K-12 Schools and Hospitals Should Learn From Each Other

By Jeffrey M. Bowen, Ed.D.

Our educational and health systems seem to share perpetual crisis.   Disconnections between results and cost and compromised purposes, control, access and funding are to blame.    

Since 2000, hospital bills have increased at an annual average of 10 percent.  Surveys show that most Americans are convinced that health care costs seriously threaten the economy.  Anxiety has intensified as Obamacare phases in and health care costs gobble up 20 percent of the GDP.

Meanwhile, funding cutbacks are acutely distressing K-12 schools.  At least 26 states are spending less per student this year compared to last.  As thousands of teachers are laid off, school boards and superintendents are reverting to bare-bones core academic programs and nervously depleting fund balances.  Federal budget “sequestration” may yet turn equal educational opportunity into a fool’s errand. 

Cost, quality, and access dominate public concerns about health and education.  A comparative analysis of these troubled national priorities may suggest linkages between their problems and possibilities.            

Hospitals deal with births, disease and death, but not by constitutional mandate.  Doctors diagnose and treat patients, and they may prescribe all kinds of specific medications and treatments, usually reflecting scientific practice.  Patients are charged directly for services with costs that are typically offset in part by insurance programs, Medicaid or Medicaid.     

Public K-12 schools, on the other hand, almost exclusively do not charge local residents directly for services as they are guaranteed by state constitutions.  Schools are supposed to engage young people in developing the knowledge, skills, and habits for future success in college, careers, and for life a democracy.  Learning goals are intended to meet a combination of social, emotional, and academic needs.  School is really a community of interests focused on providing a satisfying, motivating life of preparation that culminates with graduation.

The critical question is whether K-12 schools and hospitals are more alike or more different.  The following comparisons and contrasts will suggest some answers and hopefully yield useful guidance for the future of both institutions.     

Hospitals depend on individual plans for each patient.  They keep detailed records regarding what intervention has been tried, and which ones have succeeded and failed for what length of time.  They must measure change carefully because lives depend on it.  Schools are much less conscientious about individual plans for children.  At least for nondisabled children, the consequences reduce reliance on multi-grade instructional consultation and discourage a well articulated standards-based curriculum.

Competition is ingrained in school systems.  When some students win, others usually lose.   Competition like this has no place in hospitals where individual treatment and wellness takes precedence.  Schools should take the cue and strive toward complete but flexible individual plans for all students.  Thereby interventions can be applied consistently and for the best lengths of time.  

Special education has helped schools build bridges between themselves and the medical world.  Like medical professionals, school districts have adopted the use of Response to Intervention (RTI).  Teachers vary the time, frequency and duration of an intervention to meet individual needs, assess and compare data regarding its effects, and then if necessary utilize an alternative intervention. RTI gets at problems before the child fails dismally and has to be remediated.   Educators should expand and refine this model, along with other medical inspirations like brain-based learning, doing “rounds”, action research, problem-based case studies, scientifically valid practices (a federal Race To The Top program priority), and preventive counseling of many kinds.

Teachers long to be publicly respected like doctors.   This will not happen unless their employers empower teachers to exercise more discretion to generate students’ individual plans.  Joint accountability for results would be a must, but teachers and children would benefit from more responsive and innovative support. 

 Teachers and doctors alike are grappling with an explosion of internet-based information and new technology.  Educators are encouraged to coach or guide students to self-directed learning, while doctors and other medical staff are exploring telemedicine to facilitate prevention, diagnosis, treatment, and rehabilitation in home settings.  The key is to use technology more creatively, not as a convenient substitute for the status quo.

A warning: as technology redefines relationships, shoddy education or physical damage can occur as individuals self-diagnose or take intellectual shortcuts over the internet.  Technology must reinforce rather than substitute for licensed professional expertise, solid thinking and good judgment.

 The overlap between medicine and education can be categorized as health.  Public schools teach too little about mental, emotional and physical health throughout the grades.  By the same token, hospitals and doctors fail to reach out to their surrounding communities in ways that could definitely strengthen health services.  Sometimes hospitals view entities that seek to complement their services as competitors instead of friends.  

By promoting healthy communities, schools and hospitals could better serve the public at less cost with improved quality.  For many years I have served on the board of a nonprofit network called the Healthy Community Alliance (HCA).  Largely state grant-funded with six full-time employees, the network serves western rural New York residents by providing or coordinating programs for children and families that address chronic disease awareness, prevention, and management including physical activity and nutrition; youth mental health; and parent education.  The Alliance takes strategic advantage of emerging health and lifestyle priorities for both young and older populations.  It maintains an impressive list of partnerships and affiliations, but relationships with both hospitals and school districts are hampered by apathy or, at times uneasiness, because

a silo mentality persists.  Executive leaders of both schools and hospitals should give more attention to allying themselves with regional health networks (35 in New York state alone) to close community service gaps more efficiently and cost effectively. 

Funding is a common minefield for both schools and hospitals.  However, public schools seem to operate in a more secure, or at least more controlled, fiscal environment.  Elected school boards, annual public budget or tax rate referenda, local property tax caps, and mandated reporting requirements keep schools more accountable to their constituencies than hospitals are accountable to theirs.  

 Hospitals bill individual patients within a complex and arrangement with insurance companies.  Specified charges and billing procedures are confusing and complex.  Hospitals do not publicize standardized fees.  Usually the patients are not in any position to make careful choices. 

 In a recent Time Magazine expose, Stephen Brill (March 4, 2013)  urges significantly lowering the eligibility age for Medicare so that insurance limits can be extended on certain expensive tests, drugs, and services. Medicare controls cost reimbursements by applying certain standards for treatment.  The standards are published, specific, largely measurable, and reasonably scientific.  School districts can learn from this approach which seems superior to politically unstable funding mechanisms that are unrelated to performance.  Medicare has big flaws, but school leaders should take a closer look at its methods of cost control.  

We all want measurable results to assure performance quality as well as bang for the buck.  Our educational and medical policymakers may benefit from sharing assumptions, promising directions and potential evaluation models.  What derives from this kind of sharing may shift the attention of policymakers away from superficial standardized assessments of outcome, and instead move it toward more realistic and practical measures of productivity.