YAY – Term 1 has come to a close and I can breathe again. I’ve spent the first couple of days ordering an Ipad 2, buying an Iphone 4 (and playing with it!), doing housework and generally getting my spiritual “house” in order. Part of this ‘settling’ activity has involved reading two books – Focus by Mike Schmoker and Better by Atul Gawande.
The latter book was brought to my attention through the professional reading group to which I belong. Atul Gawande is a surgeon and this book was a collection of what he had noticed about the medical profession and the journey these ‘noticings’ had taken him towards improved performance as a surgeon and the wider profession. It isn’t new (published in 2007) and the ideas presented in the book aren’t new either. And that is one of his major points. That we may already know what is good practice and how to make things better, but, for various reasons, this doesn’t happen. Some really interesting parallels between what he writes about in relation to the medical profession and what I know about education systems and practices. Some of the chapters make for confronting reading – especially the ones dealing with experiences in Iraq, legal executions in the US and delivering babies. There are some gruesome passages about wounds to bodies and medical procedures. But the message was overpowering without being preachy.
He believes that there are three key things for success in medicine: diligence, doing ‘right’ and ingenuity.
Some quotes from the book:
“Betterment is a perpetual labour…It is to live a life of responsibility. The question then, is not whether one accepts the responsibility. Just by doing the work, one has. The question is, having accepted the responsibility, how one does such work well” (p9)
“…positive deviance idea – the idea of building on capabilities people already had rather than telling them how they had to change” (p 25)
“…diligence stands as one of the most difficult challenges facing any group of people who take on tasks of risk and consequence. It sets a high.. expectation for performance and human behaviour” (p 29)
“The easy thing for doctors and nurses is simply to follow the written rules. But each of us has a duty not to follow rules and laws blindly. We may be called upon to make a choice. We must do our best to choose intelligently and wisely. We each should then be prepared to accept the consequences. Above all, we have to be prepared to recognise when using our abilities skilfully comes into conflict with using them rightly” (p 153)
“The hardest part of being a doctor is to know what you have power over and what you don’t” (p 154)
“The seemingly easiest and most sensible rule for a doctor is: Always Fight. Always look for more you could do” (p 161)
“The good doctors didn’t always get the answers right…Sometimes they pushed too long or not long enough. But at least they stopped to wonder, to reconsider the path they were on. They asked colleagues for another perspective. They set aside their egos. This insight is wiser and harder to grasp than it might seem. When someone has come to you for your expertise and your expertise has failed, what do you have left? You have only your character to fall back upon – and sometimes it’s only your pride that comes through. You may simply deny your plan has failed, deny that more can’t be done. You may become angry. You may blame the [patient]. In the end, no guidelines can tell us what we have power over and what we don’t. In the face of uncertainty, wisdom is to err on the side of pushing, to not give up. You have to be ready to recognise when the pushing can turn to harm. ..our fight is not always to do more. It is to do right by our patients, even though what is right is not always clear” (p 164)
“Obstetrics went about improving the same way that Toyota and General Electric went about improving: on the fly, but always paying attention to results and trying to better them. And that approach worked.” (p 189)
“There is no reason we cannot aim for everyone to do better” (p 199)
“[X’s] combination of focus, aggressiveness and inventiveness is what makes him extraordinary. He thinks hard about his patients, he pushes them, and he does not hesitate to improvise. …he insists on a degree of uniformity that clinicians usually find intolerable. He can have ‘somewhat of an absence of collegial respect for different care plans’. But with his unblinking focus on his patients’ actual results, X has managed to innovate successfully” (p 225)
“..believes that the subtleties of high-performance medical practice can be identified and learned. But the lessons are hidden because no one knows who the high performers really are. Only if we know the results from all can we identify the positive deviants and learn from them.” (p 227)
“What is troubling is not being average but settling for it” (p 230)
“The infant science of improving performance- of implementing existing know-how- is [the key to saving lives]” (p 242-3)
“…successes….each one began with a readiness to recognise problems and a determination to ready them” (p 246)
“In medicine, just as in anything else people do, individuals respond to new ideas in one of three ways. A few become early adopters. Most become late adopters. And some remain persistent sceptics who never stop resisting. Nonetheless, make yourself an early adopter. Look for the opportunity to change. I am not saying you should adopt every new trend that comes along. But be willing to recognise the inadequacies in what you do and to seek out solutions.
So find something new to try, something to change. Count how often you succeed and how often you fail. Write about it. Ask people what they think.
See if you can keep the conversation going” (p 256-7)
I’m sure you can see why this book appealed.
The other book, Focus, was just as compelling a read.
It is sub-titled: Elevating the Essentials – To Radically Improve Student Learning
Schmoker focuses (no pun intended) on the importance of simplicity, clarity and priority in curriculum and in practice.
Firstly, he recommends we look at the standards of achievement in each discipline that are in curriculum documents provided by statutory bodies then prune these down to the essentials (interesting in the light of the developing Australian Curriculum). We then teach these through effective lessons that consist of clear learning objectives, determining prior knowledge, direct instruction, guided practice and checks for understanding. He says things like: “we suspend all new initiatives until checking for understanding is consistently implemented in our schools in almost every lesson”. He believes that the many and varied foci that have become part of schooling are taking away our focus on what schooling should be about – learning.
I have a great sympathy with Schmoker’s argument and, after only recently coming to the same conclusion myself after nearly 30 years of classroom teaching (see previous entry Stories of Learning), I am all afire to set my own focus for the rest of this year to try and compel my colleagues to reflect on their own practices and refocus on this imperative – in systemic ways as well as in individual disciplines and individual classrooms.
If you want some professional reading to light the flame inside, I would highly recommend these two books to you.
Best wishes for the upcoming term.