An article in The New York Times about Doug Lemov’s book “Teach Like a Champion“ made me think more deeply about what to do with outcomes measures in health care.
Lemov has analyzed how successful teachers teach, measuring how long they wait for students to answer questions to how much eye contact they have to when they move around in the classroom and when they don’t. And he claims that these seemingly intuitive and almost invisible skills need to be learned and practiced.
“[The] Los Angeles school system tabulated the performance of roughly 6,000 teachers, using measures of student achievement. The best performing teacher in the whole system was a woman named Zenaida Tan. Up until that report, she was completely unheralded. The skills she possessed were invisible. Meanwhile, less important traits were measured on her evaluations (three times she was late to pick up students from recess).
[T]hese subtle skills are often not recognized or even discussed by those who talk about education policy, or even by those who evaluate teachers.
[This is like] the skill of herding cats. The master of cat herding senses when attention is about to wander, knows how fast to move a diverse group, senses the rhythm between lecturing and class participation, varies the emotional tone. This is a performance skill that surely is relevant beyond education.
This raises an important point. As the economy changes, the skills required to thrive in it change, too, and it takes a while before these new skills are defined and acknowledged.”
Thinking of where we are in health care, measuring “outcomes” is only the beginning. It needs to be followed by intelligent analysis of which methods and approaches produce those outcomes. And any implementation of what works in one community or one clinic needs to be tried and evaluated before we can be sure it also works for our own patients.
The New York Times’ article’s sobering conclusion is that the skills required for the future will not be fully defined or acknowledged in the present. Just like the highest achieving teacher received no recognition for several years, doctors that practice excellent and up to date medicine are sometimes penalized for disregarding lingering yet already outdated guidelines or prioritizing important outcomes nobody thought of measuring yet over pseudo measures that are easier to quantify.
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