Education should be more like medicine, educators are often told. High-quality research is disseminated to physicians who unfailingly apply it to improve healthcare.
It is a simple and appealing idea, but it is one that often breaks down in examination rooms as physicians’ biases and habits meet patients’ unwillingness or inability to comply with treatment plans.
Like new teaching approaches, however, medical innovations spread at different speeds, a phenomenon explored by Atul Gawande in “Slow Ideas” in the July 29, 2013 issue of the New Yorker. Here are two examples:
Before surgical anesthesia was discovered in the mid-1800s, “… attendants pinned patients down as they screamed and thrashed, until they fainted from the agony,” Gawande writes. Within a year of its invention anesthesia spread around the world, although, as Gawande notes, “… there were forces of resistance…. Some people criticized anesthesia as a ‘needless luxury’; clergyman deplored its use to reduce pain during childbirth as a frustration of the Almighty’s designs.”
Another major innovation in medical-practice came along a decade or two later, this time the elimination of germs to prevent infection, a leading cause of death at that time. In this case, however, it took a generation for the recommendations to become routine.
Reasons for the uneven spread of innovation
Gawande suggests likely causes for the varied speed of implementation—the source of some problems were invisible (for instance, germs), and new practices may have been contrary to physicians’ beliefs and/or were more technically complex to apply.
“This has been the pattern of many important but stalled ideas,” Gawande writes. “They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful.”
Gawande notes the power of institutional culture and the failures of traditional approaches to change—seeking to persuade through “rational evidence,” making demands accompanied by threats, or offering incentives. “[N]either penalties nor incentives achieve what we’re really after: a system and a culture where X is what people do, day in and day out, even when no one is watching.”
“In the era of the iPhone, Facebook, and Twitter,” he writes, “we’ve become enamored of ideas that spread as effortlessly as ether. We went frictionless, ‘turnkey’ solutions to the major difficulties of the world—hunger, disease, poverty. We prefer instructional videos to teachers, drones to troops, incentives to institutions. People and institutions can feel messy and anachronistic. They introduce, as the engineers put it, uncontrolled variability.”
Gawande adds: “But technology and incentive programs are not enough. ‘Diffusion is essentially a social process through which people talking to people spread an innovation,’ wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people, But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.”
Implications for school administrators and teacher leaders:
- There are no “teacher proof” ways to spread new ideas and practices, technologically or otherwise.
- That’s because the spread of new ideas is intensely interpersonal with all the complexities and demands of human nature and group dynamics. “Messy” is an apt term to describe such processes.
- The diffusion of new ideas and practices is enabled by a culture of continuous improvement. It is also a means by which such cultures are shaped.
- The spread of innovation happens over time through the social influence provided by countless individual and small group conversations. “Training” and other forms of “presentations” may help initiate those conversations, but they are never a substitute for them.
My next post will offer another perspective on Gawande’s ideas stimulated by a letter to the editor of a subsequent issue of the New Yorker.