Comparing Education Reform to Health Care

At Bridging Differences, a reader exhorts us to read a recent New York Times Magazine article which tells the story of a physician who is making use of data to drastically improve patient outcomes. She then challenges us to try to tell her why education is so different than medicine, proclaiming “There is good reason to start using standards and evidence-based decision-making in education,” and, “Enough excuses for the ‘art’ of teaching.”

Well I read the article, but my thoughts about what education can borrow from the story are a little different.

The report tells about Dr. Brent James, a Salt Lake City physician, who undertook a project to develop a protocol for the treatment of a severe respiratory condition which causes its victims to end up in ICU on a ventilator. James wrote the initial version of a protocol and left copies in a binder at patients’ bedsides so other doctors could refer to it and use it (or a portion of it), if they chose to do so. Their participation was totally optional.

Over time, a computerized record system tracked the patient outcomes, and a team met frequently to review the information and rewrite the protocol when it seemed wrong. The result of this careful, low pressure, collaborative effort was a highly refined and effective treatment plan. The protocol's eventual success was due to this entire process, a process which is very unlike any of the top-down mandates which teachers are subjected to these days.

Another doctor interviewed for the article states, “He [James] knows that the minute he says, ‘I’m right, and you must do this,’ he loses everybody but the true believers.” Near the end of the article, the author tells us, “James told me that one of his first challenges, when talking to a new group of doctors, is to persuade them he is not accusing them of failure.”

To today’s urban public school teachers, nothing in James’ approach will sound familiar.

The primary lesson in the story, as I see it, is about giving professionals due respect and how to best solicit their cooperation for change. James demonstrates how to be a highly skillful leader who earns trust as he uses a wide range of tools, which include collecting and evaluating data as well as maximizing collaboration, to produce improved results. At no time does he charge other doctors with being “failures,” or engages in name-calling as is commonly done to urban public school teachers today (such as calling their places of work “dropout factories” and “failing schools”).

Sadly, I believe it is from an utter societal disrespect for teachers which led to No Child Left Behind’s punitive use of data. As the story about Dr. James so perfectly illustrates, careful collection and analysis of data can be used in a much more mature and effective way.

The Broader, Bolder Approach proposes excellent alternatives to the currently popular, unbalanced school reform strategies, but unfortunately they haven't been presented to the public by the mainstream press. For instance, a 2009 report produced by the BBA recommends that next version of the Elementary and Secondary Education Act permits states flexibility in designing their accountability systems, provided these systems include qualitative evaluation of school quality and do not rely primarily on standardized test scores to judge the success of schools. It proposes “a new accountability system that combines testing with qualitative evaluation is needed to replace the discredited No Child Left Behind Act.”

Specifically, BBA recommends that:

• The federal government should collect state-level data – mostly from an expanded National Assessment of Education Progress (NAEP) – on how students of different backgrounds perform in a broad range of academic subjects, as well as in the arts, physical health and fitness, citizenship habits, and other necessary knowledge and skills;
• State accountability systems should supplement higher quality standardized tests with qualitative evaluation of districts and schools to ensure the presence of a supportive school climate, high-quality classroom instruction and other resources and practices needed for student success.

It is important for the public to be informed about these discussions. As David Leonhardt, the author of the Times article, wrote:

This debate between intuition and empiricism is as old as Plato, who thought that knowledge came from intuitive reasoning, and Aristotle, who preferred observation. The argument has seemed especially intense lately, as one field after another has struggled to define the role of human judgment in a data-saturated society. The police officials in New York City who overhauled crime fighting were classic empiricists. The debate over education reform revolves around how well teachers can be measured and what the consequences of those measurements should be. These disagreements can sometimes be exaggerated, because everyone agrees that intuition and empiricism both have a role to play. But the fight over how to balance the two is a real one.

One last thought about comparing the work of doctors to that of teachers.

If one is using the work of doctors in the hospital setting, one must realize that this is an environment which controls absolutely everything done to the patient. Inputs and outputs are monitored every hour and no compliance on the part of the patient is required. For example, when patients refuse, or are unable, to take the pill by mouth, then they are given the medicine by injection. If they are disoriented and refuse to stay in bed, physical restraints will be applied.

If we are going to compare doctors to teachers, it would be more useful to use the example of doctors who see patients in a clinic setting. These doctors are not guaranteed that their patients will comply with any of the treatments which they prescribe. Advice can be given to take the medicine as directed, and to follow other treatment regimes, but this doesn’t mean that any of the recommendations will be followed. The ball is in the patient's court, along with their ability to pay for the prescription, or not, as well as the presence of enough family support to help them follow the prescribed treatments, or not.

Since they are self-selected or explicitly selected, the nature of today’s charter schools are the equivalent of physicians who absolutely refuse to see patients suffering from the most chronically severe health conditions, or those who are less-than-adequately compliant. There is little logic in comparing the outcomes of this particular set of doctors to those who provide treatment to any, and all, patients who happen to walk through their clinic doors, as is the case for the true public schools. Compliance with the mission of the school, or not, is a huge factor over which the traditional public school teachers only have a limited amount of control.

It is a national travesty that the voices aired most often by the media these days are those of the teacher-haters and clueless idealists who believe the fundamental reason for low academic achievement in our cities is because every urban public school teacher is incompetent and lazy. This is the sour attitude behind the dominant education reform movement and it is just plain wrong.

I am not saying that the functioning of schools could not be made better and more efficient. Any organization can, and should, constantly be tweaked, but it should be done with mutual respect and collaboration. Healthy and frequent self-assessment is a good operating standard for any organization, including our whole society and even the nuclear organization that exists in our homes. I also believe the vast majority of schools have been doing this to some extent all along.

It's time for the dominant school reform crowd to stop lying about how great charter schools are, and they need to stop attacking public school teachers. It's time for these people to face the fact that other societal factors are very much at play, and that, no matter how much they are perfected, schools will only be able to do so much.