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Patient Activation

A cutting edge movement in medicine—and especially in Community Health Centers—focusses on what patients can do to manage and improve their own health. It starts with the assumption that the choice people make in such areas as exercise, diet, smoking, and alcohol are as consequential to health as is all of medical technology. This moves medicine to the change management field and to understanding how to help patients move from passively receiving services to actively managing their health. In many cases, the inability of people to create success for themselves is seen as associate with low self-confidence and self-efficacy. People have to know that they can change their behavior and that the change will lead to better health before they will take great initiative.

In many social and human service areas activating clients, consumers, or customers by another name would seem to fully apply. Do participants see themselves as receiving a service or as getting help to make intentional change? I am impressed with one promising step that takes the idea of setting targets from organizations and programs to participants.The national program called School Turnaround, a division of The Rensselaerville Institute (TRI) uses an intervention approach to reverse decline in failing schools. One of its tactics in the strategy around compelling outcome clarity is student target-setting.  Each student in the school knows what he or she is trying to achieve. I want to learn 5,000 new words…I want to learn how to spot the main idea and separate it from the theme of a book I read…I want to know how to make inferences—not just what is written but what it means. And—yes—I will move from a score of 63% to 78% on this test and here are the October and December benchmarks I will reach.     

When you go into a traditional classroom and ask students what they are doing you hear that they are reading a story. When you go into a School Turnaround classroom you hear that students are trying to learn how to spot the main idea on each page. What difference intentionality makes! How purposeful are your participants in your programs? Are they sitting through the session or are they looking to achieve something in each and every hour with you?  Perhaps “patient activation” can help.

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The Achievement Lock of Education

Marissa Dobbert is a middle school math teacher at a charter middle school in Sarasota, Florida.  She was selected as the 2020 Middle School Teacher of the Year in Sarasota County, Florida.  I used her as an example of tracking milestones in a January workshop for nonprofits in Manatee County.

I read about Marissa in an article in the Sarasota Herald Tribune and called her.  Being in the Results First business, I began by asking her how her students achieved academically compared with other students.  In Sarasota County, 55% of students in the lowest 25% performing group made gains on the Florida State Assessment (SFA) in the last reported year.  In comparison, 67% of her students made progress.  

Marissa reflects the characteristics of sparkplug leaders to a T.  First, she is drawn to challenges. She taught advanced courses and could not wait to get back to working with struggling students. Second, she is highly energetic, noting that she stands on chair and moves quickly—bouncing around the classroom to create and sustain attention “like a crazy person.”  Third, she is very focused on achievement and has two highly specific steps she considers essential to achieving them

First, Marissa focuses on creating a connection.  Her sense is that calming fears of students who have never succeeded at math and creating a connection between her and the student is an essential starting point.  In my parlance, engagement is her first milestone. She is clear that no amount of teaching will make much difference until she can see and hear some level of connection between her and each student.

Second, Marissa forgoes dutifully teaching the full-to-the brim math curriculum.  While she is held to the same standards of academic achievement on the Florida State Assessments (FSA) she teaches at a charter school that gives her some flexibility in approach. She uses that to concentrate on what she sees as the most important skills. Her assumption is that knowing all math content is less helpful than knowing the small number of essential tools that let students handle problems in most, if not all, content levels.

Marissa also uses problems to which the kids can relate.  Rather than a text book question, she translates textbook questions to the kinds of situations she and her students face. This gives not just context but motivation. 

There you have it. The procedural lock in social and educational programs is to get through all prescribed content. The achievement lock is to change the process and hold results as the constant.