Social discussion of CS in K-12

[George Reese <reese AT illinois.edu>]

Title: The Marshall Memo

Dear Ctrl-Shifters,
This came through on one of the digests I get. It reminded me of what Dave Hohman was talking about from his experience with the Google folks. The discussion was about incremental changes versus 10-times-as-good changes (I paraphrase). This article is about how the whole bell curve moved over in the treatment of cystic fibrosis and that inspiration and devotion as well as data were key.

George

 

3. Improving medical treatment and improving schools

            In this District Management Journal article, former Massachusetts superintendent and state education official Karla Brooks Baehr summarizes “The Bell Curve,” a 2004 article by Boston surgeon Atul Gawande on improvements in the treatment of cystic fibrosis, and draws parallels for K-12 educators. Gawande says that a diagnosis of cystic fibrosis (CF) used to be a death sentence – in 1964, a child with the condition had a life expectancy of only three years. But in 1964, a physician in Cleveland named LeRoy Matthews claimed that his CF patients had an annual mortality rate of less than 2 percent, compared to the national rate of more than 20 percent. The CF Foundation started collecting data from the 31 existing cystic fibrosis treatment centers to see if Matthews’s data were for real, promising that no data from individual centers would be made public.

The data showed that Matthews really was getting outstanding results – the median age of death for his CF patients was 21 years, seven times the age of patients treated elsewhere. This naturally raised the question of what Matthews was doing differently, and he shared his approach: He and his colleagues viewed CF as a cumulative disease and provided aggressive treatment long before patients got sick. The Matthews approach rapidly spread to other CF centers, and within six years, average life expectancy of patients nationwide was 18 years. Because of the CF Foundation’s data, the treatment of this disease is now far more consistent among doctors across the nation. Each center goes through a rigorous certification process, follows the same detailed guidelines, and participates in research trials to improve care. New ideas spread quickly from center to center – for example, a mechanized vest invented at the Minneapolis CF Center to replace daily “chest thumping.”

But there is still a bell curve of results: the average life expectancy is 33 years nationally, with the best center getting more than 47 years and the worst considerably less than 33. “If the bell curve is a fact, then so is the reality that most doctors are going to be average,” says Gawande. “There is no shame in being one of them, right? Except, of course, there is. Somehow what troubles people isn’t so much being average as settling for it.” And this troubling realization is a powerful driver of improvement.

Gawande tells the story of Cincinnati Children’s Hospital, which had an excellent reputation but mediocre results for its cystic fibrosis patients. In 2001, the hospital boldly decided to release its CF data as part of a strategy for winning a multimillion-dollar grant. Not a single family abandoned the hospital because of its firm commitment to improving treatment. The hospital then persuaded the CF Foundation to reveal the names of the top-performing hospitals and systematically studied their methods. It turns out that methods were less important than attitudes.

Gawande describes the difference in patient care between Cincinnati’s center and a doctor at the top-performing Minneapolis Center. Meeting with an adolescent girl whose lung function had declined since her last visit, the Minneapolis doctor was relentless, aggressive, and collaborative. He would settle for nothing less than 100 percent lung function – in other words, as good as someone without cystic fibrosis. He explained to the girl the difference between a 99.95 percent chance each day of staying well with treatment and a 99.5 percent chance without treatment, adding up the .05 percent daily difference over 365 days to show an 83 percent versus a 16 percent chance of making it through the year without getting sick. He insisted that the girl enter the hospital for 2-3 days to make up for lost ground. In Cincinnati, the doctors, who were good people working as hard as they could, made none of these demands of a similar patient and let her leave with a follow-up appointment in three months.

Heeding these and other comparative lessons, the Cincinnati center dramatically improved its performance and now ranks among the best cystic fibrosis centers in the nation, with an average lung function over 100 percent. Over time, the bell curve shifted significantly to the right – but there is still a bell curve, with the average lung function at 75 percent. The struggle to improve care continues.

How do these insights apply to K-12 schools? Baehr says that the recent introduction of a 4-3-2-1 teacher-evaluation scale has brought about a dramatic shift from the previous 2-point scale in which 98-99 percent of teachers were rated “Satisfactory” to a bell-shaped curve that spotlights mediocre and average performance and naturally drives improvement. And the public release in Massachusetts and other states of student growth percentiles – detailed, meaningful, credible, comparative data – will lead educators and parents to compare learning results in schools with similar populations, stop excuse-making for poor performance in schools with “needier” students when comparable schools are doing better, and stimulate the spread of the most-effective practices.

Gawande distinguishes between “lagging” indicators (the cystic fibrosis death rate, for example), which don’t provide much guidance for improving performance, and “leading” indicators (patients’ lung function and body mass index), which are much more helpful in spotting problems early and facilitating improvement. In education, state test scores and graduation rates are lagging indicators, informative but not very helpful. Baehr suggests the following might be effective, easy-to-measure leading indicators:

-    Third-grade reading proficiency;

-    Fifth-grade attendance;

-    Eighth-grade writing proficiency;

-    Ninth-grade promotion rates;

-    Success in high-school college-prep mathematics courses.

The key is focusing on results in a few carefully chosen areas and then working on staffing, training, scheduling, curriculum, technology, and other interventions to make a difference. “As educators,” says Baehr, “we can accept that the bell curve of performance does exist – and always will – for our districts, our schools, our educators – and ourselves. We can seek to move the performance of our individual districts to the right – from low to average, from average to high, or from high to higher. We can learn with and from one another how to tighten the bell curve, and we hope to shift it to the right: yesterday’s high performance in education should become tomorrow’s merely average... [We] need to seek out credible, actionable data, and respond non-defensively with high expectations and a sense of urgency…”

Baehr returns to the comparison between excellent and mediocre CF centers to explain how some schools and districts have improved results: “Just as at the Minneapolis and Cincinnati CF centers, the telling difference between high- and low-performing schools came not from the strategy they used, but from the difference in focus, intensity, intentionality, and sense of urgency each school brought to the challenge of implementing that strategy.” She sees these elements in schools that are showing the way:

-    An instruction- and results-focused principal galvanizing individual and collective responsibility for improving results for all students;

-    A mix of deliberate improvement efforts, expectations, practices, and continuous feedback;

-    Teams of teachers with effective coaching pursuing continuous improvement;

-    A well-orchestrated system of data collection and analysis that informs a responsive and adaptive system tuned to students’ specific academic needs.

 

“Lessons from Health Care” by Karla Brooks Baehr in The District Management Journal, Spring 2014 (Vol. 15, p. 12-19), available for purchase at http://bit.ly/1pvkjR4; Gawande’s article is at http://www.newyorker.com/archive/2004/12/06/041206fa_fact?currentPage=all.