TIME AND AGAIN I find myself returning to Amartya Sen’s definition of merit as an incentive system that rewards the actions a society values. As I have argued throughout part 2, a shift from honoring testocratic merit toward democratic merit produces a variety of benefits aligned with the values our culture professes: students display a higher capacity to problem solve, a greater demonstration of both leadership and peer collaboration, and an increase in fairness. As the title of part 2 indicates, these are the “solutions”—but their impact does not end in the field of education. They also carry a heightened significance: a culture shift, from testocratic to democratic merit, can translate into benefits for our whole society. Returning to Professor David Labaree’s observation: America has always conceptualized education as a training ground for tomorrow’s citizens, leaders, and professionals. Increasing collaborative skills in a classroom can—as these students graduate and enter the workforce—reverberate throughout society by increasing collaborative skills in the workplace.
Thus, I’d like to go a step further in considering how a shift toward democratic merit can not only positively affect our classrooms but also positively affect our societal institutions and governance. There are strong indications—through anecdotal and empirical evidence—that the skill sets promoted by systems of democratic merit will better serve the challenges of a twenty-first-century world, which demands complex problem solving and collaboration among diverse individuals. Indeed, it is becoming increasingly apparent to today’s business leaders and politicians that increased collaboration—rather than pure competition—is what will lead to greater outcomes.
I want to offer two examples that illustrate how both the professional and political sectors can benefit from graduates who know how to collaborate, problem solve, and embrace a diversity of perspectives. First, I’ll consider the story of Atul Gawande, who demonstrates how collaboration can improve health-care quality in this country while decreasing its spiraling costs. I will then turn to Archon Fung’s study of how cross-collaboration can lead to better governance and legal solutions. Both of these stories shed light on how a shift toward democratic merit is not only ideal but also necessary to move us forward into the demands of a twenty-first-century world.
BY TRAINING, ATUL Gawande is an endocrine surgeon. He has a reputation in the operating room for being bold, innovative, and detail oriented. Colleagues will attest that Gawande is known for being a self-professed rock ’n’ roll fanatic who listens to artists like David Bowie while performing surgery,1 for encouraging doctors to collectively engage in constant self-reflection, and for meticulously following checklists during procedures.
However, it is Gawande’s work outside the operating room that illustrates the potential power of a culture shift toward democratic merit. Gawande is also a prolific writer. In numerous opinion pieces, articles, and books, he has explored the best practices in medicine in order to suggest improvements in the medical industry. In 2009, Gawande decided to take on a major issue preoccupying Washington, DC: how to bring health-care costs under control. In tackling this issue, Gawande highlighted how cultures of collaboration and communication can lead us to better solutions.
In Gawande’s words: “The explosive trend in American medical costs seems to have occurred here in an especially intense form.”2 According to a 2008 World Health Organization report, the United States spent more on health care per person than any other country in the world. WHO also found that the United States spent the highest percent of its gross domestic product on health care. Of course, none of this would be a problem if more expensive health care translated into better health care. Unfortunately, most studies have found that having the world’s highest health-care costs do not result in the United States having the world’s best health-care system. In fact, the 2000 WHO report ranked the United States thirty-seventh in health care, behind nations like Morocco, Cyprus, and Costa Rica.3 In 2007, the Commonwealth Fund did a study that looked at health care in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. Their report ranked the United States last or next to last in four out of five criteria, including quality, efficiency, and access.4
Gawande observed that rising costs were leaving countless individuals uninsured or drowning in medical debt. Just as important, high costs were also “devouring our government.”5 He recognized President Barack Obama’s concern that “the greatest threat to America’s fiscal health is not Social Security. . . . It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”6 Gawande decided to search for solutions, and he uncovered a possible answer to efficiently curb costs while enhancing care: greater collaboration between medical providers. Gawande would publish these findings in a 2009 New Yorker article “The Cost Conundrum,” which gained attention from readers across the country, including President Obama.
That year, Gawande’s questions about health-care spending brought him to McAllen, Texas. McAllen calls itself the Square Dance Capital of the World, but it has another reputation: it’s one of the most expensive health-care markets in the country. The only city that outspends McAllen on per person health-care costs is Miami, which has much higher labor and living costs. Gawande interviewed businessmen, hospital administrators, and doctors in McAllen and neighboring counties, and various theories were offered to explain why, for example, McAllen’s Medicare costs were twice the national average.7 Some residents hypothesized that McAllen’s population was not healthy and, therefore, required higher spending. But Gawande disproved this theory by finding that cities comparable to McAllen in terms of demographics, such as El Paso, were no more healthy and yet spent much less on health care.8 Others suggested that McAllen’s health care must be superior to that of other regions. However, there was no indication that the city’s services produced better outcomes than those of neighboring cities, like El Paso. But Gawande concluded that McAllen’s higher costs did not correlate with higher quality, noting, “Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse, on average, than El Paso’s. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.”9
Instead, Gawande found a different explanation for the higher costs in McAllen: professional culture. The hospitals that drove up spending costs did not provide better care. They simply had medical practitioners who were driven by profit and competitive self-interest. In contrast, institutions like the Mayo Clinic, which provide higher-quality care and lower costs, exhibit a different culture: collaboration among practitioners.
Gawande suddenly became less interested in the problems of McAllen and more interested in how the Mayo Clinic built a culture that produced one of the highest-quality, lowest-cost health-care systems in the country. The Mayo Clinic implemented two noteworthy practices. First, it discouraged competition by pooling all the money received by doctors and the hospital system. Doctors instead received a salary. CEO Denis Cortese explained that this payment reorganization occurred so that “the doctors’ goal in patient care couldn’t be increasing their income.” Unlike the doctors in McAllen, who aggressively competed with neighboring practitioners to maximize personal profit, Mayo Clinic doctors worked together to provide the best care for patients. To nurture this collaborative culture, the Mayo Clinic implemented a second important practice: staff members participated in team brainstorming sessions. Gawande observed that “the doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients.”10 These two changes in industry practice were intended to produce better care for patients. The Mayo Clinic succeeded in this goal, and as an unintended side effect, it also produced society-wide benefits by lowering health-care costs.
Gawande pointed out that the Mayo Clinic story is not an aberration. Other hospitals have reached similar results when a culture of collaboration replaces a culture of profit-driven competition. For example, the health-care system in Grand Junction, Colorado, ranks among the highest in quality care providers and yet incurs among the lowest costs. Michael Pramenko, a doctor and medical leader in Grand Junction, explained that the rise in quality and fall in costs correlated with two changes. First, doctors agreed they would not compete over insurance providers but would instead universally agree on fees for all patients. This drove down costs. Second, practitioners agreed to meet regularly in small peer-review committees to go over their patient charts together. By increasing group problem solving, practice problems decreased and quality of care improved. Once again, the culture of collaboration over competition was a recipe for better outcomes, both for patients and for taxpayers.
The methods adopted by Mayo Clinic and Grand Junction to achieve better health-care outcomes are the same as those promoted by classrooms organized around democratic merit: a culture of collaboration rather than competition, a sharing of diverse perspectives, and increasing equity among colleagues. By promoting teamwork and collective problem solving, a culture shift toward democratic merit could drive us in the direction of solving health care’s most pressing problems while also improving quality of care. That’s just one way that workforce practices that encourage cross-collaboration and communication can lead to increased productivity and success in the twenty-first-century marketplace.
Embracing democratic merit over an obsession with testocratic merit and competition can have important implications not only in the world of business but also in how our society is governed. Recall David Labaree’s observation that one of the purposes of a public education system in a democratic society is to prepare citizens to participate effectively and meaningfully in the processes that govern us. A healthy democracy depends on everyone having equal opportunity to understand and shape public action. When our education system produces a culture of competition instead of collaboration, or when it produces citizens who cannot work together to solve problems or incorporate diverse voices, this has important consequences for democracy. We have seen how individuals breaking out of their narrow roles to cooperate and experiment with others can make health care more effective, efficient, and individualized. An example of a similar innovation in local government can show how the culture shift that I propose can improve democracy more broadly.
Archon Fung is a political scientist who has taken a close look at how collaboration, experimentation, and diversity can best relate to the way we govern ourselves. His work is concerned with a simple question: how can we make our political institutions more democratic? To find an answer, he decided to look not at the highest levels of the political process but at a far more humble site: a network of community police and school boards established throughout Chicago in the mid-1990s.
Rather than leaving the supervision of schools and police to a central office, this innovative initiative gave the community a voice in managing these institutions.11 For example, parents, teachers, students, and neighbors volunteered as members of a community board for their high school, meeting regularly to make decisions about personnel, budget, facilities, and curriculum. These boards were set up at the level of a single police beat or elementary school, a scale small enough that the most closely affected individuals could have a direct say. For instance, policing routinely involves discretion and local expertise on the part of individual officers. Rather than managing this discretion with one-size-fits-all policies designed by a central office, local boards allowed citizens to come together and direct police discretion toward problems that residents consider important.
Fung spent two years in Chicago, sitting in on these meetings, carefully observing how they worked, and also noting when they didn’t. Because the boards in Chicago were set up on a small-enough scale for participants to focus on pragmatic solutions to specific problems, Fung labeled this model “street-level democracy.” One of the hallmarks of street-level democracy is its openness; where the traditional democratic process expects participants to enter with their views determined by political commitments, street-level democracy allows residents to develop and clarify their thoughts on complex political matters through deliberation and experimentation. Fung describes how two people with completely different views on a political or cultural question are unlikely to find a way to work together in the typical political process. In the context of making the decisions that are necessary to making their neighborhood safer, however, they can easily work together to solve problems. Through that process, they can even learn to trust one another.
Fung explains how these collaborative or participatory models can produce better results than hierarchical, pyramid-like management structures. In fact, the Chicago initiative emerged from a belief that public services might be more effective if managed with direct input and participation from the people they serve. Though the centralized nature of large bureaucracies seems to promise coordination and efficiency, Chicago residents were frustrated that the city was failing to educate children and keep streets safe, especially in poorer communities. These large bureaucracies had originally grown as the problems we wanted government to address became more complex: whereas police had once focused simply on catching perpetrators of crime, we now also expect them to prevent crime, and we judge their performance based on the crime rate. As cities grew, pyramid-like bureaucracies seemed like the best way to manage complex functions like policing, education, and environmental control. But the more complex these functions became, the harder it was for bureaucracies to remain effective and equitable at the individual and local levels. It took toppling these pyramid-shaped hierarchies on their side in the form of street-level democracy to ensure that the complex problems of Chicago residents were dealt with in a way that remained effective.
Fung describes a neighborhood-policing board in Chicago’s Rogers Park area. Residents of the neighborhood had noticed an increase in drug dealing, prostitution, and late-night noise on one particular street corner. After meeting to discuss the problem, residents learned that the landlord of a laundromat on the street corner had refused to renew the previous management’s lease and instead had rented the laundromat to his son. Whereas the old management had tolerated drug activity, the son now took steps to discourage it, removing indoor pay phones and banning anyone involved with drug activity from the premises. As a result, drug dealers and their customers started congregating outside the laundromat and using outdoor pay phones across the street. Once the residents identified this source of the problem, they immediately took steps to fix it. First, they organized walking groups to create a positive community presence in the streets. Second, they approached the owner of the outdoor pay phones. When he agreed to remove the phones but learned he could not cancel his contract with the phone company, the community board pressured the company to at least block incoming calls from the phones. Rather than leaving this problem to some kind of centralized fix (such as the city removing all pay phones from street corners) or waiting for police to catch and arrest the criminals, residents developed a pragmatic solution, through trust, experimentation, and persistence.
Fung emphasizes that street-level democracy requires not just creating new political processes but also teaching the personal qualities that citizens need to productively collaborate and deliberate with their neighbors. If we want public education to prepare citizens who will participate more effectively in our democracy, then we need to ask if the values and skills our education system teaches actually nurture these qualities. Does lining everyone up according to achievement actually produce better citizens? How do we teach the next generation how to effectively collaborate and deliberate with others?
Fung offers another example that shows the importance of making decisions collaboratively: two residents of a neighborhood each faced problems they wanted the police to address. One lived by an open-air drug market and was worried about recent shootings there. The other lived in a wealthier part of the neighborhood and was concerned about teenagers drinking in the park by his house. Absent community policing, their best means of attracting attention or resources to either problem would probably have been for one of them to lobby more vocally than the other. In fact, even at a community meeting, the residents’ instinct probably would have been to show up and make the loudest case for why his problem mattered more. But in a process that emphasizes individual collaboration and deliberation, the two residents simply shared and justified their concern to each other—as if they were talking through a physics or a math problem in a classroom, both trying to find the right answer. After a while, the resident from the wealthier neighborhood who was worried about underage drinking recognized that the shootings were a more pressing issue. Rather than competing, the residents collaborated.
Unfortunately, this is not how our democracy currently works. Nor does the meritocracy encourage this kind of thinking. Our political process allocates public resources through a kind of competition: individuals and groups act in their own rational self-interest, demanding the changes most important to them, and the loudest or most credentialed voices win. This is how defining “merit” narrowly and individualistically, rather than collectively, manifests itself in the political process. The problem isn’t that the resident from the wealthier neighborhood was concerned with underage drinking because he didn’t care about the issues his poorer neighbors faced; it was just that he was never asked to sincerely consider them. No part of the traditional democratic process asked him to empathize with the concerns of others or to compare his concern to other problems in the neighborhood. He only had to advocate for the problems he knew about. His role was to compete against his neighbors, not work with them.
Fung emphasizes the importance of another quality that our culture’s current obsession with testocratic merit does not cultivate: a willingness to try fresh approaches knowing they might fail. Just as Mazur and Treisman found in their classrooms, Fung found that meetings were most effective when participants were open to changing their minds based on new arguments and evidence, rather than by being stubborn or dogmatic.
Fung further describes how this process of experimenting with and adapting solutions also resulted in participants feeling more invested in the outcomes. He tells the story of a crusty police officer who spends his days stopping suspicious-looking teenagers on the street, not because he is naive enough to believe this really improves safety but because he simply believes it’s his job. Likewise, he attends the community policing program only because his job requires him to do it. When he learns at a meeting that these patrols anger residents, he cuts back on the practice to avoid controversy, earning a bit of their trust. Later, when residents tell him to focus on an area where they claim that criminal activity is occurring, he discovers two drug houses he never would have known about otherwise. With help from the residents, they evict the drug dealers.
On one level, this story is about how police improve their work by listening to the community. But Fung emphasizes another development: collaboration has changed how the police officer views his job. He now sees how his actions can actually make a difference. Before, he was just doing what he needed to do to get paid, regardless of whether it actually made a difference. But now he is starting to build an interest in seeing the neighborhood improve through his actions. Likewise, residents who previously only saw the police swooping into the neighborhood to harass people for no clear reason now recognize an opportunity to work with law enforcement, to limit damaging practices and encourage better ones.
Fung also looked at who exactly was doing all this participating. After all, just as our current political systems tend to reward those with more money or time to spare, Fung wondered if those same people also have more influence even in supposedly collaborative processes. Instead, he found that even in community groups that featured a range of economic or educational backgrounds, collaboration was possible once residents started thinking beyond their narrow self-interest. He studied a geographically and economically segregated police precinct, where median incomes on the east and west sides of commuter-rail tracks differed by almost $30,000. Because the tracks were such a solid physical barrier, the problems each side faced rarely spilled into the other. As such, residents had a clear interest in trying to secure more police resources for their own side. Yet they formed a board to deal with their problems. Fung noted that cynics might expect this board to not function productively, given residents’ fundamentally contradictory interests and their initial inability to genuinely empathize with and incorporate the perspectives of others. Fung wondered if the wealthier residents would use their higher incomes, free time, education, civic skills, and institutional connections to dominate community meetings, as they can do with the traditional political process—or educational beauty contest.
Fung sat in meetings observing the group for its first ten months. He reports that, just as skeptics might suspect, the west side residents did initially have more influence in the meetings. During the first four months, the group set the community-policing agenda, with the more articulate and aggressive residents dominating the conversation. Though residents from the poorer east side continued to attend the meetings in equal numbers as their counterparts from the wealthier west side, they mostly kept quiet. For example, at one session, the meeting facilitator asked residents to propose “new business” for the meeting. When a police officer reported on multiple shootings on a particular street corner on the east side, the facilitator attempted to open the conversation up further by asking if anyone felt the corner was an ongoing problem. No resident answered, and no further action was planned. In comparison, west side residents had raised concerns about street peddlers and urged police to enforce vendor-license requirements more strictly. The police did, and the peddlers were gone within three months. The west side residents also raised concerns about traffic violations, such as drivers hopping curbs or cutting through traffic lights, and demanded a stop sign at a busy corner. The police promised to increase traffic surveillance at these spots, and the alderman’s representative promised to request the stop sign.
Once again, the problem was not that west side residents were trying to shut out their east side neighbors. Rather, the group simply operated the way many groups do that lack the skills to work collaboratively; by default, their proceedings fall into the hands of those who can explain a problem the most articulately or aggressively.
Fortunately, this began to shift by the second half of Fung’s time observing the group. Part of this was due to a change in procedure from a free-form town-hall-style format to a five-step process in which the group would (1) list problems and rank them according to priority; (2) gather all the information that different residents had about the problem; (3) figure out steps that residents, police, and other city workers would take to deal with the problem; (4) implement the strategy; and (5) evaluate how implementation went.
This structured, thoughtful, and open-ended approach to problem-solving echoes the kind of thinking that the creative educators I described earlier in the book are trying to teach, as well as the kinds of skills that innovations like performance-based assessments are designed to test and reward. Fung observed how it produced much better outcomes than when the group simply focused on whatever concerns were raised by the loudest or most articulate residents.
In the meeting that Fung observed, the idea for this structured problem-solving process came from a community organizer who had learned that the police issue “beat plans,” ranking safety problems according to urgency. She thought these plans should be developed by residents, not police, and proposed that the group list problems and prioritize them. One resident mentioned a drug house on the west side of the neighborhood, and everyone quickly agreed this was the single most important safety issue for the group to address. Several months of meetings had been largely silent on this problem, and suddenly all participants, east and west, black and white, agreed it should be their biggest priority. Rather than each person ranking what was the most important to them or competing against one another, the group proceeded to allocate shared resources based on a consensus about what was most important for the community as a whole.
Fung also looked at areas with even more extreme poverty, to see whether street-level democracy could be effective even in these conditions. While one might expect that people with more free time and resources would be the ones who can afford to spend their evenings at meetings discussing crime, Fung found that residents from poorer neighborhoods and residents without college education actually participate at greater rates. Specifically, he explains that in two neighborhoods with identical crime rates, income levels, and racial compositions but different levels of college education or median income, the one with fewer college-educated residents or a lower median income was more likely to have better attendance at community meetings. Whereas our current meritocratic approach to politics bars people from having a meaningful say in public action unless they know how to compete with and outperform everyone around them, street-level democracy opens politics up to all kinds of perspectives and focuses these perspectives directly on solving the problems people care most about. Street-level democracy encourages citizens to listen to the perspectives of their neighbors and peers regardless of what credentials accompany those perspectives.
Chicago residents participated at these community meetings because they saw that their participation made better schools and safer neighborhoods possible. Rather than viewing themselves as passive consumers of public action that bureaucrats produce, collaboration encouraged and rewarded these citizens’ direct civic engagement. Although the residents participating in these meetings had initially done a poor job of listening to others or working together, this improved once the city developed a curriculum to teach them problem solving and collaboration skills and when the groups turned to a process that was open-ended and valued diverse perspectives. Unfortunately, our education neither teaches nor rewards these skills, instead urging children to compete individualistically and narrowly to reach the top of a hierarchy. Just as the obsession with competition and individualistic merit begins in classrooms, so can a more effective democracy.