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Introducing Atul Gawande, Educator

One of my favorite authors on improvement and performance today is Atul Gawande. His insights have profound implications for educational leaders, and he may be one of the most influential reformers to come along in a long time.

But you won’t find him at Teachers College or ASCD. Atul Gawande is a surgeon.

In Better, he writes about numerous aspects of improvement in healthcare. In The Checklist Manifesto, he explores the power of checklists to reduce errors in complex fields such as aviation (where checklists are ubiquitous) and medicine (where he hopes to make checklists part of standard practice). I finished these two books in a day or two each, and am working on his first book, Complications, now.

Complications Better Checklist Manifesto New Yorker

In addition, Gawande writes regularly for The New Yorker.

Here’s Gawande in a recent appearance on The Daily Show with Jon Stewart, in which he talks about The Checklist Manifesto:

Clearly, there are many parallels between the challenges in healthcare and those faced by educators. I will soon have more to say on The Checklist Manifesto and Better from an educator’s perspective (you can subscribe to email updates using the form in the sidebar of this site).

Gawande will be in Seattle on May 3 if you’d like to hear him live.

If Education Were Like Healthcare

Medicine and education are both professions funded largely by the government for the public good, but with very different structures for billing and professional compensation. What would schools be like if they operated like medical clinics?

Teachers would be paid not for their time or their performance, but for the number of tests and activities they conducted. Publishers would spend billions of dollars advertising their assessments and instructional materials directly to families, urging them to ask for specific materials to be used in their child’s school.

These two factors – compensation and advertising – would lead to an explosion in the number of exotic and experimental practices and interventions used in schools. Students would often be given redundant assessments in an effort to do everything possible to inform their education (and drive up their bill).

Families could sue teachers if their children failed to meet standards, and teachers would have to take out malpractice insurance. These liabilities would rapidly drive up the cost of education.

Lawyers would appear in TV commercials offering to sue schools for failing to successfully educate students, and huge verdicts against teachers would drive up the cost of malpractice insurance and drive some teachers to leave the profession.

Students would not be guaranteed an education; they’d have to have school insurance. However, students could get emergency tutoring if they’re in a desperate situation, but no day-to-day schooling. If students were unable to pay for the services they receive, the school could sue them to recover its tutoring costs, leading many families to bankruptcy.

Wealthy families would have better insurance which would pay for elite private schools, and would grumble about free handouts to uninsured students.

Teachers would be able to create specialty education clinics, and refer students to expensive educational services provided by branches of their own clinics. For example, if a student failed to learn to read, they could be referred for an expensive evaluation and intervention services, all of which would be paid by the school insurance. Some teachers would become extraordinarily wealthy in private practice, while others would continue to work for paltry salaries in public schools. Demographers would note the shortage of the latter, especially in urban and rural low-income communities.

Instead of two or three secretaries per school, we’d need a dozen or more to handle all the insurance claims – after all, the school-insurance companies would have to pay for all the lessons, tests, tutoring, field trips, lunches, supplies, and other costs associated with schooling.

Teachers would use computerized inventory and service-tracking systems to bill students and their insurance for every pencil, every trip to the bathroom, every sip of water from the water fountain, every handful of Goldfish crackers, every tissue, and every Band-Aid.

Schools would continue to buy supplies in bulk at low prices, but would impose a substantial markup in order to cover the cost of supplies for uninsured students. It wouldn’t be uncommon to bill $3.50 for a Band-Aid or $7 for a pencil. Using a chair and desk would be $150 a day, not including the use of space in the room (another $300).

While students would continue to be taught in groups, they’d be billed individually for the educational services they received. Teachers would continue to assess students’ prior knowledge, build on this knowledge to introduce new concepts, reinforce students’ understanding through guided and independent practice, and assess students’ mastery.

Each stage of this teaching and learning process would be a separate billable professional service, and students who ask questions or ask the teacher to check their work will have this noted in their bills. Each paper graded would incur a flat fee; a skilled teacher could generate thousands of dollars per hour in billable work.

The cries for education reform are frequent and loud, but the current national debate on healthcare reform offers us the rare opportunity to reflect on the strengths of our education system compared to other complex social and professional service systems.

Comments on education, healthcare, and the similarities and differences between them are welcome.