Canaries
and Coal Mines
Before the
development of modern detection equipment, coal miners used to bring caged
canaries with them into the mines because these birds were known to be more
sensitive to the presence of the poisonous gas methane than humans. If the canary died, it was time to get out,
and fast! Reflecting this little bit of
history, the phrase “canary in a coal mine” has come to serve as a metaphor for
almost anything that can give us advance notice of some other impending event.
When it comes to anticipating and understanding the need
for and the form of Education Transformation, I believe that Health Care is our
“canary in a coal mine.” Let me
explain……
Arguably, we have some of the best health care in the
world. People from all over the planet
come to the USA to benefit from some of the best medical attention that money
can buy. And yet, we Americans are actually less healthy than the people who
live in those other countries. In a
recent report from the National Academy of Sciences(1), we are told that
“Americans are far more unhealthy that people in 16 other developed countries.” In spite of the fact that we spend $8,600 per
person per year on health care – more than twice what countries such as
Britain, France, and Sweden spend – our infant mortality rate is higher and our
life expectancy is lower than these other nations. For whatever reason, American health care
costs too much and produces inadequate results, and so we find ourselves in the
midst of a heath care crisis… and a health care reform movement that scares a
good number of us.
Perhaps not surprisingly, these are some of the same
problems we face in our education system.
Higher Education in America is of the highest quality in the world, but
it costs too much and it educates too few.
When measured in aggregate as total cost per student completion (a
measure that is comparable to the $8,600 per person per year we spend on health
care), we spend $590,549,000 ($354,329,000 in direct public resources) per year
of community college education and produce 11,116 graduates – that’s $53,126
per completion. And, only 38% of our
adults (25-34 old) in Oregon and nationwide complete a post secondary degree or
certificate, a figure that puts us behind at least 14 other countries, including
Canada at 56%, and South Korea at 62%.
The parallels between education and health care are just too strong to ignore,
and I believe that the problems we share have some of the same root causes – as
well as some of the same solutions.
Health care has been and is now at an increasing pace
moving through a transformation that focuses on four things: outcomes instead
of procedures; more uniform (if not universal) access; increased stratification
combined with increased coordination of the delivery model; and all with a
continued focus on quality. These are
also the essential components of education transformation.
Focus on Outcomes
For health care, the Outcome is
a healthier people: reduced infant mortality, increased length and quality of
life. It is NOT number of office visits,
number of medical procedures performed, or the financial investment made. Are we healthier? Yes, or No.
For education, the Outcome must
be a more productively educated people. It is NOT how many people are admitted,
how many classes are offered and taken, or the financial investment made. Are we more productively educated? Yes, or No.
Universal/Uniform Access
For health care, Access means
that all people have time-appropriate access to the health care that will be most
effective in helping them to live healthier lives. It does NOT mean that people can get into an emergency
room when all else fails, nor does it mean that people can use health care to
pursue non-healthy purposes, or purposes that jeopardize the health of others. Access has to be a pathway that leads to the Outcome;
Access to a destination of better health and not just to more health care.
For education, Access means that
all people have access to the educational opportunities that are most likely to
result in them being productively educated.
It does NOT mean admitting students so they can swirl, taking classes
they don’t want and/or don’t need until the ones they do want/need become available,
nor does it mean admitting them into remediation gauntlets that effectively “weed
them out.” It doesn’t mean “Access to Access,”
nor does it mean Access to everything. Instead,
it means Access to the clearly defined and readily available pathways that lead
to being more productively educated, and not just to another class.
Stratification and Coordination of the Delivery Model
Long before the current push for
health care reform, the health care profession figured out that a delivery
model that depended on the doctor to do everything from taking our temperature,
drawing our blood, and checking our pulse, to filling out the paperwork, making
our next appointment, and sending us (or our insurance company) the bill would be
unsustainable. It would reduce access,
cost too much, and not allow the doctors to focus their skills on the areas
where they could do the most good: diagnosis and treatment. So health care began to stratify its delivery
model and, in the process, creating new professions like Medical Assistant,
Medical Technologist, Physical Therapist, Pharmacist, Phlebotomist, Registered Nurse,
and on and on. And the result has been a
less expensive delivery model that is actually better because it employs the
specific expertise of different people along the delivery pathway. Unfortunately, in the process the health care
delivery model has become more confusing and less effective because stratification
has not been paired with coordination of health care. To a great extent, the focus of the current
health care reform efforts is on coordination.
While the process of stratifying
the education delivery model has begun – we have Counselors, and Registrars,
and Deans and such – this transformation has not yet reached into the
classroom, where I believe it has the greatest potential for both reducing cost
and improving outcomes. “Disaggregating
the Instructional Role” is the somewhat industrial/mechanical but nonetheless
descriptive label for this educational parallel to the stratification of health
care. It is a process in which content
development, instructional design, knowledge acquisition, knowledge
application, learning assessment, and other components of teaching-learning are
made into discrete functions and where the faculty instructor is thus freed
from other activities in order to focus on the work where their expertise and
passion can be focused where it makes the most difference – that point or place
in which students learn to make constructive use of the things they know. Such disaggregated models can have place-and-time
bound, virtual, and/or a mix of face-to-face and technologically-mediated
components, incorporating emerging concepts like learning analytics, and game-based
instruction, virtual learning constructs with personal avatars (think The Matrix),
and/or more traditional features like seminars and even lectures. Incorporating anything and almost everything, a well-coordinated strategy of disaggregation
allows for a more specialized application/incorporation of methods and persons in
order to maximize the effectiveness of the teaching-learning experience.
Quality
In many ways, the focus on
Quality is much the same as the focus on Outcomes, but I want to make this
focus explicit. The transformation of
neither health care nor education can come at the expense of Quality, but we
can no longer measure quality in terms of the number or office visits,
procedures performed, days in class, or resources expended. Quality must be measured in terms of health
achieved, and meaningful degrees earned.
Over the past couple
of months I have finally taken on and completed a project I have thought 
And, in the process of building my sauna, I discovered
something that once eluded me but now seems so self-evidently clear…. Saunas
are not “built;” they are formed. Formed
out of the collective human labor of those who construct it, formed out of the
collective human sweat of those who bathe in its heat. Formed, because at its very essence, a sauna
is not a building or a room but instead, a community. And, more often than not, a community of men.
I didn’t understand
this until my friend Chris and I began to build, and I began to read a book he
loaned me, The Sauna, by Rob Roy. Yes, the book is all about the varieties of
construction methods employed to build these peculiar little places made sacred
by the Finns. But, behind all of the
details about cord wood, stone, sod, glass and cast iron and heat, the book is
really about a relationship that develops between the people and the space of
their creation…. and about the
relationships that develop out of that created space being shared. 
