Saturday, October 27, 2012

Health care is already blended

Its funny how life gives you insights. Yeaterday afternoon, my wife had some severe stomach pain, so we went to urgent care at the palo alto medical clinic. During our five hour visit, i was struck by four huge similarities between healthcare and high quality blended schools. First, technology was used in several ways throughout the time we were there. The first and the one my wife was most thankful for were painkillers. True, this is relatively old technology, but it is striking how little the adults can do to help your pain and how immediately the medicine helps. So its better for the patients and better for the staff because they dont have to spend time calming you down. This is alao true for the antiobiotics they finally prescribed. Even after five hours and a lot of pain killers, by the time we got home, my wife was in pain again. So i went to the 24 hour pharmacy and picked up the antiobiotic prescriptions. Within 30 minutes of taking the antiobiotics, she was starting to feel much better. Imagine the amount of time that the staff would have had to spend with my wife if they didnt have this simple technology. This is strikingly similar to what happens when we have the right online learning program for the right gap in a childs knowledge. It just works and they learn what they need almost every time. The amount of remediation time from the staff this saves is incredible, and the outcome for the student is better, they learn it faster and better. We dont have enough of the right online lessons to prescribe yet, but that is improving very quickly.

The second striking similarity is the use of technology for diagnosing what ails you. Our entire five hours at the cljnic was basically a process of collecting data thru blood samples/etc and most importantly through a ct scan. Once these were done, the situation was pretty clear. She had an infection in a part of her intestine. This is so similar at rocketship to our focus on using technology to gather data on exactly what a student knows so that we can identify gaps and change their individualized learning plan to specify what activity is next in their developmentally appropriate sequence. The centrality of the ct scan in my wifes healing process and of the assessment and analytics we do to identify and remediate gaps is a direct parallel and the most important aspect of both health and learning.

The third area of the visit that struck me as incredibly similar is the central importance of the adults in the process. The ed industry has somehow come to think of technology as disempowering, thretening to jobs, etc. using healthcare as a corrollary, it is just the opposite. Because people dont have to spend time on low value things, they can focus on making sure you get the meds and assessments you need to prescribe medicine which will make you feel better. That probably works 80% of the time and the last 20% more significant things like operations or therapy need to happen. But because you have taken care of the 80%, the staff has time to focus on the last 20% which is high value add. Exactly the same is true in a good blended school. Much of the assessment and remediation is just part of the day to day system, saving master teachers the mental space to work on the tough challenges. Within the human caital side of health care, the differentiation of roles is incredibly valuable. The ratio of doctors to patients has got to be 1 to 100. Of the 600 minutes we spent there, we robably only had 5 minutes of the doctors time to determine what assessments needed to be done, prescribe the pain meds, and make the prescription once the assessments were done. But we didnt feel bad about that, because there were plenty of senior and junior nurses making my wife feel comfortable, getting the iv going, wheeling her down to her ct scan, etc. in education, we have this idea that if the teacher doesnt do everything herself, it wont go well. Nothing could be further from the truth in a blended school. Because you have associate teachers and paraprofessionals doing a variety of tasks to make sure students are learning, the master teachers play the role of doctors - triaging problems, looking at data, working on the tough problems, and helping the student to apply their knowledge to critical thinking problems (getting even healthier).

The final observation i had is how completely individualized this sophisticated system allows healthcare to be. You are never in a situation where the doctor says - everyone take this medicine right now or im going to gove you a ct scan because thats what we do for every patient. The opposite problem is true in most of public education - we group students regardless of need and teach to the median, clearly a recipe for failure. In blended schools, we focus on dynamically grouping students based on what they need next developmentally. Individualization clearly works better for both health and learning.

It is striking when you are thrown into a foreign situation like we were yesterday, how much perspective it can give you on what you do every day. It reaffirms for me that we are headed in the right direction in education with blended schools. Now we all need to scale it up.

1 comment:

  1. John -- thanks for the thoughtful post, which I'm catching late. Health-education parallels are fascinating as regards task shifting and tech's impact.

    Khosla had a great piece on this recently arguing that 80% of doctors' work on diagnosis & prescription will be supplanted by tech ( In addition to improving outcomes directly through personalization and quality standardization (a la edtech), this will help free up doctors to do more value-added work, similar to what you say about master teachers above. It'll also enable nurses and other less highly trained health pros to take on more of the overall work of healthcare. Similarly, in education we'll be able to make wider and better use of tutors, less experienced teachers, and even peers.

    It's interesting how little discussion there is in edtech about what the technology means for humans. It basically allows radical, liberating reinvention of how we deploy people (and not just teachers in our common understanding of what a 'good teacher' is) in schools, and therefore what kind of people and skills are needed. In addition to what Rocketship is experimenting with, it's exciting to see MATCH trying out the all-tutor model in connection with a blended set-up. It would be great to see schools pushing more on Mazur-like peer-driven learning, with small-group learning and (e.g.) 6th graders teaching 5th graders. There's lots of research showing that teaching others what you've recently learned is an effective way to consolidate and deepen the learning.

    Over at, we're thinking about how this applies in higher ed. Where in health the cost/skill task shifting gradient runs from doctors to nurses to community health workers to patient (with the ultimate layer of disruption being patients taking on more responsibility for their own health), in higher ed it runs professor to TA to tutor to student. What's exciting is that moving down the gradient doesn't mean worse outcomes - it often means better outcomes.