The Sham and Shame of “Best Practices”

I posted this February 3, 2010. I have since made some changes in the post. Given the adoption of Common Core Standards in 45 states and the District of Columbia and the current emphasis on putting the standards into practice across thousands of districts, I felt that the phrase “best practices” needed another public scrubbing.

In medical practice, evidenced-based “best practices” have led the way t0 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? Its origin seems to be in the business sector with management consultants. 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, for example, 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. Need I 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 Medicare prescribed “best practices” and then new studies upending 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 in their recommendations to practitioners 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. Since there is no Medicare agency in U.S. schools to prescribe “best practice,” appointed 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.

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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 had little traction in the world of reform-minded policymakers eager to put into place, for example, the latest technology. 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).

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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 unexamined reforms. This is both a sham and a shame.

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18 Comments

Filed under how teachers teach, school reform policies

18 responses to “The Sham and Shame of “Best Practices”

  1. Great post. I always thought the term was bogus. This is education, not physics. What’s best not only depends on the context and the individuals, but you will never know if what you did was really “best.” Another problem I have is when educators talk about closing the achievement gaps. The only way you do that is to slow down the fast learners, which some schools do rather well. If you have every kid learning as fast as possible, the gaps will increase, which should be the goal.

  2. Technology has of course enabled and exacerbated the spread of “faddish and unexamined reforms” you describe in your final paragraph Larry. The combination of technology with marketing practice has a lot to answer for. It gave us the “digital native,” “21st Century Learning,” “flipped classrooms” and many, many more vacuous but popular concepts which owe far more to the world of marketing than serious research.

    As an ex English teacher and academic author who has worked closely with many skilled, marketing professionals, I know that, whereas scholarship requires effort and sophisticated levels of literacy: marketing requires visual imagery, linguistic simplicity and crucially…novelty.

  3. I’d put the problem in somewhat less relativist terms. We probably should be striving for a “best practices” approach to education. For one thing, this would help us avoid less-optimal outcome-based approaches:

    http://www.paul-bruno.com/2013/06/outcome-measures-are-what-you-get-when-you-dont-have-best-practices/

    The problem is just that right now we don’t have many “best practices” because either the research isn’t there or too many educators reject it.

    But that doesn’t change the fact that “best practices” are a good thing to have.

    • larrycuban

      Thanks, Paul, for taking the time to comment. Your point is well taken. Depends, as Groopman says, on which practices become best because research studies–double-blind even–trip over a simple distinction: Again Groopman: policymakers and researchers “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.” I believe that also applies to schooling.

      • Bridget

        The difference now is that there is a new wave of ignorance of what the research says about best practices in education. Some actually are based on research, as well as common sense. The problem now is that the reformers/deformers have hijacked reform language to include education “reforms” that are not only not founded in research, but are actually destructive to education and harmful to children. But maybe that was the plan all along. Destroy public education and replace it with private, corporate, for-profit, business models whose goals have nothing to do with educating children.

      • larrycuban

        Thanks, Bridget, for taking the time to comment.

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