In Silos to Systems (2010) Sally B. Kilgore and Karen J. Reynolds examine the current state of public education–with its concerns about funding, quality, and workforce–balanced against a culture that is stronger on its stated values than in its demonstrated ability to adapt to new challenges. The authors present a reason for action. They evolve a vision of what public education should be. They carefully build the equivalent of a SWOT analysis, forming a hypothesis and then asking the essential questions in the “if we did this, would that happen” framework of experimentation. In all of these aspects of good process they are following the proven formula that is at the basis of continuous improvement in an enterprise built on a traditional professionalism. Like healthcare, education is in transition necessitated by new and enormously stressful and challenging externalities.
I have long felt that many of us have failed to appreciate the complex common ground between the challenges of public education and the challenges of the Triple Aim. The Triple Aim is an impossible objective without understanding and managing the interface between healthcare, education, the economy and our collective efforts to improve everything that contributes to the harmony of our common existence.
Quality education and effective high-quality healthcare are core to our continued evolution toward the better community and better personal experience in that community that everyone desires. We often forget that we are always one generation away from the loss of many of our hard-won accomplishments, if we allow our efforts to improve education flounder.
The outstanding PBS presentation of the Roosevelts by Ken Burns reveals another moment in time when we came close to a complete collapse as a functioning nation. Jared Diamond is famous for Guns, Germs and Steel but the message of his book Collapse is actually more apropos for those who think about the vulnerability that we share for tomorrow. Education and health are inseparable to our collective survival and continued movement toward a better world.
Healthcare’s appetite for resources leaves everything else that we do together in a more compromised position. After healthcare takes an enormous bite out of society’s marginal ability to support the needs of everything that must be publically funded or considered as a cost of doing business in a competitive world, there is precious little left for education, public infrastructure, and the public supports to culture upon which good health is dependent. Not only does healthcare disproportionately extract funding from the public coffers in relation to education, but healthcare drives much of the increase in spending for education as new education dollars go to cover the cost of rising employee health and retiree health benefits. Educators are constantly asked to do more and more with less and less and it is our children who will suffer the reality described in the Hebrew Scriptures “…visiting the iniquity of the fathers upon the children unto the third and fourth generation.”
Atul Gawande made the connection between education and the damage it gets from excessive waste in healthcare a few years ago when he revealed that the last billion dollars of new money in the Massachusetts education budget was spent on healthcare and not on new teachers, teacher’s aides, computers, or books. Professor David Cutler, the health care economist from Harvard University who sits on the Health Policy Commission, has just produced a readable and detailed description of the interdependence between health and prosperity, explaining the negative impact that current healthcare spending has on every aspect of the economy. Don Berwick’s campaign for governor tried to tie the necessity of better education to both the fiscal and physical health of the community.
A few years ago I explored the literature of “distributed leadership” and discovered that the title and concept were the product of creative thinking in education circles. The relationship that state and federal policy makers and funding sources have with local school boards, local school administrations and the principals, teachers, parents and the stakeholders in our community are good examples of complex enterprises where the question of “what do I get to decide?” and the concerns of “where and by whom?” don’t have clear answers.
These considerations mirror and may be even be more complex than the same questions in healthcare. There is confusion and a lack of consensus or standard process in both healthcare and education. Both are struggling to find new operating models and a more secure access to necessary resources. The existing confusion about the true root causes of the current dysfunction adds to the uncertainty about what is waste. It decreases potential for improved quality in both of these areas that are so critical in the lives of individuals as well as in the collective experience of our community.
