Serve The Patient, Serve The Student, Starve The Bureaucracy

This week’s Courier Herald column:

In my day job, I spend a good bit of time working on policy solutions in the areas of medicine and education, among other topics. They are complex areas, without singular problems nor singular silver-bullet solutions. The fields appear to have very little in common. And yet, many of the barriers to success in each field have a similar root cause.

My mother spent the first ten days of this year in the hospital. It was not a pleasant visit, not that hospital stays usual are. The information we received about her condition and reason for hospitalization was incomplete and contradictory. We had difficulty getting basic questions answered. All communication, we were told, was to come from the doctor. “The”, singular, doctor, who we saw for a couple of minutes per day. She eventually made it clear to us in no uncertain terms that she had already answered our questions and didn’t care to be asked again, nor to have her orders questioned.

After firmly requesting she be replaced by my mom’s doctor from a previous and very recent stay, that doctor said “Had I seen you on your first day here, you wouldn’t be here now”. By that point she had a new infection (that she predicted she would get on day 2 of her stay – a prediction doctor #1 ignored) and she remained in the hospital four more days.

My mother, a registered nurse, made it clear as my sisters and I worked the hospital’s bureaucracy that the nurses and techs were giving her great care and were very responsive to all her requests. That much was evident. And yet, despite all of their efforts to go above and beyond, the net effect of the first several days of her stay was that she was arguably worse off for having been there than not.

Mom understood a basic lesson of unaccountable bureaucracies. The people on the front lines – often the hardest working and lowest paid – are the first to get the blame. As such, she didn’t want to make a fuss. She was more worried about the blowback to the wrong people than her own health.

So what does this have to do with education? Nothing, except everything.

At the end of the day, hospitals exist to serve the patient. Period.

And yet, when there’s a problem or question, the bureaucracy must be served before the patient’s concern even begins to be addressed. Insurance reimbursements, state and federal regulations, policies designed to limit legal liability, and respect for internal hierarchies are routinely invoked as reasons to deny, delay, or otherwise obfuscate direct requests from patients – also known as the customer.

In education, the titles and situations are different, but the excuses are the same. The teachers are on the front line, yet they too suffer from burdensome state and federal regulations, policies to limit legal liability, and are at the bottom of the education hierarchy. They’re expected to work miracles, but if there’s a problem they’re the first to feel the heat.

In this case, the customer is the student. The needs of the student are far from the center of education policy these days. Whether in education, or in medicine, too often the needs of the bureaucracy must be served before those of the student or patient can be addressed.

Recently I had to help a friend pick out a nursing home. It’s amazing how different the patient-provider relationship is when an insurance company isn’t involved. Yes, there are still a lot of regulations governing quality and delivery. But there’s an amazing amount of flexibility and adaptability that providers are willing to offer when there is competition for the patient’s dollar – and a direct relationship between the buyer and seller. The prospective resident – and his needs – are front and center.

It’s refreshing to hear talk of healthcare reforms coming out of Washington to make healthcare more patient centered. Let’s hope there is reality behind the talk.

Let’s take this same lesson and apply it to education while we’re at it. Schools serve many functions beyond education these days. The least important among them is to serve as a jobs program for adults. Especially, for administrative bureaucrats. The priorities must be inverted to establish a direct relationship between the customer, and a provider that can and will meet their needs.

We must get education at all levels to be more student focused. The organizations that best serve their student customers need to be rewarded. If the needs of the students are put first, including funding based on student need, all of those other problems for the adults involved will end up taking care of themselves.

Charlie Harper is the publisher of and the Executive Director of PolicyBEST, which focuses on policy issues of Business Climate, Education, Science & Medicine, and Transportation.


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