June 07, 2010
Show me the value!
During the last year or so of the seemingly endless health care debate, there has been a lot of hand wringing and yelling about what’s needed to fix the health care system in the US. The funny thing is, if you read anybody who really knows anything about these things, who has thought deeply about these issues, there is a pretty simple, general consensus about the main thing that is wrong with health care in the US, and most of the world over - it isn’t based on outcomes. It’s a fee-for-service system that doesn’t reward anyone, doctors or patients, for better health outcomes. If that system were changed to some kind of pay-for-performance system with more accountability all round for the actual value derived out of the health system - cost relative to quality - this would be a really great first step in curing what ails us. Part of this paradigm shift is to put the patient at the center of their own health care, utilizing technology innovations to move towards “care anywhere” networks where the patient gets the care they need, where and when they need it.
Thinking and reading about this subject recently made me think about education and whether any of these concepts could be applied to this other broken US system. I’m particularly thinking about it this month as a lot of my local school boards vote whether or not to approve their budgets, budgets that have already been stripped down to the bare bones as services are canceled and any class or activity extraneous to the state testing regimen is threatened.
Perhaps some of the principles that could be applied to health care could also be applied to education. For example, in many ways education is also a fee-for-service endeavor rather than a pay-for-performance one. Of course, the first thing people will start writing to me about is that the American education system is paying schools for performance as test results, the very tests that I have criticized. But this isn’t what I mean when I talk about pay-for-performance. My children’s school, as part of its enrollment outreach has been talking recently about attempting to better articulate the value of the education the school provides. Articulating it by bringing back alumni to discuss how such an education shaped their lives, bringing in heads of local high schools to discuss what they see as distinctive in the children that come to them from the school. That’s what the value of the education is, not the snapshot of a standardized test score, but the kind of child that school ends up graduating and the contribution that child can make to the world and the quality of the life they can create for themselves. This is the educational outcome, the value of an education.
Now, I don’t claim to know how you might go about creating metrics around this rather esoteric notion, but it does seem to me that an education system where the average teacher’s focus is no longer than a school year and the test results at the end of that year has something wrong. Again, just like health care, we spend a lot and don't necessarily get good value for our education dollars. The New York Times quoting Jon Schnur, who runs a Manhattan-based school-reform group says, “a country that spends more per pupil than any other but whose student performance ranks in the bottom third among developed nations isn’t failing its children for lack of resources but for lack of trained, motivated, accountable talent at the front of the class.” I don’t mean to be overly critical of teachers, any more than a critique of the health care fee-for-service system is a criticism of doctors; neither set of professionals has much choice about the system they are forced to work in. Rather, I am posing this question: what if we put students at the center of education in much the same way that progressive thinkers about health care posit we should put the patient?
At first blush, this seems absurd to even question; if health care isn’t about patients and education isn’t about students then what are they about? But I think almost everyone in the US, and probably elsewhere, can identify with the depiction of a health care system that seems about almost everything except making us healthier people at the end of the day; hospitals are worried about not being reimbursed, doctors are terrified of being sued and insurance companies are determined to pay for as little care as possible in order to maximize their profits (which of course, is what corporations are supposed to do). The very last thing that the system seems geared to encourage is wellness - our well being and ongoing health as consumers. In much the same way, too much education these days is geared towards getting enough children to pass standardized tests so that school districts can claim their share of federal dollars. Let’s take a step back and say, “what about the child? What is the educational value this child derives from the system at age 18?”
One of the possible silver bullets for the healthcare system is the use of technological innovations to disrupt the healthcare status quo; mobile technology connecting to medical devices, social media, virtual-world disease support groups, these are just some of the technologies that are helping patients take control of their own health, managing their chronic diseases, promoting wellness, providing “patients like me” support groups and promoting medical adherence.
There are some examples of schools providing web-based educational offerings, and certainly at the college level there are quite a few examples of the use of virtual worlds to facilitate learning. However, for the most part, at the pre-college level, technology solutions are not deployed in innovative ways that might create real educational value for the average student. Teenagers today are obsessed with their cell phones and texting. Why not utilize this for educational purposes? As I’ve discussed previously, video and computer games can play an invaluable role in education. Teens and Tweens are clearly hooked on social media. How can this be used in an educational setting? How can we use these modern tools to provide education anywhere networks? Perhaps the idea of a traditional 8-3 school day is as antiquated as the idea that you might go to see a doctor without first Googling your symptoms, reading up on possible diagnoses on WebMD and then posting a Facebook request asking friends for doctor recommendations.
Clayton Christensen writing about the place of disruptive innovations in health care in the “Innovators Prescription: A Disruptive Solution for Health Care” says that historically, “the incumbent leaders in an industry just could not find a way to maintain their industry leadership when confronted with disruptive innovations. The reason...is that they lack the motivation to focus sufficient resources on the disruption.” If we extend the health care analogy: who lacks the motivation to bring disruptive innovations to bear on education? Well, the teacher’s union for one, a body that sometimes seem more intent on protecting teachers than children. Certainly it seems that the average school district has no incentive to mess with the status quo. So who? Parents? Students? There is clearly some realization on the part of the Federal Government that something needs to happen, but I believe that the "Race to the Top", while trying some interesting ways to make schools and teachers more accountable, is still an insufficient solution, ultimately merely giving lip service to the concept of educational innovation.
There’s no doubt, this isn’t an easy problem to solve, but neither is health care. The first step, much as it has been in health care, has to be to think of new ways to frame the problem. This has been my modest contribution to this dialog.
Posted by Sarah Firisen at 12:15 AM | Permalink