Professional Practice - Client Performance Linkage

SUNDAY, APRIL 3, 2011
One of the joys I find in accruing age is the unique combination of perspective and intrinsic reward. Early in my career my views were shaped by my experiences, my beliefs, what I read and learned, and those around me. I was reluctant to express what I really thought or felt for fear of rejection, ridicule, or worse, banishment and failure. As a teacher it was tough to tell my principal, "I think your schema is flawed." As a principal it was tough to tell my superintendent, "I think your decisions are based on your political insecurity and not sound educational philosophy." As a superintendent it was tough to tell my board and community, "What you value about public education and believe to be appropriate steps for improvement are seriously flawed and based on political tripe, not sound research." Now, I can say what I darn well please and, in fact, relish the role of the child on the edge of the parade pointing and laughing at the naked emperor.

One of the downsides in accruing age is the slow but inevitable acceptance of the aging of my body. I shall not quote the Lion King, but clearly I have reached the stage where biology moves faster than philosophy. As I earn health issues, (and I think of it as "earning" because those younger than I have yet to put in the time nor have lived enough life to wear out the parts I am wearing out!), I dutifully report to the appropriate health care professional for diagnoses and prescription. Inspiration for this post arose while sitting in sea of fellow sick folks, captured life boat fashion, awaiting rescue as we are summoned one by one behind the door where pain may end. (No one feeling well and of sound mind would choose to waste one's time in the narrow confines of stiff vinyl chairs watching Fox News on a mounted TV below which is posted a "Do Not Change the Channel" sign.) I prayed to be next, rescued from both my physical and intellectual pain.

I started counting. Three people behind the sliding glass window who checked us in, gave us forms, processed our yet-to-be filed claims, and maintained the rescue sequence. Once summoned behind the door, another person collected today's data, height, weight, blood pressure, body temperature and confirmed what chemicals I was still ingesting as prescribed from previous visits. Finally I was asked, "Why are you here today?" What a wonderful question. Clearly she knew, as did I and everyone else in the waiting room, that we did not simply awake and say, "Today, I am going to sit in the waiting room of my doctor's office because I enjoy the company of folks who feel terribly." I showed up because I ailed. I was led to room #3, a room with a sturdy file holder on the door, a series of buttons illuminating the lights over the door, and inside, a small desk with cabinetry, a mobile stool, a chair, and the elevated examining table, elevated for the doctor's comfort, not mine. My file placed in the holder, the appropriate lights illuminated and the door shut with the words, "The doctor will be with you shortly." Though I was tempted to point out that the doctor's height was of no concern to me, I resisted and awaited the person I came to see in the first place after encountering 4 other adults in two other rooms.

The long-awaited doctor arrived neither timely or shortly, reviewed my data, offered several hypothesess regarding both source of ailment and cure, and then referred me to another room to gather more data which included the extraction of bodily fluids, to yet another room equipped with expensive contraptions that irradiated me, and referred me to another doctor who has made a fortune specializing in my particular category of ailments and who will no doubt have me wait in another room, fill out more forms, gather more data, order even more tests and call me back to repeat the process leading to prescription. Remarkably, I left my doctor with pieces of paper and nothing he had done made me feel any better.

None of the above is remarkable or unusual and I suspect each of you experiences much the same. Yet, as an educator, I was struck by the similarities and differences of the medical experience vs. the educational experience:

Both institutions collect data. In the medical institution data is frequently collected and used for diagnostic purposes. Last month's temperature and blood pressure are irrelevant today. Last year's student score on a standardized test will haunt the student, the teacher, the school and the system forever. Doctors not only collect more data than schools, they have a fleet of folks trained to collect those data. Schools rely on teachers and counselors to collect the data, and the data is more spurious whether it comes from teacher made tests or state developed and enriched private sector contractor standardized multiple choice tests. School data is used to judge, medical data is used to diagnose. Schools must show improvement in the data or face consequences. If schools are judged relative to a mean, then the mean is always in flux. If everyone is improving, no school can perform better relative to the mean. The goal of the medical profession is to prescribe to achieve the mean. If my temperature is too high, returning to the mean is viewed as success. In other words, the goal of the medical profession is to stabilize everyone at the mean. The goal of schools is to get our patients to improve their own mean. The instruments used in medicine are rarely challenged. The instruments used in education remain a huge source of debate.

Remarkably, even given the reliability of the instruments, the measures, the data and the goal of merely returning the client to the mean, the medical profession is not held accountable for the outcomes. They are held accountable for prescriptive process, that is, given the data, was the appropriate diagnoses achieved and the appropriate treatment prescribed. If not, we call that malpractice. But malpractice is not based on patient performance but on doctor performance. If the patient dies and the doctor has followed all the best diagnostic and prescriptive practices, then there is no accountability for the doctor, no malpractice. Getting well, that is, returning to the mean, is up to the patient, not the doctor.

Perhaps even more remarkable, given the degree of error in standardized testing, the spurious data, and the goal of improving student performance, is that educational practitioners are held accountable for the students' outcomes. It is considered school malpractice if a student does not perform better this year than last year on the test. Most amazing of all, is that the teacher, the school, the system are held accountable not only for the diagnoses and the prescription, but for the improvement of the patient! Given fewer resources, seeing clients in groups larger than one at a time, fewer trained specialists to collect data, fewer sophisticated instruments, and fewer options regarding treatments, educators are more responsible for client performance than those in the medical profession. We do not assume that the learning the client achieves simply means the client is responding well to treatment. We assume those who prescribe the treatment are responsible!

Imagine applying the same accountability to the medical profession. Doctors would all quickly choose to specialize in plastic surgery or dermatology. Few would work emergency rooms where patients die. Few would become oncologists where patients die. Few would seek to treat the most challenging of ills for fear that their scores will go down. Holding the medical profession accountable only for diagnoses and prescription affords us experts in every field.

Imagine applying the medical accountability model to education. Each child would enter the school and be subjected to a battery of assessment instruments determining level of knowledge, learning style, interests, aptitudes and abilities. These assessments would be administered by non-teaching professionals. Teachers, handed the data and given time to review, could meet with each student and offer prescribed treatments based on the individual characteristics of each client. If they did not improve, then they would be asked to call us in 3 days when we would repeat the process, or would be referred to a specialist who might be able to prescribe additional treatment depending on the learning obstacles. Teachers and schools would be held accountable only for the quality of the prescribed treatment, not the improvement of the learning of the child. If our prescription follows goods research and best practice, we are free from labeling based on student performance. Teachers and others would yearn to work with the lowest performing students where the most positive impact of good prescription would be most attainable.

Lawyers are not held accountable for client outcomes. They get paid whether they win or lose. In fact, 50% of all clients lose.

Engineers are held somewhat accountable if the bridge or car they design fails to perform, but they are working with concrete data and established, proven formulas, not 6 year-olds or 18 year-olds.

Of all the professions, educators are judged most harshly by the performance of their clients and are least equipped to make good diagnoses and provide expensive high-tech treatments. And only educators both diagnose and prescribe large groups of clients all at the same time. Most amazing of all is how well we do with the resources we have while simultaneously being told we are failing, need to improve, and our funding is cut.

We must, we absolutely must, disconnect the linkage between judging teachers and schools by student outcomes on standardized tests administered once a year. The client has a role in this if the prescription is based on good diagnoses.

Wouldn't it be nice to simply ask each child, "Why are you here today?" and set about achieving those objectives? (Wouldn't it be nice if students chose to come to school and knew what they needed or wanted to learn when they got there?)

And, they would not have to watch Fox News.