Monday, March 10, 2008

Unhealthy Numbers

From the physician's point of view, the patient was reduced to a bunch of numbers. Moreover, the numbers were not organized by symptoms or diagnoses: they were organized by what tests were run and which laboratory within the hospital had processed the results. The patient's history — the record of past events and healthcare — was in a different location than current test results. Current results were in a different place than past results. Different hospitals might have different laboratories, so their results would be organized differently. But the attending and resident physicians and nurses were experts at piecing together a mental model of the state of the patient from all these numbers. Or so they said: evidence is difficult to come by.

Don Norman describes his experience observing hospitals in "A Fetish for Numbers: Hospital Care."

Of course, the reason for all these numbers is to improve patient care. Yet the result seems to be quite different:

There were so many medical devices, so many readouts and displays, that I could not even see the patient until someone walked over and pointed. Now this was an infant ward, so this particular patient was tiny, but even so this is a good illustration of modern medicine: From the point of view of the physicians, the patient is a set of test results and numerical readouts. The patient as a person tends to be forgotten (emphasis added).

In another hospital, Norman observed the following incident:

The attending physician would stand outside of the patient's door and listen to the review of the test results by all the residents. They would then discuss the results and make further recommendations. Then, as we all left to go to the next doorway and the next patient, the attending physician would knock on the open door, stick his head in and say, "How are you doing today, Mr. Forbes?" That was the extent of patient interaction.

With all this focus on numbers, the patient gets lost.

Scientists measure what they can measure and pronounce the rest to be unimportant. But the most important parts of life are qualitative. One of the physicians on my study team told us that it can take as long as 20 minutes to fill out all the required forms while she is in front of the patient, yet she is only allowed 15 minutes to attend to each patient.

It takes more time to fill out forms than she is allowed for each patient. There is no time left for real patient interaction.

Obviously, health care requires the collection and organization of numbers. But even so, more numbers do not equate to better care. If this is true in the hospital, how much more must it be true in the church?

Doug Jacoby addresses the number fetish in the church:

Have you ever noticed policemen on the highways out in force during the last couple of days of the month? Like state troopers and salesmen at month end, many, many of our ministers are more "urgent," "care more" about the lost, and strive harder to "make their goals" as the calendar month draws to an end. I believe that many of our leaders sense this, and not a few of the membership at large question motives when we become unusually intense in the final five or ten days of the month. Something about this is very wrong. It's not a Christlike behavior. We are not a corps of salesmen! We are ambassadors of Christ who believe in total disclosure of the truth, who espouse integrity, and who have Jesus as our model and our master.

But some will say, "Keeping statistics on church growth is a biblical principle. Just look at the records recorded in Acts." Take a look at the statements about numbers and "growth" in Luke's account of the early Church:

  • In those days Peter stood up among the believers (a group numbering about a hundred and twenty) (Acts 1:15).
  • Those who accepted his message were baptized, and about three thousand were added to their number that day (Acts 2:41).
  • And the Lord added to their number daily those who were being saved (Acts 2:47).
  • But many who heard the message believed, and the number of men grew to about five thousand (Acts 4:4).
  • More and more men and women believed in the Lord and were added to their number (Acts 5:14).
  • In those days when the number of disciples was increasing… (Acts 6:1).
  • So the word of God spread. The number of disciples in Jerusalem increased rapidly, and a large number of priests became obedient to the faith (Acts 6:7).
  • Then the church throughout Judea, Galilee and Samaria enjoyed a time of peace. It was strengthened; and encouraged by the Holy Spirit, it grew in numbers, living in the fear of the Lord (Acts 9:31).
  • The Lord's hand was with them, and a great number of people believed and turned to the Lord (Acts 11:21).
  • [Barnabas] was a good man, full of the Holy Spirit and faith, and a great number of people were brought to the Lord (Acts 11:24).
  • At Iconium Paul and Barnabas went as usual into the Jewish synagogue. There they spoke so effectively that a great number of Jews and Gentiles believed (Acts 14:1).
  • They preached the good news in that city and won a large number of disciples (Acts 14:21).
  • So the churches were strengthened in the faith and grew daily in numbers (Acts 16:5).
  • Some of the Jews were persuaded and joined Paul and Silas, as did a large number of God-fearing Greeks and not a few prominent women (Acts 17:4).
  • Many of the Jews believed, as did also a number of prominent Greek women and many Greek men (Acts 17:12).
  • A few men became followers of Paul and believed. Among them was Dionysius, a member of the Areopagus, also a woman named Damaris, and a number of others (Acts 17:34).

At first, this list seems to provide overwhelming support for the "biblical principle" of statistical analysis.

But a closer look shows something very different.

  • Only three verses mention a specific number (1:15, 2:41, 4:4).
  • Two of those are obviously round numbers (2:41, 4:4).
  • The other number seems also to be an estimate (1:15).
  • These are all statements of fact. There is no indication that the Apostles used any sort of accounting system to measure their effectiveness.
  • This was the very beginning of the Church. It is dangerous to assume that everything that occurred then should be made normative for all churches, everywhere, in all times.
  • It is anachronistic to think that the Apostles had anything more than a general idea of how many people were in the church at any one time. (In other words, the early versions of Microsoft Excel did not run efficiently on clay tablets and parchment scrolls.)
  • There is no indication that the Apostles spent time developing a strategic plan, much less that they used statistical analysis to evaluate the effectiveness of such plans.

I am not arguing that any use of numbers is wrong. But I am arguing that a focus on numbers can quickly lead to serious problems. A few of these might be

  • Assuming that what we do is the determining factor that produces the "results"
  • Reducing all aspects of ministry to factors that can be measured
  • Focusing on activities that seem to affect the numbers that are being measured
  • Neglecting activities that don't seem to directly improve the "stats"
  • Reducing ministry exclusively to "doing"
  • Denigrating any ministry that does not show "growth"

The parables that Jesus tells in Luke 15 are often cited as evidence that "numbers represent people." However, they could just as easily be understood as a total disregard of "numbers" in favor of individuals who "don't count." Too often, numbers don't represent people as much as they reduce living, breathing, people to cold, hard data.

Pastor Rod

"Helping You Become the Person God Created You to Be"

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