Education and health care are arguably the two most important pillars of our society. If either fails, the economic and social impact is devastating.
Our education and health care systems, designed for a 20th century America, need to rapidly catch up with a nation closing out the first decade of the 21st century. Not surprisingly, both are in the throes of some of the most comprehensive reforms in decades. With our economy still reeling from a recession, there is a strong sense of urgency for both to change dramatically in order for America to regain a position of strength.
Let's take a quiz. Here are excerpts from conversations among leaders in both fields at the Milken Institute's Global Conference on "Shaping the Future" -- a "who's who" gathering of leading thinkers and doers from around the globe who collectively should possess the capacity to solve any problem. Fill in the blank with either 'health care' or 'education.'
- Success requires that ______________ empower consumers and become much more personal. (answer: education)
- Success in ___________ requires a greater focus on outcomes and access and new collaborations for improvement. (answer: health care)
- In __________ learning from failure is as important as learning from success. (answer: health care)
- To improve ___________ we must aggregate, absorb, and act on information. (answer: health care)
- Americans are accustomed to being number one in _____________. We are too fat, dumb and happy to recognize that we have fallen behind. (answer: education)
Like most people, you may have gotten a few wrong. But this blindfolded taste test is eye-opening if you care about the future of education and health care and their inextricable link to the economy and civic health. The blurring lines between the policy conversations make it clear that the challenges and solutions are more similar than ever before.
Both sectors use terms like "patient-centered" and "student-centered" yet organize themselves in ways that serve neither -- and with skyrocketing costs. You only need to recall your last doctor's appointment where you may have been referred to multiple providers with interminable waits that included providing the same information over and over. And colleges offer courses at times and places that are convenient to ... not students.
Both health care and education hoard and shroud data for competitive purposes at best and to hide poor performance at worst -- a gross disservice to parents, students and patients. Fortunately this is changing. On the medical side, there are some small experiments being conducted to more openly share discoveries in drug therapies while still protecting intellectual property. In grades K-12, schools are collecting more test results and other measures of student performance. However, most are still not acting on the strengths and weaknesses revealed. In higher education, institutions are remarkably reluctant to share data that would allow consumers (students) to compare the performance across institutions.
Rapid technological advancements have the potential to disrupt both systems in positive and negative ways. Moving toward "open" systems should make information vastly more accessible. Health IT can speed delivery of the very latest intelligence about new and old treatments, what works, what doesn't, potential side effects and contraindications. Similarly, educators have access to extraordinary electronic information about the students they serve and curriculum and other support services matched to meet students' needs and the higher standards they must achieve.
Unfortunately, breakdowns in both systems often occur at the most important time -- at the very junctures where breakthroughs in science and research have the opportunity to meet patients' needs. For example, in biomedical research, academic center researchers are so divorced from industry that they have no idea what data points drug companies or the FDA need in order to move basic research to developing a therapy for use in patients. In education, there is a considerable amount of research, but little practical guidance for policymakers about how apply it on a broad scale. For example, governors and other state leaders would greatly benefit from the growing body of lessons learned in performance-based funding and remedial education. There must be more research put into service to improve health and education policies and practices.
Policy debates often call for both "scaling up" and "systemic change." Both have their virtues, but they are very different. Scaling up best practices is important in medicine and education, like breakthroughs in reducing infections or advances made by many charter schools. But they won't be successful if they operate in systems that reward and perpetuate the status quo. Similarly, we can have the best delivery system in the world, but if we don't have cures and therapies to deliver, it matters little.
"Outcome-based payment" is increasingly popular in both arenas. In health care, caregivers are reimbursed based on how effective and efficient care is (its value to patients) versus the number of treatments (volume). In education, there are several pilots that pay teachers and/or schools according to improvements in student performance. Higher education funding is beginning to correlate with institutions' success in graduating students versus simply enrolling them. This kind of payment reform represents the beginnings of systemic change, as institutions tend to organize themselves around the flow of money.
By recognizing these patterns and similarities, we have the opportunity to unlock the kind of rapid improvement we know is possible. With so much at stake and the promising solutions right in front of us, why aren't we making more progress in health care and education?
Perhaps it is because teaching and healing are both art and science. As a culture we are prone to a sleepy nostalgia and blind faith in the fields of health and education. We can't afford this reverie. While bloodletting and rote memorization and recitation may have made a lot of sense intuitively, as a nation we got smarter. We must get smarter again.
Terrell Halaska, Kristin Conklin and Michael Manganiello are founding partners of HCM Strategists, a Washington, D.C. public policy and advocacy consulting firm.