If the School Fits: The Hospital Analogy

Like schools, some hospitals have mascots. This adorable photo is from the University of Missouri Children's Hospital.

SteveK writes, “No school can be all things to all children.” There’s a truism. It’s kind of like saying no hospital can be all things to all patients. Here’s a brief meditation on this analogy.

How Is a Public School Like a Hospital?

The challenge of operating a public school and a hospital are similar in that both institutions have an obligation – call it ethical or professional, doesn’t matter – to improve the life of everyone who walks in the door. So they offer a range of programs and they employ a staff of generalists and specialists capable of customizing approaches to a broad range of cases.

Every so often, a hospital is presented with a case that another hospital would be better equipped to handle. The same goes for schools. The story of Matthew Sprowal – the boy who was counseled out of a New York City charter school and into one that turned out to be a great fit – is one example. But here’s where the hospital analogy begins to fray, and with it, this particular argument for school choice.

When a particularly difficult case presents itself, a hospital can arrange for more appropriate treatment at another hospital in our relatively loose health care system. That’s an excellent option to have. But despite the current push for school choice in Baltimore City, and the relatively rapid proliferation of charter schools here, less than a month ago, on June 28, 2011, the Baltimore City School Board approved a policy that strictly limits this ability. Per section I.5:

Once a student is admitted to a public charter school, a student or guardian may not be asked or counseled to leave for reasons related to academic performance, behavior, or attendance unless consistent with City Schools Discipline Policy and City Schools Code of Conduct.

(You can download the Word document of the policy from this page of the Supporting Public Schools of Choice website, thanks to Carol Beck.)

The way school choice works now, the act of choosing is limited to the application process. It’s a consumer model. You go to the market, stand in the aisle, and weigh your options. You may have preferences based on what you’ve heard from friends, or seen online, or read in brochures and ads. But this analogy breaks down, too. Because with schools – unlike with cereal or shoes or cars or any other consumer product – you’re limited to one. And you can’t really switch tomorrow if you don’t like it. (Then there’s the lottery issue to contend with.)

If the argument for choice is that every child is unique, then – barring the absurdity of a school for every child – the system has to provide the individualized attention that would get every student into the “best fit” school. Sometimes that won’t happen on the first try – especially when you’re talking about four- and five-year-olds whose strengths and weaknesses are only beginning to emerge. (This touches criticisms of the kind of testing that goes on in selective private school admissions.) If choice is to work to improve the life of the individual child, then educators – professionals, not just parents or guardians – need to take part in the work of getting every single child into the best school for them. That’s an extremely tall order.

If you want to argue that Matthew Sprowal’s story is a great argument for school choice, you have to concede that it wasn’t simply “choice” that made his life better. It was the involvement of his mother and school administrators in the act of choosing. When you take counseling out of the picture, all you’re left with is a consumerist system driven by competition and market trends. That’s hardly conducive to the kind of collaboration across schools that would be needed to find each student the best fit. Which can leave a thoughtful person wondering if individualizing public education is the true intention of the school choice movement at all.

What do you think?

Related Posts
A Taste of Cherry Picking

If the School Fits: Opening a Conversation About School Choice in Baltimore

Ten Things Everyone Should Know About Baltimore City Charter Schools


10 Responses to “If the School Fits: The Hospital Analogy”

  1. There are many problems with saying schools are like hospitals, and the two biggest might point out the reasons why the two are in such different states:
    – hospital personnel are well compensated and are generally respected by society as a whole, a quote about “saving my life” often comes up and is meant literally
    – almost everyone in our society (beyond a few fringe homeschoolers) will spend vast amounts of time in schools, only a few will be in hospitals for more than brief periods, and some will never be in a hospital after birth

    Perhaps in terms of choice there is one similarity – in a school system where are schools are at a minimum state in terms of safety, resources and staff (not the case in Baltimore City, sadly). The majority of health situations, like the majority of students, can be successfully dealt with at any hospital, and a choice might be made on feelings as opposed to crucial needs (close to home, where my mom was born, nice music in the waiting rooms). I’m not saying the end result will be identical, but there will be satisfactory results at all hospitals.

    There are situations that are not so “run of the mill” – difficult hand surgeries are at Union Memorial and both the patient and other hospitals should make sure those cases are referred there. Similarly, there are students that can’t tolerate some settings – maybe they are special need students, maybe they are especially gifted, maybe they want to pursue a field like music where early specialization is essential. These students will not be served well until they find a school that can meet there needs. In an ideal future, schools, counselors, parents and students are involved in understanding and selecting placements.

    Given that we are nowhere near this ideal future I don’t see a lot of utility in this analogy. Current education policy needs to do two things with equal urgency – bring all schools up to the minimum that I referred to in the long term and find a way to do the best possible job of educating the wide array of students that are currently in the system. That second task will probably have messy and inefficient solutions. Because education is the biggest long term quality of life issue I can think of, you can’t discount a single student or a single outcome.


  2. One more thought: Perhaps the hospital model of referring patients to the best facilities works well in Baltimore because there are so many excellent care providers to choose from.

    So, school choice is only a successful model when all schools to choose from are excellent schools. So, is there a such thing as school choice sans competition?


  3. I am weary of the hospital analogy because of the health care crisis we face in this country. While here in Baltimore, we have our choice of some of the best health care in the world, many folks throughout the US do not have access to quality health care.

    The problem with thinking about education within the framework of competition, is that when there is competition, there are winners and losers. So, this model presupposes that some schools will be of lesser quality. (I would even go so far as to say that the model of competition is closely linked to the corporate model, which some say is becoming obsolete: http://www.ribbonfarm.com/2011/06/08/a-brief-history-of-the-corporation-1600-to-2100/.)

    What if we thought about the open source culture of new media as a future model for how we approach education? What might that look like? Here’s an article for reference: http://www.economist.com/node/5624944


  4. I think your last sentence makes my point around school choice. How people choose or don’t have the opportunity to choose is the issue to be addressed and not necessarily the school. I find it interesting that many of your posts on schools of choice in Baltimore don’t discuss the many types of school options. In total there are what, 55 schools run by other entities? Not all are charters. Likewise, all students have to now choose a 9th grade in City Schools, while all 6th graders have an opportunity to choose a 6th grade placement, most of which are not charters. Further, if a parent is savy enough or works for City Schools or City government, they all seem to know how to get their kids into schools the rest of us can’t access like Roland Park, Mt. Washington, etc. If you ran a list of mayoral candidates, top employees in BCPSS and City government, etc. you’ll find a similarity between them – the schools their kids attend. Then, they want a pat on the back for sending their kids to a public school.

    The national bandwagon of making charters a bogey man is nonsensical. Looking at the historical development of schools, most schools were created to offer families a choice. Remember there would be two schools in one neighborhood – one for blacks and one for whites, when one good school could have served all of those children?

    I’ve said it once and I’ll say it again. Families must take control of their child’s schooling. Governments role in that is to cease developing policies which cause the slavery of reliance. When generations of children are raised by grand-parents and great-grand parents, teen parents, parents more focused on keeping up with the Jones’ and their next corporate move, parents interested in being their child’s friend and treating them like little adults, etc. the expectations for children will remain low based on the mental and physical resources of those parents. When there are low expectations for children both at home, in the community and at schools, you get a bad school. Most people teaching want what’s good for kids and, more importantly, tend to want to work at a “good school.” Further, most kids dropping out of school nationally test at very high rates, but, they are BORED at schools built on the prussian model of educating/elevating the talented 10th and not creating well-rounded children overall. This is where low expectations and failure to innovate hits middle America.

    With that said, I think the analogy of the hospital is faulty. Nurses and Doctors get paid way more than school staff and the rich have access to the best care. However, I bet if people started equating poor education with loss of life – expectations for schools would change universally and people would invest more time in having well-trained teachers (nurses/doctors), high quality facilities, and low-overhead in administration in support of dollars being directed to great care for all.


  5. Interesting analogy! I agree that students need both their families and their schools to pay attention to their needs, and to be in a school system that has the ability to be flexible and respond to those needs. Having worked with young people for more than 17 years, I have seen all sorts of variations in learning, and the environments that work best.

    And personally, when I was young I attended a very small, rigorous private school that was not a productive learning environment for me. Fortunately, my 5th grade teacher saw that, and suggested I go to a school where I could be more creative – I switched to public school in 7th grade (a huge county school – this was way before charters), and flourished. I was lucky to have an advocate, and parents that listened.


  6. Very interesting post. One thing I have been thinking about and that this brings up is how the concept of competition that so many school choice advocates say will help improve the quality of education at all school. I agree with you that all schools can’t be all things to all students on the one hand (even neighborhood schools)–we’re going to have to have some specialty, magnet, and charter schools, but on the other hand, we can’t tailor a school for each individual student. If school choice people and our education leaders (like, ahem, Duncan) emphasized collaboration over competition (or just realized that schools competing for students and dollars is a destructive, negative and not productive, positive ed reform strategy, I think that would go a long way. Schools and systems would work together to make sure students were being best served and in the most appropriate school for them rather than having to worry about “out-educating” one another or claiming supremacy. While there are certainly worthwhile competitions that take place in education (think sports or spelling bees), educating our children should not be boiled down to a crass competitive process.



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