How can we get better at getting better?


In nearly every book I read, I find lessons that help me improve my performance. This is true of both education related books like Daniel Willingham’s Why Don’t Students Like School? as well non-education books like Atul Gawande’s Better: A Surgeon’s Notes on Performance. Like medicine, education can be complicated and messy work. Both involve dealing with complex systems and the complexities of the human race. It can be hard. It can feel defeating at times. But just as we think we don’t have another ounce to give in our school or classroom, there’s a breakthrough, a victory, a light at the end of the tunnel. And then, we are energized for another mile of this journey.

At United Schools Network, we ground our work in an annual theme. This year, we’re studying Gawande’s Better in our quest to Do good, better for our students. The theme was introduced to our leadership team last week by considering four lessons from Better and how we might apply those lessons to our work this school year.

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Lesson #1: Making medicine go right is less often like making a difficult diagnosis than like making sure everyone washes their hands.

Gawande is a surgeon at Brigham and Women’s Hospital in Boston. It may astonish people to know that annually, two million people in the U.S. acquire an infection while they are in the hospital, and 90,000 people die from those infections. Despite this startling statistic, studies of Gawande’s hospital, as well as those of hospitals across the U.S., show that doctors and nurses wash their hands one-third to one-half as often as they are supposed to. My hunch is that there is a similar statistic hiding in plain sight in schools. Maybe it’s that one-third to one-half of lessons are poorly planned or students are far less engaged than we think. Perhaps the consequences aren’t as immediately dire as they are in medicine, but long-term, there are serious implications.

What are the educational equivalents to washing hands? Once we figure that out, how do we get everyone to do those things consistently?

Lesson #2: Devise a score for seemingly intangible and impressionistic concepts.

In 1952, Virginia Apgar was an anesthesiologist at a time when outcomes for newborns weren’t much better than they were one hundred years earlier. This all changed with the Apgar score. One minute after a baby is born and again at five minutes, a nurse gives a newborn a score using the Apgar system. It is practical and easy to calculate. Low scores lead to immediate interventions, and the system has greatly improved outcomes for newborns since.


In education, we are used to measuring a number of things, but we have no routine measure that puts all of that data together to assess how the student as a whole is faring. Could a scoring system similar to the Apgar be devised in our schools? What areas could benefit from a score similar to the Apgar? As a network of charter schools, we enroll a significant number of students each school year. We’ve experimented with an Apgar at enrollment system. You can check out the prototype linked below.

Lesson #3: Even doctors with great knowledge and technical skill can have mediocre results; more nebulous factors like aggressiveness and diligence and ingenuity can matter enormously.

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For many years, most people assumed the talent pool in the medical field was distributed like a shark fin, but when you look at the data it is much more normally distributed. The same is true in education (e.g. think of the mismatch between inflated teacher evaluation ratings and student growth scores).

Gawande describes the work of Dr. Warren Warrick who runs a Cystic Fibrosis center in Minneapolis. Warrick boils down CF treatment to the following: you do whatever you can to keep your patients’ lungs as open as possible. CF treatment is highly standardized across the U.S., but somehow everything with Warwick is different, including his results. He is a “bright spot”; someone who’s aggressiveness, diligence, and ingenuity make him a leader in the field.

The outcome data available in CF treatment led Gawande to Dr. Warrick. With the data, Gawande was able to pull back the curtain on Warrick’s work with patients and begin to identify what made him so effective. We too have to enter the classroom to figure out what the top performers do in practice.

Do we have the right kind of data to identify top performers? If so, do we know the key factors that allow them to get the outcomes they do? Assuming we can answer the first two questions, how do we spread their success?

Lesson #4: Great medicine is not easy, but it is possible anywhere.

Gawande grew up in the U.S., but his family is from India, so he has spent time there studying the way they do things in the medical field. Surgeons at an ordinary district hospital in India where Gawande observed had developed an astonishing range of expertise despite an overwhelming flow of patients, poverty, and a lack of supplies. However, they did have control over their skills. For fifteen or thirty minutes every late-afternoon, they drank chai and swapped stories about their cases of the day- what they had done and how.

Do we have similar mindsets and attitudes in our schools? How might we better focus on things we have control over? Are there simple opportunities for collaboration that we are missing?

As I reflect on Gawande’s work, I’m left with more questions than answers. But, I’m okay with that and looking forward to our improvement journey this year. Becoming is truly better than being.

More on How We’re Trying to Get Better at Getting Better

At the School Performance Institute, we are studying school design best practices both within the United Schools Network as well as at high-performing, high-poverty schools across the country. We’re opening our doors to learn from others and to share what we’ve learned at our first Study the Network workshop of the year at Columbus Collegiate Academy-Main St. on September 13th.

John A. Dues is the Director of the School Performance Institute and Chief Learning Officer for the United Schools Network in Columbus, Ohio. The School Performance Institute is the social enterprise division of the United Schools Network. Send feedback to