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?

Recruiting “Top Third” Talent into the US Teaching Ranks

McKinsey & Co recently published a compelling report on the strategies that high-performing nations use to recruit teacher talent from the top third of college graduates. In the US, the report points out, only 23% of teachers entering the workforce are among the top third, and the proportion is even lower (14%) among those taking jobs in high-poverty schools.

McKinsey reportIn Finland, South Korea, and Singapore, by contrast, 100% of teachers are recruited from the top third of college graduates. While academic talent alone doesn’t fully predict teacher performance, it certainly can’t hurt to have the best and brightest teaching the nation’s students.

In the US, only Teach for America is so selective and successful in attracting top talent. TfA admits high-achieving elite students, often from the Ivies, and admission carries serious prestige. However, TfA graduates often have no intention of staying in teaching more than a few years, and are still subject to the same labor market conditions that drive top talent into other professions. Even as TfA continues to rise in prestige, teaching itself remains a lower-status job in the US than in top-performing nations.

Most teacher preparation programs in the US screen only for basic academic and personal qualifications; recruiting “the best of the best” is difficult for a variety of reasons:

  • Starting and maximum teacher salaries are often lower than those in other professions, and are based on seniority rather than performance
  • Teacher-bashing has become a national pastime, and the prestige of the profession seems to be on the decline
  • Teacher education classes are often made very easy, to ensure that everyone succeeds; consequently, high-achieving students choose majors that are more engaging and challenging

On this last point, I can speak from personal experience. Many of my friends left the teacher education program at my university after sitting through a 3-credit course on how to use an overhead projector and a photocopier. They had no interest in having their intelligence insulted, nor in being surrounded by the university’s worst students for four years. My interest was sustained only by my much more rigorous science coursework. I graduated first in my class in the physical sciences department, yet I was the only physical science major to also earn teacher certification. Clearly, my university had failed to attract many of its best students into the teacher education program.

Finland, South Korea, and Singapore use a combination of salary, prestige, and labor-market responsiveness to ensure that teaching is a career to which the best and brightest aspire. Critically, these strategies are used with great purposefulness on the national level, whereas in the US, there is no national strategy for developing a strong teacher workforce.

While these nations’ high performance is due to a variety of factors, teacher quality is certainly a centerpiece of their national strategies for excellence:

When asked what’s accounted for the extraordinary rise in the nation’s educational performance in recent decades, Korean officials put the matter simply: “The quality of an education system cannot exceed the quality of its teachers.”

Indeed.

It’s inspiring to think what could happen in US schools if we developed a national strategy for attracting and retaining top talent in teaching. It’d be nice to know that the only people accepted into teacher certification programs are top-third students, but obviously that’s a long way off.

I hope that as a nation, we can recognize the logic of the McKinsey report’s recommendations and start to take steps to attract high performers to our nation’s classrooms. In addition to identifying how Finland, Singapore, and South Korea attract top talent, McKinsey conducted market research to determine the approximate cost of developing a comparable strategy in the US. It wouldn’t be cheap, but at a time when we’re spending billions to improve our schools, making teaching a more attractive profession to our top college graduates is certainly a worthwhile investment.

Ignoring these nations’ examples would be to stake America’s future on the idea that the U.S., alone among nations, can prepare its children to thrive in a global economy while relying on lower-achieving graduates to teach them.

Read the full report (PDF)

Diligence & Drinking from the Firehose

Yesterday was one of those days when I barely used my chair. We started a school-wide assessment on the computers, had two different meetings about a high-needs student, and had about 50 other things going on. I grasp the concept delegation, and wasn’t even directly handling most of what was going on, but it was still a whirlwind day. I left my briefcase in the car and didn’t have a chance (or a reason) to go back and get it. When I got home, I had 62 emails to deal with, which I did before bed.

Used to be in our basement All this has me thinking: This is an incredibly common experience for school leaders. In fact, it’s the reality more often than not in many of our schools. Given this situation, what does high performance look like? What does professional practice look like when the professional in question is slammed all day long?

If I were to have the opportunity to ask Atul Gawande, I think part of his answer would be this: diligence. Having systems in place, and using them faithfully, to ensure that what needs to happen actually happens, even under conditions of high stress. Using my to-do list and calendar, as well as carefully pre-thought practices for things that come up such as discipline incidents – that’s what will ensure that I do my job well even when I’m under stress.

The fact that emergency rooms operate smoothly and save lives each day, despite the chaos that rolls through their doors, tells me that this can be done. Gawande’s work reminds me, though, that personal heroism is not the answer; being prepared and committed to doing what we know (ahead of time) is necessary – that’s what makes the difference on “firehose” days.

Performance Is Instructional Leadership

The masthead of this site (currently) says that my focus is on principal performance and productivity. When we talk about school leaders’ performance, what kind of actions, duties, or art are we describing?

Rethinking Teacher Supervision and Evaluation by Kim MarshallI just started Kim Marshall’s excellent book Rethinking Teacher Supervision and Evaluation: How to Work Smart, Build Collaboration, and Close the Achievement Gap, and it occurred to me within the first few pages that performance is, in essence, about instructional leadership.

Even though many productivity strategies focus on management tasks rather than instructional leadership, the gains in performance that can result from increased productivity are in instructional leadership.

Why is this? I think it’s because instructional leadership doesn’t get the attention it deserves unless the management work is under control. Being productive enough to keep your head above water can dramatically increase your time spent on instructional leadership. To use a different metaphor, you can’t remodel your house while it’s on fire. Management work has a built-in urgency that the work of instructional leadership typically lacks.

The consequences of ignoring critical school management work are often immediate and dire, though, so it won’t work to simply act as if instructional leadership is the only priority.

Let’s say a school leader spends 40 hours a week on management work – attending meetings, doing paperwork, handling student discipline – and their remaining time on instructional leadership – observing instruction, providing feedback to teachers, planning professional development, etc. If the leader works 60 hours a week, that leaves 20 hours a week for instructional leadership (and not much personal free time).

If increased productivity can enable the leader to handle the management work in 30 hours a week, that leaves an additional ten hours for instructional leadership, without an increase in time at work. This is a 50% increase in time available for instructional leadership.

Instructional leadership is “the work.” It is the primary means by which principals influence student learning, and we simply must create time for it.

Improvement: Growth vs. Problem-Solving

2 types of improvement diagram

Growth is more or less continuous – as we refine our technique, we get better gradually over time. But growth isn’t the only type of improvement.

If there is a problem, a specific barrier to higher performance, solving it will not be a gradual process. When the problem is solved – either through an insight and a change in practice, or through outside assistance – performance takes a dramatic leap.

When you are considering your own practice, or the practice of someone you supervise, think about whether the greatest growth will come from a focus on problem-solving, or from refining existing techniques.

The Dunning-Kruger Effect: A Frightening Phenomenon

Psychologists Dunning and Kruger

hypothesized that with a typical skill which humans may possess in greater or lesser degree,

1. Incompetent individuals tend to overestimate their own level of skill.
2. Incompetent individuals fail to recognize genuine skill in others.
3. Incompetent individuals fail to recognize the extremity of their inadequacy.
4. If they can be trained to substantially improve their own skill level, these individuals can recognize and acknowledge their own previous lack of skill.

This calls into question the wisdom of peer evaluation systems, particularly in systems that have a lower proportion of competent staff.

Interestingly enough, the researchers also found that the highly competent tend to underrate their own abilities – and they say that this is a cognitive bias, not just modesty.

This is why performance cannot be a matter of how we feel. For all we complain about accountability, without clear ways to measure our results, we not only risk overrating ourselves – we have a very high likelihood of doing so in areas where our competence is low.

Full report (PDF) by Dunning & Kruger

One other notable excerpt:

Although their test scores put them in the 12th percentile, they estimated themselves to be in the 62nd.

Heroism Vs. Performance

Why do we find the idea of principal performance hard to swallow?

We like to think of the principal as a hero who does whatever it takes to ensure student learning. When we see heroes, we are drawn to them, and we tell ourselves “We need more heroes like this one!” We think heroes will save us.

And we think “If being a principal means being a hero, I must be a hero.” And we stop thinking about our own performance as school leaders.

But we will never have a shark-fin curve when it comes to excellence in school leadership:
shark fin curve diagram

Our profession will never be 90% heroes. And it shouldn’t be.

As Copland notes in his 2001 Kappan article “The Myth of the Superprincipal” (see excerpt, PDF), demands on school leaders are exceedingly high, and this expectation of heroism is problematic for recruitment and retention of effective school leaders. Expecting people to be heroes discourages qualified candidates from entering the field, and leads to burnout among those in the profession.

But the alternative is not to lower expectations for principals. Instead, we can – we must – identify what effective principals do, how school leaders improve their performance, and what can be done at the local, state, and national levels to promote improvement.

Moving the Bell Curve To the Right

In Better, Atul Gawande describes the unexciting but immensely powerful impact of improving the performance of doctors. Rather than focus on breakthroughs and new technologies, he says, many more lives can be saved by simply moving the bell curve to the right.

It used to be assumed that differences among hospitals or doctors in a particular specialty were generally insignificant. If you plotted a graph showing the results of all the centers treating cystic fibrosis – or any other disease, for that matter – people expected that the curve would look something like a shark fin, with most places clustered around the very best outcomes.

Better

But the evidence has begun to indicate otherwise. What you tend to find is a bell curve: a handful of teams with disturbingly poor outcomes for their patients, a handful with remarkably good results, and a great undistinguished middle. link (PDF)

In a recent NY Times article, Elizabeth Green sounds a similar note in education reform:

THOMAS KANE, a Harvard economist who studies education… is one of several researchers who told me recently that he now has a more open mind. “I still think tenure review is important,” he said. “It’s just, I don’t think we should throw in our towel on the other things.” There is simply too much potential in improving the vast number of teachers who neither drag their students down nor pull them ahead.

By figuring out what makes the great teachers great, and passing that on to the mass of teachers in the middle, he said, “we could ensure that the average classroom tomorrow was seeing the types of gains that the top quarter of our classrooms see today.” He has made a guess about the effect that change would have. “We could close the gap between the United States and Japan on these international tests within two years.” link

Don’t we typically act as if most educators are outstanding, with a few average teachers and principals mixed in, along with a tiny number of incompetent people who should be exited from the profession? Don’t we assume our performance curve is a shark fin?

Shark Fin Plot

It’s not.

The shark fin isn’t coming any time soon, and it doesn’t need to – our best hope is to shift the bell curve to the right.

Kane refers to average teachers who “neither drag their students down nor pull them ahead,” which is reminiscent of my recent characterization of the majority of principals as “warm bodies” who have neither a positive nor a negative impact on student learning.

If we are to consider improving performance to be the fundamental obligation of a school leader, Gawande and Kane’s insights tell us two things:

  1. We need to continually invest in professional development to move the bell curve to the right. Superstars will not save us.
  2. We need to do what we can to lop off the extreme lower end of the bell curve, where we’re actually paying people to do harm.

Providing Feedback to Master Teachers

Teachers at more advanced levels of proficiency are generally very proud of their practice, and may have been asked to serve as a mentor for student teachers or interns. With such experience, it’s easy to perceive feedback as disrespectful if it’s not delivered carefully.

On a short walkthrough, it’s not uncommon for a principal to leave feedback that fails to take into account the instruction that took place before or after the observation, and it’s easy to come to snap judgments in order to find something to write down.

One way to avoid this trap is to provide low-inference feedback – to describe what is taking place without drawing conclusions about it, then to ask open-ended questions to prompt further thinking. For example, if you observe that students are completing worksheets, and it seems to you that the task is not very engaging or rigorous, you might provide provide feedback as follows:

Students are working independently on practice sheets, while teacher circulates to answer questions and check for understanding.
Questions for reflection: In addition to personal effort, what factors determine the level of benefit students derive from written work?

This question focuses the teacher’s attention on the task’s level of cognitive demand, but without a judgment such as “This doesn’t seem very rigorous.”

Feedback for Performance: The “Next Steps” List

Principals have an obligation to provide instructional leadership for every faculty member, not just those who are struggling. But how do you make an intentional, systematic effort to provide feedback to every teacher, including those who are excellent?

Photo from Flickr user thelastminuteIt can be challenging to provide constructive feedback to your best teachers. What do you say to help someone improve their practice, when it’s already at a superior level?

The answer to this question may not be immediately obvious, so one way to address this instructional leadership challenge is to keep a “next steps” list of your staff. List all of your staff members, and keep notes on each person’s previous work and strengths, and note what the next level of work is.

For example:
Abrams – presented at math conference; working on motivating students who aren’t completing homework.
Baker – recently formed new reading groups; working with one group on summarizing expository text.
Childress – new behavior plan for JT; trying to reduce disruptions to rest of the class.
Davidson – Implemented literacy centers last month; trying to build students’ independence.

Recordkeeping is essential. Just as teachers keep anecdotal and formal notes, it’s helpful to physically keep a “next steps” list. A simple two-column sheet, with names in the left column and blank space in the right, should work.

The “Warm Body” Zone

What’s my impact as a principal? One way to look at effectiveness is to divide the spectrum (from low to high) into three distinct zones:

  • The crisis zone – ineffective leadership causing major problems for student learning and school operations
  • The “warm body” zone – maintaining the status quo, keeping the school functioning the way any moderately competent person could
  • The peak performance zone – truly making a difference in student learning

The size of the warm body zone varies from school to school. In some settings, anything but peak effectiveness will create a downward spiral into crisis. In other schools, it’s fairly easy to coast – the warm body zone is large, and it would be hard to derail the success that’s being experienced.

Our challenge is to break out of the warm body zone and into peak effectiveness. Are students in my school learning more because of my leadership? If so, I’m in the top zone, having a positive impact on student learning. If not, why am I here? Is it just to ensure that there’s a warm body in the principal’s office? Or am I driving myself and my school to excellence and results?

In schools where the challenge is to stay out of the crisis zone, reaching the peak performance zone may seem impossible. In schools with a larger “warm body” zone, breaking through to the peak performance zone can seem just as difficult.

My point is essentially this: principal performance matters for student learning. What drives you to excellence?

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.

Feedback for Performance: Low-Hanging Fruit

When giving feedback to improve the performance of those you supervise, where do you start?

If something is painfully wrong, it’s obvious where to focus your attention. If you observe practices that are harmful to students, unethical, unprofessional, or unsafe, it’s easy to know what to address first.

Fruit, by Flickr user lindsayshaverMost of the time, though, we need to provide feedback that isn’t so obvious. When someone is generally doing a good job, how do we decide what to mention, knowing that we have a limited bandwidth for giving constructive feedback?

In this situation, the critical question is “What changes will lead to the largest gains in performance?” More to the point in classroom settings, “What changes in practice will have the greatest benefits for student learning?”

These questions stand in contrast to the typical starting point for feedback, which is the “I noticed…have you thought about…?” line of coaching. Too often, what we notice from a lesson observation is based on a personal interest or pet issue, not the opportunity for improved results.

For example, if I know from informal observations that a teacher’s greatest challenge is adequately preparing for math instruction, I should not allow myself to be distracted by minor areas for improvement that I identify during a formal observation. While it’s important to cite specific evidence when providing feedback, leaders must be purposeful in collecting evidence that will support feedback in the areas of greatest need.

What is the low-hanging fruit for each person you supervise? What feedback would improve their performance the most? Think about it as you prepare for your next observation or discussion.

Feedback for Performance

If we want to get better results, we can change the working conditions, the inputs, or the actions we take to do the work. As individuals, we often don’t have much control over the inputs or conditions of our work, so the primary point of leverage for improvement is the set of actions we take on the job.

In order to do our work better, we need to get a perspective from someone else on how we’re doing, and how we might do better in the future. This, at the most basic level, is what feedback is.

Golf Swing by chuchyeager For an expert supervising a novice, the process of giving feedback is straightforward – observe, describe (with reference to a standard for excellence), celebrate successes, and make suggestions for improvement.

But for principals supervising more experienced staff, the challenges vary. Providing constructive (and not just complimentary) feedback to master teachers is no easy task. Another challenge comes when attempting to provoke thinking to challenge long-established habits or practices.

What challenges do you encounter in giving (or receiving) feedback? What have you found to be effective in improving performance in your organization?

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