INCREASED DEATH RATE OF WHITE MIDDLE AGED AMERICANS, CAUSES AND CURES

One of the key indicators of the health of a modern society is the longevity of its citizens. Because of improvements of medicine there has been over many decades a general decline in the death rate of all demographic subgroups.  It is therefore unusual, perplexing and a sign of trouble when the morbidity (illness) and mortality (deaths) of a part of a population violates this trend.  However, according to Princeton University economists Anne Case and Angus Deaton deaths of white Americans aged 45 to 54 are increasing, instead of decreasing.

Reproduced from Case and Deaton Fig. 1. All-cause mortality, ages 45–54 for US White non-Hispanics (USW), US Hispanics (USH), and six comparison countries: France (FRA), Germany (GER), the United Kingdom (UK), Canada (CAN), Australia (AUS), and Sweden (SWE)

Published in the prestigious Proceedings of the NationalAcademy of Sciences, Case and Deaton show “a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround.”

Drug abuse and alcoholism show up prominently in the statistics as can be seen from figure two from their paper. 

Reproduced from Case and Deaton figure 2:  Mortality by cause, white non-Hispanics ages 45–54

Poisonings related to drugs and alcohol have risen sharply to be the number one cause of death.  Deaths from suicide and liver failure that are linked with drug and alcohol abuse are also prominent and rising. Overall, this paints a very serious and distressing picture of this group of Americans.

Education seems to play a significant role in these results. Separating white middle aged Americans by education level shows that only that those with a high school education or less have seen a rise in overall mortality.  Those with some college but less than a bachelor’s degree have had a small decrease and the largest decrease is from those with a BA or more.  Education, once again, seems to inoculate individuals from serious social harm while at the same time providing an overall benefit to society.

MIDDLE SKILL JOBS, A PATH TO THE MIDDLE CLASS

Students from STCC's nursing program, junior pharmacy students from Western New England University, and physician assistant students from Bay Path University participated in the inaugural Inter-professional Day at STCC's SIMS Medical Center, the region's premier patient simulation facility.

A recent analysis by Northeastern University Dukakis Center documents a large number of middle skill jobs – those requiring less than a bachelor’s degree - that will open in Massachusetts in the next decade. The analysis revealed that the Commonwealths vocational high schools and 15 community colleges will not be able to fill this demand.  The report concludes that,

"while the Commonwealth must continue to invest in its colleges and universities, it needs to recognize the important role of vocational education and community colleges and assure continued, if not increased funding, for these institutions that will continue to train the majority of the state’s workforce."

Although a college education is touted as a prerequisite to the middle class, this report demonstrates that based on federal labor projections, the majority of job openings will require less than a bachelors degree.  Given that this survey was restricted to Massachusetts, this is a surprising finding since Massachusetts has an economy requiring a very highly educated workforce. If the study’s findings are correct, they should apply even more strongly to other states.

According to the report, 1.2 Million jobs will open in Massachusetts in the decade from 2012 to 2022.  Of these 33% will require highs school or less, 30% some college or an associates degree and 37% will need a bachelors or more. However, many of these jobs below a bachelors degree need specific skill development in technical and career skills through vocational and community colleges supplemented by on the job training. 

BETTER COMMUNICATION - ELECTRONIC OR FACE TO FACE?

The new 2015-2020 STCC Student Success Plan found, not surprisingly, that the college's communication could and should be improved.

“The most frequently cited concern was a lack of effective communication among departments and with our students. Faculty, staff, and students stated that not having access to critical information at key times led to confusion, frustration and missed opportunities. This issue is pervasive and at the heart of many issues presented in the Student Success Plan.” (STCC Student Success Plan, page 3)

At many public institutions of higher education, the majority of students work full or part time and have families to support. For these individuals, time is precious as they try to balance the competing demands of work, family and their studies. They want information from the college “just in time”, that is to receive the information when it is needed and useful. And they want college communication to be succinct, simple and consistent.

In thinking about communication with students, it is useful to divide the role of college employees into two categories, recognizing that there may be overlap.  In the first group are all college staff who help students get to class prepared to learn.  Those include maintainers, counselors, advisors, financial aid staff, the registrar, campus security, student accounts,  - all staff and administrators who are not classroom teachers.  In the second group are the faculty, those who are responsible for teaching and learning. The first group has to inform students about a variety of items, for example parking, required immunizations, admission criteria, scholarship applications, tuition and fees and a myriad of other matters that a student has to resolve before going to class. The faculty’s role, on the other hand, is to concentrate on instructing, mentoring and evaluating student work. In simple terms, the first group’s mission is to enable students to go to class ready to learn while the mission of the faculty, the second group, is to guide instruction.

In our discussions on campus we began to ponder the plethora of ways that we can communicate with students: face to face, via telephone, regular mail, email, text messages, and the various social media that include among others Facebook, Twitter, Linkedin, Pinterest and Google Plus. We are in the state that the British novelist J. B. Priestly warned us about decades ago, “The more we elaborate our means of communication, the less we communicate.”

How do we choose among these options?  The first step is to rank these methods of communication by effectiveness in giving students information at a time that they will find it useful. Clearly, the best way of communicating with students, with anyone, is face to face. In fact, all of our communication is based on our experiences with direct in person communication.  This is the way we learned to talk and understand language. In fact, many studies have demonstrated that social interaction and coaching by care-givers is a prerequisite for language acquisition. If one accepts these premises, we should make face to face communication with students, especially new students our primary means of communication about orienting themselves to college.  This means that secondary means, especially electronic means, should play a distinctly minor role.

The implications of this simple analysis for education is, however, profound.  If face to face communication is primary, we should structure the college experience around this necessity.  This means that staff should, as much as possible, spend their time talking directly with students instead of doing repetitive and routine clerical and bookkeeping tasks. It is this arena that electronic media and devices can be helpful by freeing staff from such drudgery. We should invest in electronic record systems to reduce the work of staff enabling them to spend more time with students.

A corollary of the need for direct communication with students both in and out of the classroom is that education is expensive and is not subject to yields of greater productivity from capital investment.  Education requires human interaction.  The number and quality of teachers and staff determines how well students are motivated and coached and how likely they will succeed in completing their education.  

PLANNING IN A NON-HIERARCHICAL ORGANIZATION

In the monogram on non-profits – a companion study of Good to Great, author Jim Collins distinguishes between executive and legislative leadership. The CEO of hierarchical military and for-profit organizations exercises executive power by being able to command subordinates. Heads of other organizations, e.g colleges and hospitals, do not have such authority and must seek to persuade employees to follow her/his leadership.  Those organizations behave much like legislatures that require a majority of members to agree before an action is taken. Much more work is required to move such an organization although the end result may be better if there is agreement among employees.

Strategic planning in these two types of organizations differ substantially. In a hierarchical organization a plan devised by a small group can succeed if it has the support of top officials.  In a non-hierarchical organization, that approach would spell disaster.  Creating a plan in the latter requires considerable input, conversation and review to have a chance to be implemented.

With this as background, my college embarked last year to create a five year plan focused on our core academic mission.  Because of this orientation we named it the 2015-2020 STCC Student Success Plan to highlight that it was not a master plan or overall college strategic plan.  In particular, the Student Success Plan did not address facility or financial issues. 

The plan was based on a series of surveys of students, faculty, staff and trustees.  Out of those surveys 17 key issues were identified. An implementation plan for the first year of the plan, academic year 2015-2016 narrowed that list to five:

1. A lack of effective communication with students diminishes their ability to succeed.

2. There is a race/ethnicity inequity in our 3-year graduation rates.

3. New and prospective students often do not understand “how college works.”

4. Very few students with developmental placements graduate from STCC.

5. Not enough students meet their academic standards to complete their courses successfully.

Addressing these issues is our work for this and next year.

HOW DOES OBAMA COMMUNITY PROPOSAL COMPARE WITH TENNESSEE AND CHICAGO EFFORTS?

The Obama proposal to expand community college eduction - America's College Promise - is based on one existing program in Tennessee - Tennessee Promise - and another that is to begin in the fall of 2015 in Chicago - Chicago Star Scholarship.  A summary and cross reference of each program has been assembled by the Massachusetts Community College Executive Office and is reprinted below:

	Tennessee Promise	Chicago Star Scholarship	America’s College Promise
Summary	·   Tuition as last-dollar scholarship, after all federal grants and aid (not including loans or work study) ·   Tennessee law, first cohort of students now enrolled ·   Students apply through community organizations	·     Last-dollar scholarship, after all federal and state aid applied ·     Starting Fall 2015 ·     eligible students can pursue associate degree at City Colleges of Chicago (CCC) at no cost - free tuition, fees, and books	·  Tuition for all costs up front ·  President will file legislation, discuss plan during 2015 State of the Union
Students Eligible	·   Only Entering HS Students w/ 2.0 GPA ·   Only US citizens	·     Current and future Chicago Public Schools graduates (undocumented students eligible)	·  All Students
Required by Student	·   Maintain 2.0 GPA while in college ·   Full-time enrollment (12-credit minimum/semester) ·   Community service – 8 hours per term, work with volunteer mentors from community organizations ·   Ongoing program meetings, advising ·   Apply for FAFSA first ·   Maintain Progress to completing program (same eligibility as federal aid)	·     Students must graduate from CPS in Spring 2015 or after with a 3.0 GPA ·     must show that they test college-ready in math and English via ACT COMPASS ·     Apply for FAFSA first ·     Must enroll in CCC Career Pathway	·  Maintain 2.5 GPA ·  Enrolled at least ½ time (6-credit minimum/semester) ·  Maintain Progress to completing program (same eligibility as federal aid)
Institutional Eligibility	·   All institutions that offer 2-year associate degree programs (public and private, and 4-years)	·     Only City Colleges of Chicago ·     Also encourage free dual enrollment opportunities to students as a “head start” for program	·  Only two-year community colleges ·  Eligible academic programs need to be fully transferable to public 4-years or in-demand training programs w/ high graduation rates ·  Need to commit to some type of performance-based reforms
Funding	·   Dedicated revenue source (lottery endowment)	·     CCC covers it through efficiencies and consolidation (specifically with a nursing program)	·  Federal Gov’t pays 75% of costs through federal budget, while participating states need to cover remaining 25% (as federal matching grant)
Costs/ Numbers	·   Estimated cost of $34M per year ·   Provides five consecutive semesters (fifth designed to make up for any dev. education courses) ·   Expects 25,000 students to apply each year	·     Estimated cost of $2 million in the first year ·     Provides up to three years of benefit (after federal & state aid), or until completion of associate degree ·     Expects 1000 students to enroll	·  Estimated cost of $60 billion over 10 years ·  Estimated $8 billion to CC’s nationally per year ($6B from feds, $2B from states) ·  Saves a community college student an average of $3,800 in tuition per year (national average) ·  Could benefit roughly 9 million students

WHAT IS BEHIND THE OBAMA COMMUNITY COLLEGE PROPOSAL

Richard Reeves in a January 9, 2015 Wall Street Journal opinion piece What We Can Gain From Obama’s Push of Community Colleges (reprinted in his blog) argues that Obama's attention to community colleges is well founded.  According to Obama, free college or at least the first two years of college will enable the United States to catch up and pass other industrial economies. According to the President free community college is "something we can accomplish and it’s something that will train our workforce so that we can compete with anybody in the world.”

Why focus on community colleges?  First, because by any standards they are cost-effective open enrollment institutions whose goal is teaching, not research.  Second, because they have such broad reach 8 million students. 

Community colleges are the point of entry for the majority of first time college students.  As seen from the chart below, poor students and those whose parents did not finish high school overwhelmingly begin at community colleges. 

Source: Richard Reeves in the Wall Street Journal, January 9, 23015

Obama's proposal draws inspiration from Tennessee Governor Bill Haslam's Promise program. That initiative provides for last dollar support - funding to augment financial aid - so that every Tennessee community college student pays no tuition at the state's community colleges.

The United States once was a leader in education for the common citizen when 100 years ago free high school became the norm in our country.  Now for most, college is the passport to economic viability.  However, our education policy and practices have not caught up with this new reality.  The Tennessee promise program and the Obama proposal are a recognition of this fact.

SEASONED PRACTICIONER EXPLAINS HOW AN IDEA SYSTEM WORKS

Kerri Kane, Director of Great Ideas @ STCC

Kerri Kane recently joined STCC as Director of Great Ideas, STCC’s idea system.  Formerly Ms. Kane worked at Health New England (HNE), a Massachusetts health insurance company owned by Baystate Health System.  HNE is headquartered in Springfield, Massachusetts and has just over 300 employees.  At HNE Ms. Kane was responsible for leading their idea system called Opportunity for Improvement (OFI).  

Below is an interview with Ms. Kane with questions in bold and her answers that follow:

Q: What similarities and differences do you observe in the idea systems in HNE and STCC?

A: The program structure and functionality is very similar between HNE and STCC because they are both built from the same model developed by Dr. Alan Robinson co-author of Ideas are Free and Idea-Driven Organization. All of the idea boards look very much alike and the meetings are run in a similar fashion. Both idea programs are very focused on ensuring a positive customer experience as well as increasing operational effectiveness.

Rapid changes in the healthcare industry like the Affordable Care Act (ACA) and HNE’s entrance into the Medicare and Medicaid lines of business brought great pressure to adapt.  Often times, the organization grew without adding staff so we had the same number of people trying to accomplish a larger amount of work.  The idea system at HNE gave associates the vehicle to bring forth ideas to increase their own efficiency and drive the changes needed in order to achieve the goals of the organization.

Although the external forces of change may not appear to be as significant in higher education, I would argue that the highly competitive market in which it exists (particularly in Massachusetts) is an even greater source of pressure to change and ‘keep up.’ At STCC, the primary focus of their Great Idea system is the success of the student. STCC realizes that bringing value to the student is one of the keys to long-term success. I believe that is a tremendous differentiator for STCC.

Q: What were some of the initial goals of the idea system at HNE?

A: HNE was very focused on using the OFI system to engage employees through problem identification and solving. The yearly engagement survey has a question ‘My opinion matters at work.’ The OFI program gave everyone a place to voice their opinion, so year after year HNE achieves very high scores in this survey.  Over time HNE began to shift focus from employee engagement to more sophisticated process improvement efforts that focused on transforming company operations, market penetration and healthcare delivery.

Q: What is your impression of the goals of Great Ideas at STCC?

A: My impression is that the college has three main goals: 1) improve services to students and the public; 2) increase employee engagement and team work;  3) make it easier for employees and the institution to embrace change. These goals are tightly linked and aligned with the overall goal  of student success.

Q: Can you talk about how an idea system breaks down barriers between departments in an organization.

Sometimes people don’t understand how their work and/or role fits within the greater workflow (or process). When teams come together to solve an issue, it helps break down the siloed thinking that can happen when you simply ‘do your work.’ Working with a cross-functional team provides a greater understanding of the larger workflow and in turn supplies  better solutions.

Q: What kind of push back did you experience and how was it dealt with?

A: Continuous improvement is not ‘another thing’ to do, but rather the way things should always be done. It is a struggle to build this into the organization and it is important that executive leaders take the lead to gain buy-in from all employees or this can be hard to overcome. However, I believe it has great benefits, long term benefits for any organization that can stay the course.

Q: What helps promote the OFI system?

A: Leadership engagement and ongoing commitment is the number one factor in the system’s success. Without diligent support  and promotion from the leaders within the organization, the system will break down. For some leaders an idea system such as OFI or Great Ideas at STCC is difficult because it requires that they relinquish the problem solving control to the people doing the work.  It can be hard to admit as a leader that you don’t know everything and to trust your front line employees.  This change in behavior requires humbleness and for some a complete change in leadership style.  HNE is now piloting a leadership development program that helps build the skills needed to be successful in ‘coaching to solve.’ Leaders will be trained in small group facilitation, coaching, and learning to develop their own (and their team’s) problem solving capabilities. I am aware that STCC has set up similar training for leaders and team facilitators.