Essential School Leader Reading

This article by Atul "Better" Gawande is pretty essential reading for most anyone in school leadership or education policy. The article is about how ideas spread and follows the story of how doctors are working to increase the percentage of hospitals using very basic protocols for newborns. Read this long-ish excerpt to get the idea:

"As with most difficulties in global health care, lack of adequate technology is not the biggest problem. We already have a great warming technology: a mother’s skin. But even in high-income countries we do not consistently use it. In the United States, according to Ringer, more than half of newborns needing intensive care arrive hypothermic. Preventing hypothermia is a perfect example of an unsexy task: it demands painstaking effort without immediate reward. Getting hospitals and birth attendants to carry out even a few of the tasks required for safer childbirth would save hundreds of thousands of lives. But how do we do that?

The most common approach to changing behavior is to say to people, “Please do X.” Please warm the newborn. Please wash your hands. Please follow through on the twenty-seven other childbirth practices that you’re not doing. This is what we say in the classroom, in instructional videos, and in public-service campaigns, and it works, but only up to a point.

Then, there’s the law-and-order approach: “You must do X.” We establish standards and regulations, and threaten to punish failures with fines, suspensions, the revocation of licenses. Punishment can work. Behavioral economists have even quantified how averse people are to penalties. In experimental games, they will often quit playing rather than risk facing negative consequences. And that is the problem with threatening to discipline birth attendants who are taking difficult-to-fill jobs under intensely trying conditions. They’ll quit.

The kinder version of “You must do X” is to offer incentives rather than penalties. Maybe we could pay birth attendants a bonus for every healthy child who makes it past a week of life. But then you think about how hard it would be to make a scheme like that work, especially in poor settings. You’d need a sophisticated tracking procedure, to make sure that people aren’t gaming the system, and complex statistical calculations, to take prior risks into account. There’s also the impossible question of how you split the reward among all the people involved. How much should the community health worker who provided the prenatal care get? The birth attendant who handled the first twelve hours of labor? The one who came on duty and handled the delivery? The doctor who was called in when things got complicated? The pharmacist who stocked the antibiotic that the child required?

Besides, neither penalties nor incentives achieve what we’re really after: a system and a culture where X is what people do, day in and day out, even when no one is watching. “You must” rewards mere compliance. Getting to “X is what we do” means establishing X as the norm. And that’s what we want: for skin-to-skin warming, hand washing, and all the other lifesaving practices of childbirth to be, quite simply, the norm.

To create new norms, you have to understand people’s existing norms and barriers to change. You have to understand what’s getting in their way. So what about just working with health-care workers, one by one, to do just that?"

Besides the obvious parallel to a school leader building or changing staff and/or student culture, I love this excerpt and the whole article because it really hits on one of my pet peeves about many education folks (especially on my side of the "ed reform" debate)- namely, that there is a technocratic solution to every challenge. What I mean when I say technocratic is that the solution lies in some new system, process, or technology. Anyone involved in education for more than a few years could create a long list of local, state-wide, or national education initiatives that sounded good on paper but failed when implemented at scale. Great ideas are necessary but so far from being sufficient and that applies equally to something as small as student culture systems at one school to something as large as implementation of Common Core assessments nationwide. What matters most in Gawande's eyes is the slow, deep, individualized work of really knowing people, relationships, and communities. In other words, culture matters more than ideas and building culture is way harder than coming up with a great system.