Both schools and hospitals are institutions under great stress that render essential human services through complex and often costly mechanisms. What might one learn from the other?
Since 2000, hospital bills have increased at an annual average rate of 10 percent. Surveys show most Americans think that health care costs seriously threaten the economy. Issues of access and quality complicate the picture. Health care is gobbling up 20 percent of the Gross Domestic Product.
Meanwhile, funding cutbacks are distressing K-12 schools. More than half the 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.
Schools and hospitals have many similarities. These include for-profit and nonprofit types, boards of directors and CEOs, differentiated patient or pupil treatments, stringent confidentiality of records, specialized and licensed staff, extensive professional development, substantial physical plants and technology, and diverse business functions. Schools and hospitals are communities as well as bureaucracies.
Hospitals depend on individual plans for each patient. They keep detailed records regarding what intervention has been tried, which ones have succeeded or failed and for what length of time. They must measure change carefully because lives depend on it. At least for the non-disabled students, schools are less conscientious about individual plans for children.
Schools should take the cue from hospitals and strive toward complete, flexible plans for all students. Thereby, interventions can be applied consistently and for the right length of time. Special education has helped schools build bridges between themselves and the medical world. Like medical professionals, school staffs 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 group rounds, inquiry-based learning, action research, scientifically valid practices (a federal Race to the Top priority), referrals and preventive counseling.
Teachers hope to be publicly respected like doctors. This will not happen unless school boards 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 tailored 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, 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 intersection of medicine and education could be called health. Public schools struggle to combine core academic subjects with learning about mental, emotional and physical health. By the same token, hospitals and doctors are challenged to reach out to their surrounding communities in ways that could definitely strengthen health services. By promoting healthy communities, schools and hospitals could better serve the public at lower cost.
For many years, I have served on the board of a nonprofit network called the Healthy Community Alliance in rural Western New York. Largely state grant-funded with six full-time employees, the network provides or coordinates programs that address chronic disease awareness and prevention, youth mental health, parent education and management, including physical activity and nutrition.
The alliance takes 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 uneasiness because “silo thinking” lingers. School and hospital executives should prioritize alliances with regional health networks to close community service gaps more efficiently and cost effectively.
Funding is a minefield for both schools and hospitals. However, public schools operate in a comparatively controlled fiscal environment. Elected school boards, annual public budget or tax rate referenda, property tax caps and mandated reporting requirements keep schools more accountable to their constituencies than most hospitals are accountable to theirs.
Hospital charges depend on a confusing combination of costs derived from different sources. Hospitals do not publicize standardized fees for specific services. Usually patients are not in any position to make informed choices.
In a recent Time magazine special report, Stephen Brill urges significantly lowering the eligibility age for Medicare to 40 so that insurance limits can be extended on certain expensive tests, drugs and services. Medicare controls costs by reimbursement based on certain standards for treatment. The standards are published, specific, measurable and reasonably scientific. Connecting performance standards to cost reimbursements seems to hold promise not just for medicine, but as well for schools where politics often override educational performance. Medicare may have big flaws, but it also saves big money.
Everyone wants measurable results to assure performance quality and bang for the buck. School and hospital leaders should make time to discuss their commonalities. By climbing out of their boxes, these two institutions could reconnect cost with quality and multiply productivity.
Jeffrey M. Bowen, of Delevan, has served as superintendent of the Yorkshire Pioneer Central School District, research director for the New York State School Boards Association and supervisor of on-the-job training in an Air Force hospital. He is a founding member and vice president of the Healthy Community Alliance in Gowanda.