Saving Money in Education by Learning from Health Care[1]
As professional educators we have much to learn from our wealthier more established older professional siblings medicine and business. While business has taught us to more effectively use data in education, medicine has taught us more and is closer match as it shares a similar mission. Like medicine we seek to analyze individuals and plot the best course for them. And like medicine we do not accept the idea that some people just cannot make it. We try hard for all students.
Recently Atul Gawande published a piece in the New Yorker where he begins by talking about Jeffery Brenner. This is a quote from the Gawande's article about the first patient Brenner worked with.
The first person they found for him was a man in his mid-forties whom I’ll call Frank Hendricks. Hendricks had severe congestive heart failure, chronic asthma, uncontrolled diabetes, hypothyroidism, gout, and a history of smoking and alcohol abuse. He weighed five hundred and sixty pounds. In the previous three years, he had spent as much time in hospitals as out. When Brenner met him, he was in intensive care with a tracheotomy and a feeding tube, having developed septic shock from a gall bladder infection.
The traditional model, the one in effect now, for working with a patient like this is for them to occasionally have a 20-30 minute meeting with their doctor and then, when things go haywire they go to the ER. This had been the model for Hendriks and in recent years he had been spending more than half of every year in the hospital. He had no home, he couldn’t work and when he fell down he was so heavy that he had to call 911 to help him get up.
Brenner did some fairly simple things to help Hendricks. He began spending time with him and talking with him about his life. He learned about his interests and what his life had been like in healthier days. Brenner began to work with a small team that included a nurse practitioner and a health coach[2]. They met frequently to discuss Hendricks’s health. The nurse checked in with him at his home on a regular basis and if he missed an appointment someone came to talk with him immediately.
The success has been remarkable. Hendricks has lost weight, has stopped smoking, drinking and doing drugs and has lost more than 100 pounds. Active in his church before his bad health he has returned to that community. A line cook before he now makes healthy meals for himself. His medical problems remain but they are well managed and because of this if he has to go to the hospital he stays for a few days not a few months. The doctors do not have to rebuild him every time he comes in at the point of major crisis.
Of course this kind of care is not easy and it could not be done for everyone. That is the exact point. Not everyone needs this kind of care. Brenner has looked at medicine like a police chief looks at a neighborhood. Where are the areas that need the most attention? Where does the most crime occur? Brenner has looked at what he calls hot spots of care and has identified those patients. Now Brenner and his team have hundreds of these “worst of the worst” (his words) cases. They truly work as a team on their group of patients. Every day they begin with a meeting and they look at who has missed an appointment or who has a concerning medical test. Then they take action right away. Some patients are doing fine and need nothing, others need a visit from a health coach, others need to come in and see a doctor right away. Each patient receives appropriate and timely care when they need it.
Have I hit you over the head with it too obviously? Clearly this all applies to the Concord School District. I am not going to say that what we have done in attempting to educate all children is wrong. Far from it—examples of wonderful caring educators can be found throughout the district. What we have learned in recent years is that it is not the people, it is the system. I am sure that before Dr. Brenner, there were many wonderful people who worked with Mr. Hendricks to care for him and at points keep him alive. But they were working in a system that was built for most people. Most people only need a 20 minute office visit every once in a while. Just as most students do just fine in the model that has been the basic default educational model for decades.
What can we learn from the medical model that can help students learn?
[1] Inspired by Atul Gawande. All of the ideas are his. I just summarized them and morphed the process for
[2] Health coaches are an interesting part of Brenners approach. They are not necessarily connected with medicine. Often times they have not gone to college. One mentioned in Gawande’s article worked at Dunkin Donuts. Her experience in customer service is what made her a successful health coach. She was interested in helping people and that is all that was needed.
