Health Care and Education Reform: Double Trouble

With all the linkages, there aresimilarities between health care and education that have not received as much attention: a largely intractable problem, poverty, and a cautionary message about technology.
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I have been struck by the frequency with which experts recently have linked the issues confronting our health care and education systems. At first, I did not appreciate the depth of the linkages between these two central social priorities, and now I struggle to separate them.

At a conference recently, I heard Dr. Gary Gottlieb, the CEO of Partners HealthCare (which runs Brigham & Women's and Mass General Hospitals), speak to an audience of college presidents and trustees about some of the shared challenges facing our nation with respect to both health care and education. Key among the issues he identified was "bending the cost curve" without sacrificing quality. He joked that while his field was under continual fire, he was willing to make the presentation because the costs of higher education had increased over the past decade even more than the costs of health care!

Added to that, a recent article in the New England Journal of Medicine addresses how to improve assessment of both healthcare providers and K-12 teachers. The author, Debra Malina, Ph.D., noted that both arenas would benefit from bottom-up as opposed to top-down assessment, recognizing the intangible variables that lead, respectively, to patient and student improvement and job satisfaction.

Lastly, I learned about a sold-out conference held this weekend on the impact of culture on psychotherapy, particularly how cultural norms profoundly impact therapeutic outcomes and that understanding culture differences enables physicians to think about their patients (and themselves) more effectively. Culture and identity are inextricably connected. While there was no explicit reference to education, we know campuses will increasingly have more immigrant students. Certainly, these students would benefit from professors, staff and administrators' improved capacity to appreciate cultural differences and the impact these difference have on learning and psycho-social adjustment.

With all the linkages, there are two similarities between health care and education that have not received as much attention: a largely intractable problem, poverty, and a cautionary message about technology.

First, with respect to outcomes, costs and future improvement, health care and education are impacted directly by the consequences of poverty. Until we address and curb poverty we will not solve the inequities in the access to and delivery of quality health care, and access to and success across the educational pipeline. Moreover, improved wellness and college graduation will remain elusive. Two examples: On the healthcare front, pregnant women living in poverty give birth to lower birth weight and less healthy infants. On the education front, children as young as 18 months from low income families are already significantly behind their higher income peers in word recognition, a known precursor to reading capacity.

Bottom line, sizable and sustained improvement in both healthcare delivery and education cannot be achieved within their own closed systems. Most physicians, nurses, principals and teachers are not all failing to do their jobs effectively. Instead, hospitals and schools turn out to be ill prepared and poorly equipped to resolve poverty.

Second, technology will be a major part of reform in both our health care and educational systems. Technology will take many forms, from the simple to the complex. From electronic and easily transferable medical records to robotic surgery that shortens hospital stays and improves outcomes, we are seeing almost daily advances in medical use of technology. Educational systems, including colleges and universities, are turning to technology to provide or augment learning and support quality remediation, with MOOCs being just one example.

As we are seeing now with Obamacare, the planned insurance improvements are being held hostage to failed technology; the computer systems, including telephone support, are flawed and not operating effectively. The president has acknowledged and decried the gaffes.

In the education realm, many of those teaching students across the educational spectrum are not prepared for or trained to deploy technology effectively in or outside the classroom. Ditto for parents -- at least those who have access to technology in their homes. Program designers are not always aware of the challenges students, parents and teachers face getting technology to work effectively and easily.

If the flipped classroom and other more revolutionary changes in teaching are ever going to be implemented and effectively deployed, teachers and professors will need to augment their technological capacity, not just how to use the technology but how to think about the technology and its use. Otherwise, like the implementation of Obamacare, quality improvements will be undermined by failures -- both at the design and implementation level.

I recently read Jose Antonio Bowen's relatively new book, Teaching Naked. Here's what frightened me about its innovative approaches to learning for the "digital" students of today and tomorrow: faculty throughout our educational system will need to think differently about how to prepare for and then manage the classroom and out-of-class assignments. They will need to change how they think about the substance they teach and the role of the teacher and the classroom.

The cautionary tale of Obamacare is that healthcare improvements can be thwarted by failures in technology. The glitches impact both perception of the quality of and capacity to implement the changes. Before educators become too wedded to technological solutions, we need to make very sure that the technology works and that the challenges of deploying it, using it and having access to it are solved. Otherwise, as we are seeing with health care, improvements will be derailed and the underlying messages distorted. We cannot afford that outcome in either health care or education.

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