kitchen table math, the sequel: "the persistence of bad industry practices"

Sunday, August 23, 2009

"the persistence of bad industry practices"

in the September Atlantic:

ALMOST TWO YEARS ago, my father was killed by a hospital-borne infection in the intensive-care unit of a well-regarded nonprofit hospital in New York City. Dad had just turned 83, and he had a variety of the ailments common to men of his age. But he was still working on the day he walked into the hospital with pneumonia. Within 36 hours, he had developed sepsis. Over the next five weeks in the ICU, a wave of secondary infections, also acquired in the hospital, overwhelmed his defenses. My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.

About a week after my father’s death, The New Yorker ran an article by Atul Gawande profiling the efforts of Dr. Peter Pronovost to reduce the incidence of fatal hospital-borne infections. Pronovost’s solution? A simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures. Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption. But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them. The story chronicled Pronovost’s travels around the country as he struggled to persuade hospitals to embrace his reform.

It was a heroic story, but to me, it was also deeply unsettling. How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people.

by David Goldhill
Atlantic Monthly September 2009

The subject of formative assessment came up in the Comments thread for Allison's post about middle school math pre-tests.*

Sitting here in Evanston Hospital, keeping watch over my mom and reading the National Reading Panel Reports of the Subgroups in the lulls between crises,** I had a blinding flash of recognition when I read the passage above.

My blinding flash was not about hospital sterilization procedures and physician hand-washing, however. No. My blinding flash of recognition was all about formative assessment, (aka collect & correct).***

Ed and I have now been lobbying our school district to use formative assessment (pdf file) ("assessment for learning") for four years. Four years!

Moreover, the district has been paying formative assessment consultants to teach teachers how to use formative assessment for at least two years.

But do we have formative assessment?

No, we do not.

Not only do we not have formative assessment, we do have administrators sending FOILable emails to parents in which they openly refuse to provide formative assessment when directly asked to do so.

Formative assessment at its simplest means: find out what the kids learned, then reteach the stuff they didn't learn.

Can't get it; district won't do it. Or doesn't do it. Either one. I don't know any district that does.

And that is "deeply unsettling," as Goldhill says. How is it possible that parents have to beg schools to provide an essentially cost-free idea that stands a chance of getting kids to college ready to do college work?

update 1:49 Chicago:

* [news flash: at the moment, I can't log on to the old ktm site, which had a number of good posts about formative assessment. Usually when this happens the site eventually becomes available again, but we'll see. I really need to get it backed up, finally. Here's the URL for the search page:]
** Do you know the meaning of the words meaning troponin leakage? I do.
*** It's possible I have been writing an education blog for too long.


Catherine Johnson said...

I've got to see if I can get a copy of the study:

Class size reduction or rapid formative assessment?: A comparison of cost-effectiveness
Educational Research Review
Volume 4, Issue 1, 2009, Pages 7-15

Stuart S. Yeh, a,

University of Minnesota, Educational Policy and Administration, 86 Pleasant Street, S.E., Minneapolis, MN 55455, United States

Received 18 October 2007; revised 26 June 2008; accepted 25 September 2008. Available online 2 October 2008.


The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student–teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR was found to be 124 times less cost effective than the implementation of systems that rapidly assess student progress in math and reading two to five times per week. Analysis of the results from California and Wisconsin suggest that the relative effectiveness of rapid formative assessment may be substantially underestimated. Further research regarding class size reduction is unlikely to be fruitful, and attention should be turned to rapid formative assessment and other more promising alternatives.

Allison said...

Nothing like reading about how doctors and nurses wear their scrubs out to lunch and dinner to make you feel sick about c. Diff and MRSA.

Hospitals are no places to get well!

Anonymous said...

I had c. diff last year. I came down with symptoms about 3 months after surgery. I guess I was lucky, because the toxins from the c. diff bacteria can kill people, but it's hard to feel too lucky when you're stuck at home day after day. It's a really good thing I didn't have a job at the time, because I couldn't have gone, and it took well over a month to figure out what was wrong and treat it.

My GP gave me a week's worth of flagil to kill the bacteria. While I was taking the flagil I was better, but two or three days after I stopped, the diarrhea came back. I got the doctor to prescribe another week's worth of flagil and that, plus daily massive doses of probiotics, sort of fixed things. I ended up seeing a GI specialist and he put me on a month's regimen of flagil - 3 a day for a week, 2 a day for a week, 1 a day for a week, 3 pills a day every other day for a week. Since then I've been "cured," but the GI specialist told me to take Culturelle weekly for the rest of my life, and that I'll always be extremely susceptible to a repeat infection.