Thursday, December 17, 2009

Testing, Testing

In the Dec. 14 issue of The New Yorker, physician Atul Gawande takes on one of the persistent critiques of the current health care debate:

“We crave sweeping transformation, however all the current bill offers is … pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude. And yet—here’s the interesting thing—history suggests otherwise.”

The history that Gawande is referring to is that of the federal agricultural extension agency, where multiple small scale ‘experiments’ helped transform the productivity of farming. It’s a history that could inform federal policy in education as well.

Gawande grew up in my backyard. His parents are well-respected doctors (now retired) and all of us have a certain pride that our county produced such a literate physician (he is the author of several books and is regularly featured in The New Yorker). And it is a testament to his broad thinking that he finds in the history of agriculture policy seeds of a lesson for health care.

I don’t want to recapitulate all of what Gawande has said in this piece, it’s a quick read and I recommend it. But I guide you to it because what he has to say about health care reform is worth considering when we think about how to support our public schools. Simply put, his point is that while we may want a quick fix for health care, one probably does not exist. And, if the history of federal intervention into local practices teaches us anything, the best thing we could do is seed promising practices and do our best to disseminate what works. Here is an extended quote from the piece, insert ‘education’ for ‘medicine’ and you get the point:

Much like farming, medicine involves hundreds of local entities across the country—hospitals, clinics, pharmacies, home-health agencies, drug and device suppliers. They provide complex services for the thousands of diseases, conditions, and injuries that afflict us…Our fee-for-service system, doling out separate payments for everything and everyone involved in a patient’s care, has all the wrong incentives: it rewards doing more over doing right, it increases paperwork and the duplication of efforts, and it discourages clinicians from working together for the best possible results. Knowledge diffuses too slowly…And the best way to fix all this is—well, plenty of people have plenty of ideas. Its’ just that nobody knows for sure.

The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front…

We have our models, to be sure. There are places like the Mayo Clinic in Minnesota; Intermountain Healthcare in Utah…that reliably deliver higher quality for lower costs that elsewhere. Yet they have had years to develop their organizations and institutional cultures..Even they have difficulties...Each area has its own history and traditions, its own gaps in infrastructure, and its own distinctive patient population. To figure out how to transform medical communities, with all their diversity and complexity, is going to involve trial and error. And this will require pilot programs—a lot of them.

When I read this I think of what would have been helpful nine years ago when NCLB was passed. If the feds first would have realized that our schools are profoundly local entities with a national mission. When I open the doors every morning 450 some kids come in with 450 different learning styles, injuries, strengths, and dreams. Some general strategies reach all of them, but no one of them is a carbon copy of another. We work daily to rewrite the book on how to meet our kids’ needs; rethinking the organization of the day our advisory program or our curriculum. Honestly, really, nobody knows for sure what will work from one day to the next. We rely upon our shared wisdom, research, experience, and, yes, just plain gut-instinct (so, by the way, do good doctors and farmers).

And we rely upon models. We have visited other schools, gone to meetings, invited friends to visit and critique. They all have their own limitations; no one thing fits us exactly. But we bend and shape them into our own pilot program, the one that seems to fit us the best…today, that is—it may be different tomorrow.

While we do this we work in a system that rewards all the wrong things. The matrices we use, standardized test scores, are one dimensional and easily manipulated by tutoring, pushing kids out of school, and doing more around lower level memorization skills that teaching for higher level thinking. The pile of paperwork and reports seem designed more to keep bureaucrats in business than to help kids learn. And the rewards/punishment system is set up as a ratings game with losers and winners rather than all boats rising together.

I think the bottom line here is that we trusted, some 70 years ago, local farmers to take on productive practices and produce the food we needed. And for the most part we trust our doctors to have our best interests in mind and believe they are willing to do what is right if they are given the opportunity. The same can be said of teachers, still one of the most trusted professions in America.

So, when it finally comes time for the reauthorization of ESEA those that represent us in Washington might do well to keep in mind what we learned in providing for our stomachs when they think about how to provide for our minds.

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