Canaries and Coal Mines

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.

 

(1)    http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=13497&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+nationalacademies%2Fna+%28News+from+the+National+Academies%29