologist, I knew next to nothing about money and eventually being grilled by a program officer about individuals with HIV/AIDS and would need to change many, if expenditures.
not all, of the instruments I had prepared, she just responded that this was a clinical decision and that was that.
I thought that this was a one-off experience, but I was wrong; once I was in this care network, I moved from one or- In a second study, I suggested that the best way to effec- ganization and one care model to another, never having to write tively collect the data needed to evaluate the success of a specific a single grant proposal. Sometimes projects were self-funded, treatment protocol was to have the home care personnel enter often organizations had received funding from foundations to the care that they provided on smartphones. In this way, the data undertake the project, sometimes private for-profit companies could be efficiently collected, transferred, catalogued and pre- provided the money so that their products could be evaluated, but regardless of the source of the funding, I was not responsible The one issue that was a major concern I had to con- for obtaining it. This, of course, contributed to my loss of control form to my university’s policy on consulting, which allowed me as I became an “employee” and had to defer to the desires of the only one day a week. Of course, there were holidays, weekends organization or company. However, I was an “employee” who and the summer in which I could work as much as I wanted and was not dependent on the money because I was still employed thus, it was more an issue of scheduling, than a lack of time on by my university, so I could pick and choose which projects to the research. The key to keeping my university’s administrators undertake.
happy was retaining the level of publications and professional activities the same as before I left the boat. This turned out to be The real benefit of not having to search for funding was a challenge for reasons that I, once again, did not anticipate. the time I gained. Not only did I not have to write proposals, and then rewrite them, but there was no longer that interminable PUBLICATION CHALLENGES delay between getting the idea for a research project, writing the proposal and waiting for the funding, if it came, in order to I assumed that I would be just as successful in publishing the start the research. When I agreed to work on a project, it almost results of my increasingly non-academic research as I had been always started right away; sometimes actually quicker than I in my more conventional anthropological career. This turned out would have liked, but there was never the usual waiting associ- to be naïve, as I quickly discovered that the type of ethnographic ated with trying to obtain funding to conduct my more conven- research I was doing was seen by many reviewers as being way tional anthropological research. And I must admit that I became too far off the boat for publication. The reasons varied some- addicted to the speed of projects moving from inception to initia- what, but in essence all came back to the lack of another type tion in weeks and not months or years.
of control: control of the parameters of research. I should have seen this coming, since during my first non-academic projects a colleague I was trying to recruit to help me in data analysis, The other unexpected benefit of working directly with experienced so much frustration in the type of data I collected care providers, I did not have to submit my work to my uni- that he stated with great exasperation, “the data keeps changing, versity’s medical faculty dominated Institutional Review Board how do you expect me to analyze it” and walked away from the (IRB). Whether a hospital, a visiting nurse service, an assisted project. I didn’t even get a chance to explain to him that the data living facility or a care management company, all of them had were changing because of the nature of the population—older their own review boards and it was someone else’s job to get the post-surgery cardiac patients who had been in the hospital for research project approved, not mine. I often had to submit sup- at least 19 days—and the very flexible interview schedule being portive material along with the instruments that I proposed to used to capture the information that appeared relevant to track use to collect data, but I did not have to submit and resubmit my recovery after discharge. I had no control who was included in proposal and once again experience delay, waiting for the next the study—the discharge planners selected them—I had little in- meeting of the IRB.
put into the questions asked—the cardiac surgeons had the most input—and it was very difficult conducting follow-up interviews Of course, not submitting my work to my university’s once the subjects were out of the hospital because of their age IRB had some repercussions, the most consequential being that and health status. Thus, there was missing data, variation in I could not use any university resources in my research. At first the timing of the follow-up interviews, frequent re-admittance this appeared to me to be a real handicap, because I couldn’t to the hospital and significant subject attrition (death). By any use graduate students to help in the collection and analysis of standards, the data set was less than pristine, but I was elated data, the university’s computer center or any other resources. that there was any information at all and the hospital staff was However, I very quickly came to realize that this was not neces- excited that they had concrete, if messy, data they didn’t have sarily a bad thing. For example, as every academic researcher before. What we were able to find helped the discharge planning knows, using graduate students in research is a mixed blessing, staff refine their care model, which was the goal of the project, since their major responsibilities are class work, writing papers in the first place.
and taking exams, often resulting in them not being available when they are most needed. Employees at the organization, on What I thought was an anomaly turned out to be the the other hand, are at the organization full time and have a buy- norm, over time, as instruments I used, selection criteria for sub- in to the research that graduate students can never have. Yes, em- jects I employed, data that I collected, and analytical techniques ployees have to be trained and not all will be fully committed to I applied, were continually defined as not methodologically “rig- collecting the data, but overall I have found that they are, when it orous” enough by journal reviewers. It’s not as if I didn’t know comes to collecting data, at least as dependable and effective as and use appropriate anthropological methods used in more aca- graduate students. As for analyzing data, 20 years ago not hav- demic research. For example, I had used sophisticated sampling ing access to my university’s main-frame was an inconvenience, frameworks in my ethnographic research. Even under extremely but not a deterrence to crunching my data. Today, given the ad- challenging conditions when conducting anthropological re- vances in computing and software, I can do at home on my own search in Somalia, I used a random sampling to select villages PC what I need to do with no real problems or delays. for inclusion in the study and for household heads to interview. But once I began to work on the ground with care providers, portant source of information. It was at these discussions that I I had to alter my entire view of what constituted a reasonable first realized that the key issue was one of control of the research population to study, which turned out to be whatever popula- process; as long as the researcher could filter out the self-defined tion the care providers deemed the most important. The need noise, the more control that she/he had, and the more chance of to find solutions to real world problems, in my mind, if not the statistically significant results being the outcome. When I point- reviewers, trumped the need for purity in the methodologies I ed out that statistically significant results often had nothing to employed. Ultimately, my solution was to seek out journals that do with “significant” real world results, i.e., findings that could were more focused on publishing work on the evaluation of the be used to improve specific aspects of care provision, my argu- actual delivery of care.
NOISE IS NOT ALWAYS BAD On the other hand, when I presented this same argu- ment to care providers they were largely confused by my differ- But the entire experience of struggling with reviewers led me to entiation between academic and real world significance. These an interesting conclusion: what most researchers see as noise, were bright, sophisticated care providers, many of whom had I view as the most important research component. By noise, I participated in research at some point in their careers, but they mean that internal validity is compromised by the interaction of could not understand why academics were so concerned about research variables, e.g., selection criteria not being randomized, standard deviation rather than with findings that could have a the data collection instruments being subject to change over real impact on the care that was provided to their clients/pa- time, thus contaminating the data. In the ethnographic research tients. Of course, being an academic myself, I felt compelled to that I have conducted in the real world, I’ve never had the luxury defend why so many of my colleagues were so obsessed with re- of using any form of sampling, simply because the populations search for research’s sake by pointing out that academic research have been too small and fluid. As for maintaining the sanctity of has resulted in findings that had an impact in the real world. This the questionnaires, surveys and interview schedules that I have argument was politely dismissed and I quickly realized that I employed, I gave up any attempt very early in my journey. If a was figuratively trying to unite two groups with vastly different question did not result in data that could help in the assessment, world views and that I was not going to convince either that the it was quickly jettisoned and others added, violating one of the other had merit, so I gave up and just went about more work. basic tenets of anthropological research. The reason for this vio- lation was simple: the goal of the research was to obtain infor- WHERE THINGS STAND mation that could be used to assess the effectiveness of the care being delivered, not maintain purity. In addition, I have never It is not correct to say that I completely gave up, because I’m tried to keep the objectives of the study from the participants still advocating for more academic researchers to get out of the nor employed control group—all violations of standard research safe, controlled environs of the university and apply their skills practice. And why have I ignored these protocols in my real in the real world of care provision; but it is a hard sell. Although world research, whereas I consistently applied them in my aca- normally I’m not that reflective, I have had to think about why demic work? Simply because the goals of the research were so I have been willing to continuously engage in research where I different. Academic research is conducted primarily to impress have so little control. I think that 2 things drive me to this work: other academics with the rigor of the methods employed and to freedom; and trying to make a difference. In a strange way, the convince granting agencies that you are worthy of funding. The freedom that I experience engaging in this non-academic re- goal of the anthropological research I’ve been involved in for the search is the result of me giving up a quest for control. Yes, as I last 20 years is to explore ways and means of delivering better, explained previously, I have little control over the specific topic more timely and cost effective care to a particular patient/client to be studied, the research calendar, subject selection, publica- population. It is a question of solving problems, within a very tion and presentation outlets and the methods employed, but in limited time-frame and budget, and everyone involved under- turn, I can spend almost all of my time actually collecting and stands that there have to be compromises.
analyzing data. I’m free from trying to please granting agencies, negotiating with the university’s IRB, stoking the egos of my In many ways, the attempt to eliminate noise is another co-PIs and other academic researchers, running after money to control issue with the researcher defining things that get in the support a large academic research structure and, perhaps most way of a perceived clean analysis. Almost a decade ago, I wrote importantly, free from waiting around to get the money and re- an article with a colleague titled, Embrace the Chaos, It’s not ceive the permission that allows me to start collecting the data. Noise: Lessons Learned from Non-Traditional Environments,2 From my perspective these benefits far outweigh the need to and presented similar ideas at a series of workshops, national cede control and this is before I add in the second reason for my and international conferences, and professional meetings of care willingness to go so far from the boat: my work can and actually providers. The response to the article and the talks was extreme- has helped improve the delivery of care.
ly informative. Academic audiences responded, as I expected, fairly critically to my methods and claim that noise should not In a time long ago and what seems like a different gal- be filtered out of research but, instead, should be seen as an im- axy, I scoffed at using social science research to help people in the real world. My exact feeling that I expressed for close to 2 the collected material in order to understand the content of the decades was, “if you want to help people become a social work- behavior observed and reach conclusions. The only difference is, er”. I now believe that I was wrong or misguided or just full of rather than the conclusions being about the distribution of labor myself, because for most of the last 20 years I have been telling between raising sorghum and livestock, my conclusions in this my students and younger anthropological colleagues that if their field site concern the effectiveness of a new care delivery model. research is not helping people beyond the hallowed halls of their It’s still anthropology; it is only the field site that has changed. universities, they are just wasting their time. It probably sounds strange to many academics when I say that I get much more I’m fully aware that few anthropologists will take even pleasure when my research impacts the way care is delivered a single step off the boat and that many others will dislike the than I do having an article accepted for publication, but it does. feeling associated with not being in control and immediately Does this make me a social worker? No, but it does make me climb back on board while very few will either stray much be- a social scientist who believes that his work should be socially yond the shore line and fewer still will actually enter the jungle; relevant and that the most relevance is gained by helping people. but if even a couple do, then I will have succeeded. And if these few can persuade others that getting off the boat is worthwhile, This essay has become much preachier than I intended, maybe over time there will be a large enough number of re- so let me return to my main theme: more anthropologists should searchers toiling in the real world to make a difference and, at get off the academic boat and see what they can accomplish in the same time, experience the freedom that comes from not be- the messy real world. I believe that, in many ways, the key to ing in control.
persuading anthropologists to conduct research in the real world is the broadening of the definition of a field site. I have argued