A Cautionary Tale and a Call to Action: The Performance Management Parallels between Teachers and Physicians

James M. Loy, Miami University's College of Education, Health, and Society

To the casual observer, there might not appear to be many similarities between the educational system and the healthcare industry. But according to Andrew Saultz, assistant professor in Miami University’s College of Education, Health and Society, the common ground between school teachers and primary care physicians goes much deeper, and potentially carries more impact, than either group may realize.

Both fields, of course, attract caring and compassionate professionals dedicated to the improvement and wellbeing of others. But at a much more systemic level, both are also facing increasing legislative pressure to conform to various data-driven performance management metrics and outcomes-based measurements.

For most teachers this is nothing new. For years, educators have been forced to endure intense political scrutiny and have tried to push back against a long list of regulatory reforms. But for physicians, the threat of independently imposed quality control standards intended to quantify, measure, and incentivize performance is all very new.

But this political lens has begun to turn its gaze toward the healthcare industry, and though it is not yet at the level faced by teachers, Saultz believes it eventually will be.

Andrew Saultz“I think it is inevitable that the use of data will continue to expand in healthcare, as it has in education,” says Saultz. “Healthcare is moving in a direction that is very data driven and outcomes orientated. You’ve seen some of this already in surgery. Surgeons will calculate the risk of the surgery and some surgeons might not want to operate if the risks are too high because they are evaluated on the percent of successful surgeries.”

In a new article published in the Annals of Family Medicine titled, “Measuring Outcomes: Lessons From the World of Public Education,” Saultz and his co-author, Professor of Family Medicine John Saultz, state that this growing trend in healthcare is partly a response to a decrease in overall quality and an increase in overall costs, which lawmakers hope to mitigate by enforcing a system that would ideally boost the efficiency and effectiveness of primary care physician patient services.

The problem, however, is that legislators are assuming that the data used to design such quality-control measurements and reform metrics is both accurate and actionable, which it very often is not.

Furthermore, Saultz also sees a danger of employing value-added models (VAM) to measure and incentivize individual performance. Many have decried VAMs because they only prioritize end results over continuous improvements to actual practices. Such models, they argue, are typically best reserved for business-related fields, not necessarily those that prioritize goals beyond just efficiency and productivity alone.  

This is very all similar to what has already occurred in education, and Saultz sees parallels that can benefit both industries going forward.

First, because this problem has continued to unfold over the last two decades for teachers, past and present political machinations to reform education should serve as both a wake-up call and a learning opportunity for physicians who may soon find themselves in a similar salutation.

Secondly, it also represents a renewed opportunity for the teachers themselves, who could potentially leverage the social capital of physicians to gain a new sense of empowerment and support.

“The examples of education serve as a cautionary tale to say there are these unintended consequences that have led us down a road in education where I don’t think a lot of educational professionals are very happy,” Saultz says. “I think one thing that teachers did was resist the reform to the degree that they weren’t even a part of shaping any of it. But physicians have, perhaps, more of a capability than teachers did in terms of shaping reform moving forward.”

Teachers were first forced down this road at the state level in the 1980s, and then at the federal level beginning with the No Child Left Behind Act in 2002. Since then, performance management has become a way for lawmakers to leverage data-driven metrics to establish standardized requirements by which teachers and schools are evaluated, and then subsequently rewarded or punished, based on the results.

This has placed teachers under increasing pressure to meet an array of politically mandated standards designed to maximize efficiency and effectiveness across schools, and it has sparked fierce debates among educators and lawmakers alike, both of whom often view this issue from very different perspectives.

Proponents argue that performance management is a way to improve public institutions while building public trust. But critics see these metrics as unfair or inconsistent, or even completely misaligned with the nature of other important teaching goals that require patience, compassion, understanding, thoroughness, and personalized student attention.

This has all resulted in the “unintended consequences” to which Saultz refers including the damage to teacher morale, the loss of local community control, constantly shifting educational policies, an increase in frustration, anxiety, and uncertainty among educators, as well as a “narrowing of purpose,” which has incentivized teachers to prioritize high standardized test scores above all else.

This problem is still sweeping across the educational landscape today, and Saultz believes it to be a fate physicians can avoid. If, that is, they are willing to take a more preemptive and proactive role in the political reform process.

This is what teachers have so far failed to achieve. Most feel as if performance management regulations have been unfairly thrust upon them. But even though education is already entangled in policies that can potentially depersonalize, disempower, and de-localize the profession, there are still ways to achieve more positive outcomes.

“One of the ways to think about policy is across disciplines,” Saultz says. “Often times we get so siloed that we forget these phenomena are happening in other places. And what if teachers and physicians got together and said, ‘Wait a minute. The use of data in this way is not helpful to students. It is not helpful to patients.’ I wonder about the possibility of creating coalitions across these disciplines to have a louder voice.”

Saultz, therefore, is not only calling for proactive involvement among healthcare professionals, he is also urging both parties, both teachers and physicians, to come together upon a common political ground, to reexamine an overbearing measurement paradigm that threatens to undermine the nature of their true work.

Just like primary care clinicians, teachers exist on the front lines of society, and they are in the best position to advocate for more support and understanding, instead of more quality controls and measurement standards and reform policies that can often do more harm than good.

But first, teachers, just like physicians, need to get more involved in the political process. And whether that means attending school board meetings, serving on school boards, running for office, or even forming an interdisciplinary coalition with healthcare professionals, it will require action.

“We have a lack of teacher voice in our policies, and we have policy makers who, by and large, have never been educators,” Saultz says. “As a result, they are viewing education through a lens of what might work in business, or in other sectors. And they are not understanding the complex classroom climate, and the details to being a teacher to the degree that they could. So I think teachers have an opportunity - and I know they are overwhelmed - but I hope they find allies to help rise up and have a stronger role in these policies.”

Article Citation:

Saultz, A. & Saultz, J.W. (2017). Measuring outcomes: Lessons from the world of public education. Annals of Family Medicine. 15(1): 71-76.