Lessons on Performance from the Hospital

Posted earlier this week at LeaderTalk

We had a surprise on Saturday – our baby girl arrived nearly 5 weeks early and was breech, so we had to have an emergency C-section. The baby is in NICU right now and making steady progress. We’re in one of the best hospitals on earth in which to have a baby, and I feel profoundly grateful for the care we’re receiving. We’ll be here for a while, and for a hospital, it’s not a bad place to be.

While we’re here, there’s plenty of waiting to do, and I can’t help but draw some lessons from our hospital experience, and make some comparisons with the world of education. Richard Elmore and colleagues make such a comparison into their central metaphor in Instructional Rounds, and the past day has given me insight into a few instructive similarities and differences between hospitals and schools.

1. Treatment plans are highly directive
In hospitals, there are extremely specific procedures for virtually any set of circumstances, to ensure that the desired outcomes (healthy patients) can be achieved with a high degree of consistency. There is no pretense that “whatever you want is fine” – there is a well-defined best practice for virtually every circumstance. While the patient still has some degree of say in his or her care, hospital staff have no qualms about being very directive and even downright bossy.

In education, we tend to “try” things and make suggestions to parents, rather than insist on a specific plan of action. Of course, people go to hospitals when they’re in crisis, which places clients and professionals into different roles.

2. Failure is not an option
The NICU devotes an incredible level of support to high-needs patients. Whatever the baby needs, the baby gets, regardless of cost or hassle. We would consider anything less morally unacceptable, assuming we have the resources. If the situation worsens, the interventions intensify.

In education, resource constraints (such as access to tutors, teacher:student ratios, and learning time) are generally considered a given, and the results are allowed to vary. In schools with a well-developed RTI model, the most intensive levels of support are given to the students who need support the most. However, schools are not designed (or funded) around a “failure is not an option” mission.

3. The division of labor is…interesting
Most of the people we’ve interacted with so far are nurses, and it’s clear that the nurses do the vast majority of the work. They use their own professional judgment in the day-to-day choices about patient care, but are always bound by the doctor’s care orders. Doctors make decisions about all aspects of the treatment regimen, but carry out very little of it themselves. In addition (as Elmore emphasizes in Instructional Rounds), doctors consult with nurses and each other in developing and adapting treatment plans.

In education, most decisions about what students need (by way of instruction, supports, accommodations, and interventions) are made and carried out by teachers in isolation. We don’t have a doctors-and-nurses division of labor; if anything, teachers are both doctors and nurses, and principals are most like hospital administrators – responsible for everything that goes on, but not involved in direct service to clients.

This has me wondering: What might it look like to have, say, two or more teachers (perhaps with complementary areas of expertise) and a large number of tutors working with a large number of students? Many of the things teachers do could easily be done by people with less training. Teachers could check in and revise the plans – the care orders – as they go on rounds.

How Similar Are Education and Medicine?
Education has a lot to teach medicine, too, so I’m not suggesting that the solution to educational improvement is becoming more like the medical field. Schools and hospitals are both complex organizations working for the public good, but the economic, human resources, and professional practice realities are drastically different.

If you’re interested in learning more about improvement in medicine, I highly recommend Dr. Atul Gawande‘s books and New Yorker articles, which are rife with potential analogies for how we can improve education. Thanks to my mentor, Carolyn Gellermann, who works in both education and medicine, for introducing me to Dr. Gawande’s work.

Depending on how long we’re in the hospital, I may have more to say about what the medical profession can teach the education profession about how to improve. What lessons for performance improvement in education would you draw from the medical field?

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.

x How to Handle Every Kind of Email
Google+