The Sham of “Best Practices”

In medical practice, evidenced-based “best practices” have led the way to improved health care in the U.S., according to its champions. In the federal stimulus legislation, over a billion dollars was devoted to determining “what works and doesn’t” (President Obama’s words) in diagnosing and treating patients. Now that is serious money for a serious cause.

In education, “best practices” are continually laid out by policymakers, researchers, and media journalists as guides for school boards, superintendents, and teachers to follow in improving student test scores and building better schools. Recent reports lay out “best practices” on classroom management, professional development, and school working conditions that “can revamp classrooms and schools to close the achievement gaps and promote excellence in learning for all students.” For the federal “Race To The Top,” the U.S. Secretary of Education laid out four models of turning around chronically low performing schools. These models were drawn from “best practices” for rescuing failing schools, even though some were contested.

Where does phrase “best practices” originate? I checked around the blogosphere and its origin seems to be in the business sector with management consultants and corporate gurus. It has become a buzzword across governmental, educational, and medical organizations. In becoming popular, the phrase has drifted away linguistically from its original meaning of effective practices in accomplishing goals to mean faddish or trendy activities.

Even in medicine. Jerome Groopman recently reported startling reversals in “best practices.” Based upon rigorous studies, an expert panel of medical researchers recommended to Medicare that it was a “best practice” to control blood sugar levels for very sick patients. “That measure of quality, ” Groopman said, “was not only shown to be wrong [by subsequent studies] but resulted in a higher likelihood of death when compared to measures allowing a more flexible treatment and higher blood sugar.” Groopman listed reversal after reversal of Medicare approved “best practices” for treating kidney disease, pneumonia, congestive heart disease, and other conditions–and I won’t mention the “best” age for women to have mammograms.

What is going on here with “gold standard” research studies (experimental design, random assignment of subjects, etc.) that initially become the basis for a Medicare prescribed “best practice” and then new studies upend the supposed “best practice” treatment?

According to Groopman, experts who recommended “best practice” treatments (and their advice became Medicare mandates to all physicians) “did not distinguish between medical practices that can be standardized and not significantly altered by the condition of the individual patient, and those that must be adapted to a particular person.” He gives the example of putting a catheter into a blood vessel, a procedure that involves the same steps for every patient to avoid infection. This “one-size-fits-all” mechanical procedure differs from prescribing a “best practice” for a complex disease such as diabetes, congestive heart failure, or breast cancer. Not making this critical distinction leads experts to overreach and, in time, turn a “best practice” such as hormone replacement therapy for women into a fad. A similar situation plagues school reform.

In reforming schools, except in particular narrow instances of practice–the use of phonics to teach young children to decode words–few expert panels (e.g., the National Research Council report on reading in 1998) sift the available evidence drawn from rigorous studies to recommend standardized practices. There is no Medicare in U.S. schools to prescribe “best practice.” Instead, blue-ribbon commissions, responding to a national problem (e.g., the Cold War space race, poverty, global economic competition) advise policymakers on standard practices–think Nation at Risk report in 1983–that should be used to improve schooling.

The distinction Groopman made that medical experts failed to sort out practices that can be standardized on all patients from those that must be adapted to a particular person has little traction in the world of reform-minded policymakers. Prestigious educational panels, issue reports, some anchored in research but most collections of practices that seemingly are successful with some students, some teachers, in some places. These panels then advise policymakers to standardize these seemingly successful practices on all schools.

Reform-driven policymakers are more interested in scaling up and uniformity (what Groopman referred to as one-size-fits-all procedures for inserting a catherer) then contextual differences among schools and districts (what Groopman referred to procedures that have to be adapted to a particular patient). I am not the first educator, nor the last, to make the point that school reform is a value-driven (not research-driven) business where policymakers depend far more on faith than facts and far more on uniformity than context.

In comparing “best practices” in medicine and education, I now see more clearly how (and why) state and federal policymakers, grasping for anything that looks like success, spread faddish and unstudied reforms. This is both a sham and a shame.

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12 Comments

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12 responses to “The Sham of “Best Practices”

  1. I recently posted an item on my blog that discusses how people on both sides of the political fence are fighting against national one-size-fits-all standards. They may have different reasons but any time people on the left and right agree I pay attention.
    Douglas W. Green, EdD

    http://www.drdouggreen.com/2010/01/right-and-left-agree-on-something/

  2. Would you argue for a much more robust education research agenda that can help educators distinguish between the catheter and the nuances of treatment for diabetes (or, at least, their education equivalents)? Many educators I meet are starved for guidance on what can work for their students. That’s why they heed the siren song of best practice.

    • larrycuban

      Claus,
      Yes, I would want a “more robust education research agenda” to help educators “starved for guidance” on what works for their students. That would include a sharper, more assertive IES “What Works Clearinghouse.” Of equal importance, I would want federal and state policymakers to say openly to school boards, administrators, and teachers that the “best practices” they endorse, even push, are current guesses on what might work for your particular settings, not carrying the GoodHousekeeping Seal of Approval or any promise that they will work elsewhere. Yeah, even at my ripe age, a streak of naivete persists in the hope that those who make funding decisions can be transparent about faith driving “best practices,” not facts.

  3. Akee123

    At a minimum, lets at least agree on what doesn’t work:
    -large group round robin reading
    -students in rows
    -teacher having kids memorize minor facts

    • larrycuban

      Sorry, Rob, I do not agree with the three you put forward as “bad” practices. In the right place, with the right teacher, at the right time, those practices can be “best” for those kids. Yep,the context matter which makes it so hard for researchers and policymakers to find generic “best practices” for all kids across all settings.

  4. Larry,
    You are spot on to ascribe this awful phrase to the marketeers. In the educational technology world they love it because they believe it acts like a goad to “resistant” teachers. But such is the strength of PC ideology in education that, certainly in the UK, you will now see “best practice” replaced by the far less confrontational, “good” or “successful” practice. Truly Orwellian.

  5. This seems right on target with the Cynefin framework: problems are either complex, complicated, chaotic, or simple. Only simple and some complicated problems lend themselves to “best practice” solutions.

    • larrycuban

      Hey, thanks Mitch for putting me on to the Cynefin framework. I had not heard of it before and although the concepts are familiar I will look into it.

  6. Loved this discussion! Featured you on my blog today as “The Daily Quote” … and you are right on target with your points. Anyone who has reared more than one child knows that what worked for the first rarely works for the second. “Best practices”? Even in industry, it’s just the newest medicine-man hoo-ha. And why should education look to the commercial work for its inspiration? Our objectives are not compatible. Critical thinking vs. the profit motive?

  7. Pingback: Worst Practices from Mike Trucano of WB | Out of School Learning

  8. John

    What I find amazing as a teacher is that back in the beginning of public education (1850′s) there was no such thing as “high school” reform. We huge inventions that took place in the 1850′s and up until today. This whole thing of “Best Practices” is really a sham. It’s a way for university instructors to say, “look at me and what I have done”. In fact, even throughout the world, Asia and Scandinava included, our systems practically reflect each other. The only difference is socially, such as families, and the level of spending on education.

  9. Pingback: Manifesto for Teaching Online – Aphorism No. 4 – “‘‘Best practice’ is a totalizing term blind to context – there are many ways to get it right. “ « Design Futures Archaeology

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