What knee surgery taught me about access to education

Unplanned additional costs and complicated, unexpected additional steps are issues in both healthcare and education. Instead of finding ways for people to navigate these challenges, true change will come when we find ways to eliminate them. And, when we can’t, finding ways to ensure they aren’t unplanned or unexpected.

About six months  ago, I had knee surgery to correct the damage done by years of athletics.  I anticipated the issues that come with any surgery, but what I didn’t realize was how closely the process would mirror the experiences of so many in the United States attempting to access education and afford educational necessities like textbooks.

The “hidden” costs of surgery, college

Luckily, I have good insurance, so the surgery itself only cost $200. A good deal, right? It is, but what you don’t think about is all of the additional costs that no one tells you to plan for, such as:

  • Special soaps and bandages
  • Special food/drink
  • Ice for an ice machine
  • Prescriptions for after the surgery
  • Over the counter medicines for after the surgery
  • Physical therapy and follow-up visit co-pays

These “unplanned costs” totaled over $2,000.

Often in the Open Educational Resource realm (OER) we hear the argument, “Tuition is the huge cost, so why not work on that instead?” Indeed, tuition is a huge cost and does need to be addressed. Thankfully there are groups that are addressing this very thing.

But the students that get past the tuition hurdle find themselves facing unexpected costs that can make or break their success. The College Board does a great job of estimating some of these, but so many people just look at the bill from the college or university and think “this is the cost” when in reality, it isn’t the cost. They’ve planned for that big cost, some saving for years to afford it, so while a $100 extra may not seem like a lot, when you find yourself in a position where “I have no money left” and someone says “here’s another $100 you need to spend,” all of a sudden $100 is the straw that broke the camel’s back and causes someone to give up.

When I was working at a community college, I saw how quickly an unplanned, hidden cost of college could impact student enrollment. The state I worked in passed a law requiring each community college student to get a meningitis vaccine before coming to college.  But here’s the kicker, the shot was $125. And that was the last straw for these students. They’d given all they had to give, paid all of the other fees, there simply wasn’t $125 left. And so, students started dropping out in record numbers.

Hey look! More hoops to jump through

If there’s one complaint I have against doctors in general, it’s that they can be notoriously bad about communicating all of the steps and expectations of something like a major surgery. Or, as some have posited, this may be intentional to keep you from backing-out, but I digress.

Major things my doctor missed telling me:

  • There’s a pre-op appointment you must attend, during working hours. In total, this’ll cost you an hour of driving (and gasoline) and 2 hours at the appointment, for a grand total of 3 hours.
  • You can’t drive for at least 10 days after the surgery. To really get the context of this shock, we found this out about 20 minutes after I came out of surgery. Imagine someone walking up to you right now and saying “Starting right now, you can’t drive for the next 10 days.” But wait Nicole, you say, shouldn’t that have been obvious since there’s crutches involved? Not really. I’ve been able to drive with a right foot injury and crutches before.
  • You’ll be averaging 2-3 follow-up appointments per week for 4 weeks. All must be done within normal working hours.
  • You’ll be averaging 2 physical therapy appointments per week for 12 weeks. Each appointment will take 1.5 hours plus 60 minutes of driving, for a total of 5 hours per week.

I’d like to take a moment to especially focus on bullet points two and three above, I couldn’t drive and I had to go to four appointments per week during working hours. This meant that my now-husband would have to take off from his work to drive me, or I would need to incur ride-sharing costs. On one hand, this really made me grateful for the flexibility in both my and my husband’s work, that we were able to do so many things within normal working hours with no issue. But it also left me wondering, how do people manage that don’t have someone who can do this for them and don’t have the money to pay for ride sharing?

This reminds me the processes that a student has to go through during higher education.  When I was the marketing director at a community college, I asked a friend of mine, who was enrolling in college, to let me shadow her during the whole process.  The first appointment to get her enrolled took 4.5 hours, the second one took more than 2. Orientation was a third night (did I mention she has 3 small children?) and was another 2 hours, which culminated in us both staring at a computer screen, trying to figure out to build her class schedule, at a total loss. I can see why so many give up.

tl;dr (in summary)

Unplanned additional costs and complicated, unexpected additional steps are issues in both healthcare and education. Instead of finding ways for people to navigate these challenges, true change will come when we find ways to eliminate them. And, when we can’t, finding ways to ensure they aren’t unplanned or unexpected.

 

“To sell something surprising, make it familiar; and to sell something familiar, make it surprising”

This trend makes perfect sense through the lens of Raymond Lowey’s “Most Advanced Yet Acceptable” (MAYA) principle, that the Atlantic Magazine writer Derek Thompson summarized beautifully in his article about what makes things cool, “[Lowey] said to sell something surprising, make it familiar; and to sell something familiar, make it surprising.”

Five different phones, of various age, to show how they originally looked like a phone and then moved to a full screen.
The evolution of devices, particularly the iPod/iPhone evolution, is a popular example of the MAYA principle. “Mobile Device Evolution” by Adam Selwood, via Flickr Creative Commons is licensed under CC BY 4.0

This week, I was skimming readings and came across Ivy Ackerman’s presentation at the 2016 PSFK Conference, where she discusses the “High-Low Dining” concept, namely putting high end restaurants in surprising “low” areas and low-end food in “high” settings. For example, she highlights Sadelle’s New York Bakery, where you have to make a reservation to dine on….bagels, in a high end setting.

MAYA Principle

This trend makes perfect sense through the lens of Raymond Lowey’s “Most Advanced Yet Acceptable” (MAYA) principle, that the Atlantic Magazine writer Derek Thompson summarized beautifully in his article about what makes things cool, “[Lowey] said to sell something surprising, make it familiar; and to sell something familiar, make it surprising.”

So Sadelle’s made the bagel surprising. And people are loving it.

Think about how logos evolve; as one of my colleagues pointed out, the Starbucks logo has changed very gradually over time, so gradually that most people didn’t really even register that it happened.

I’m personally a sucker for novelty kitchen items (please don’t buy me any though, I have plenty!). Why do I love them so much? Most likely because they’ve taken something familiar and made it surprising, like these matryoshka dry measuring cups, which I love so much I won’t even use them for measuring things. So yes, this trick even works on marketers, or at least, it works on this one.

When I think about our work in open educational resources (OER), this also explains the popularity of expert-written, peer-reviewed, fully developed resources with print copies readily available. OER is so much more than a book, but basically, we’ve made it look like a book. We’ve taken something surprising, and made it familiar.

Contemplation questions

  • Are you working on something that’s surprising or familiar?
  • How could you apply the MAYA principle to your work?
  • Can you think of products or services that you love or hate that the MAYA principle may be influencing?

 

 

 

 

Implementing change series: It’s all or nothin’, baby

“If you want to make a significant change, it’s all or nothing, baby,” was my final thought during a presentation about increasing OER use at a college or university at this years CAMEX college bookstore conference.

a boy jump into a lake
“all in” by popofatticus, via Flickr Creative Commons is licensed under CC BY 4.0

“If you want to make a significant change, it’s all or nothing, baby,” was my final thought during a presentation about increasing OER use at a college or university at this years CAMEX college bookstore conference.

Instinctively, we all know this, but we favor the route of least resistance. And, in our time and resource-pressed world, with so many competing interests, it’s difficult to dedicate what we need to make something work. With that said, we have to go all-in if we truly want to make a big impact.

For example, if you want to lose a good amount of weight, you may go to your doctor and ask your doctor how to lose weight. The doctor tells you:

The people who really lose a lot of weight and keep it off do ALL of these things:

  • Eat breakfast
  • Eat primarily fruits and vegetables
  • Exercise at least 30 minutes per day, 6 days per week
  • Reduce their calorie intake by 500 calories per day
  • Incorporate weight lifting into their exercise routine 3 times per week

And yet, so many people will walk away and pick only one. They may say to themselves “Ok, I’ll start eating breakfast each day” and ignore the rest. And then they wonder why they aren’t successful! The doctor said “do all of these” and the patient heard “do one of the following” and did just that.

Similarly, you see this in advertising and marketing work often with small businesses. Their agency will say, “your goal is x and this is your program that will get you there.” The client business will then pick-out one thing on that list, do only that, and wonder why they didn’t meet their goal. The client gets mad and fires the advertising agency because their plan didn’t work. Except, the client didn’t follow the plan.

In my work consulting colleges and universities on how to dramatically increase Open Educational Resources (OER) use on their campus, I’ve found there is a specific formula to success:

  • Do a minimum of 8 direct tactics throughout the academic year
  • Have day-to-day involvement from each of the key departments for success (faculty, library, instructional design, disability services, bookstore, etc.)
  • Have one active, vocal senior administrator sponsor that will champion the initiative through communications
  • Plan your year of activities out in advance to keep a continual high intensity level of activities and communications going throughout the academic year
  • Track successes and progress by outcomes for each action: Number of faculty interested, number of faculty adopting OER, number of students impacted, student success metrics.
  • Modify your plan to favor the strategies that you are having the most success from (based on the number of faculty interested, number of adoptions, and number of students for each action)

Schools will contact us regularly saying,  “Our initiative is great, but this OER thing just isn’t working for us.” When I dig deeper, something is missing from above formula, they’ve tried to skip a step or a few steps. I’d love to tell them that less effort could get them the results they want. If it could, I’d recommend less, but the truth is, if they want significant change, they have to do all of the above.

Are there times it makes sense not to go all-in? Absolutely. You may not have all of the resources to go all-in, or your political climate may not be right yet. And that’s ok; it’s not unusual, when working with schools, that I recommend a slower approach until they are ready for the big leap. At that point, however, you need to adjust your results expectations to match your effort. And, if you want to get to the high results, work toward getting in a position where you can go all in.

Implementing change series: Plant a seed

When someone holds a strongly-held belief, presenting new facts or information and thinking they will change right away is a fools errand. In the majority of cases, they won’t. So, I take solace in planting seeds.

A few years ago, I was talking to a friend of mine, a college English professor, who was discussing a book club meeting he was at. One of the other members stated a belief about the text, that was factually incorrect.

This conversation happened years ago, but here’s my best recollection of what happened next:

Me: Did you let them know that’s false?

Him: Nope

Me: Why not?

Him: I could tell they hold that belief very strongly. They weren’t ready to hear the fact about it. If I’d countered with that fact, they would have shut down. So I just asked them for support what they said, which they couldn’t provide, but got them thinking. My job isn’t to change their mind fully, I couldn’t do that with such a strongly held belief, my job is to plant a seed toward new information and understanding and hope that it grows.

Planting Seeds

This conversation really changed my perspective on change management. When someone holds a strongly-held belief, presenting new facts or information and thinking they will change right away is a fools errand. In the majority of cases, they won’t. So, I take solace in planting seeds.

I recently read a Washington Post article about Derek Black renouncing his family’s white supremacist stance. This is a great example of seeds being planted, it wasn’t just one dinner, or one conversation, that moved Derek Black, it was a number of encounters and conversations that moved him to where he is now.

In my work consulting schools on encouraging faculty to adopt Open Educational Resources (OER), I’ve witnessed this many times with faculty. and administrators. There are some faculty who are ready to make the leap right away, and I coach institutions to focus on helping those faculty adopt, but I also consider the work we’re doing on their campuses now as planting seeds for those in the late majority or laggards part of the Diffusion of Innovation Curve.

Similarly, there are also faculty who I’ve now worked with for three years to adopt. They email me every six months or so, ask a question, and disappear again. Each conversation is a seed that brings them closer, and it’s very exciting when one of these faculty do decide transition to OER.

As I’ve written about before when discussing advertising ROI, most major purchase decisions also aren’t made from a single communication or a single source of communication. It’s usually a series of seeds, an ad they see, a conversation with a friend, an experience they’ve had, that move someone to purchase.

What does this mean for OER and other change initiatives?

  1. Still track faculty or consumers who say “yes” now. This gives you an idea what parts of your initiative are working.
  2. Keep track of who interacted with you, but didn’t say yes. You planted a seed with these folks and you have a good chance these folks will say yes in the future.
  3. Make note of other ways you can tell a seed was planted. If for nothing else, to remind you that you are making progress. But,  #1 on this list should always your main focus with any of your actions, followed by #2. This one is just gravy on top. See Combine Active and Passive Strategies for High Impact Results for a more detailed outline of these three.

What does this mean in personal conversations?

What I learned from my friend, is, when someone states a strongly held belief that you think is untrue, don’t counter directly. Take a deep breath and plant a seed by asking for more information. But, you also have to open to maybe having them plant a seed in you during this process as well.

Implementing change series: Timing is everything

“In most cases, our direct mail piece is worthless. But in the hands of someone who just found out  they need new windows? It’s priceless.”

An owner of a window company made this statement when one of my colleagues asked him how he thought direct mail was working for him. Obviously, we’d need a lot more data to prove that it is, indeed, providing good return on investment (ROI), but the implication of timing is dead-on.

If it’s raining and there’s a crowd, it’s a good time to sell umbrellas and ponchos. If there’s a party or event without food being served, the timing is perfect for a food truck. But, for most large change initiatives (where we’re asking for a big change and/or a long-term change), it can be much more difficult to know when the timing is perfect for two main reasons:

1. The timing isn’t the same for everyone you’re trying to reach.

In the window example at the beginning, not everyone needs new windows at once. There may be parts of the year when it’s more likely someone will find out they need new windows, but it’s still scattered throughout the year.

Similarly, in my work promoting Open Educational Resources (OER), every faculty member doesn’t consider new textbooks and alternatives to textbooks at the same time. They may consider new books every year, every three years, or whenever they decide it’s a good time to. There’s no set formula.

2. The timing depends on external factors (usually beyond your control).

For someone to decide to make a change, usually there’s some sort of event that precedes that decision. Again, looking at our windows example, a homeowner considers new windows when they are told they need them by a home inspector or if their current set of windows is damaged somehow.

With OER, the event could be a complaint of the high cost from a student, or a publisher raising their prices again, or a technical error with the publisher’s system, or a discussion within the department of how to reduce high drop/fail rates.

Sometimes you’ll be able to anticipate these events happening, like monitoring publisher prices, but many times you may not even know they’ve occurred.

Being in the right place at the right time

A young man jumping off of sand. The timing is such that you see a trail of sand.
“jump” by Barry Badcock, via Flickr Creative Commons is licensed under CC BY 4.0

The simple solution would be to shout from the rooftops about the change you’re encouraging all the time. But, in practice, this is not only costly, but can leave those that you are trying to reach tone-deaf to your message. Think about that person who sends you too many irrelevant emails, do you read them all anymore? I’m guessing not.

The better solution is a pulse schedule. This is where you keep a low hum of communication about the change out there at all times, but you amp-up your messaging around those critical events and external factors you can predict.

A great example of a pulse schedule is candy manufacturers. In the U.S., candy manufacturers are always advertising, but for a couple of weeks (lately a few months!) leading up to major holidays (Halloween, Christmas, Easter, Valentine’s Day)? They are everywhere, there’s no escaping the barrage of marketing from them. These are their pulse times.

With OER, the pulses are around the academic calendar. The first pulse to encourage faculty to consider OER should happen when the faculty come to the welcome back event for faculty at the beginning of the fall semester. They are refreshed and ready to start a new year. The second pulse comes mid-way through he semester, faculty are in between their busy start-up period and exam periods. Similarly, there’s another great pulse time mid-way through the spring semester, leading up to the bookstore deadline for Fall (usually early-mid April).

By keeping a constant hum of communication about the change initiative and ramping-up (pulsing) when people are most open to the change, your can maximize your efforts for encouraging change.

Implementing change series: Combine active and passive strategies for high-impact results

Implementing a new project, cultural change, movement, etc. is never easy. But one thing that can make it easier is to define each of your strategies as either active or passive.

Dog actively chasing a ball
“photomarathon15” by Delphine Savat, via Flickr Creative Commons is licensed under CC BY 4.0

Implementing a new project, cultural change, movement, etc. is never easy.  But one thing that can make it easier is to define each of your strategies as either active or passive.

Passive vs. Active Strategy

Most of us are familiar with the line from the movie Field of Dreams, “If you build it, they will come.” This is the classic example of a passive strategy; they build the place for people to enjoy, but they make no effort to encourage people to come. The idea is, if it’s there and people want it, they will find it. While it makes for an inspiring movie, it’s only partially true when it comes to implementing change with results. These types of passive, or indirect strategies, do help support the overall strategy, but they must be mixed with active strategies as well.

An active strategy is much more direct; if you do this action, you can expect a specific result related to your goal directly from that action. For example, in a business, if your goal is to increase sales, branding marketing (image ads, corporate sponsorships of community causes) would be passive to making a sale, while sales representatives asking for purchase, coupons, special sales offers etc. are direct/active strategies.

Examples: Politics and OER

One example that I think can hit home for everyone right now is politics. Instinctively, we all know that complaining about politics or debating with our contacts on social media isn’t going to lead directly to change. We may change a mind, eventually, but that isn’t going to solve the larger issues.

  • Holding a demonstration or protest: Most people would think that this is active, but, since it usually won’t lead to changing someone’s mind or changing an outcome, it’s passive
  • Calling your elected representatives and asking them to vote a specific way on a bill: Active
  • Venting on Facebook: Passive
  • Donating to an organization who will directly go and advocate for change: Passive for you, but active in the sense that you are financially supporting someone else to directly ask for change (which you may not be able to do on your own)

In my work for Rice University’s OpenStax, I consult with colleges and universities to encourage faculty to transition to Open Educational Resources (OER), including free textbooks. As part of this process, each school writes a strategic plan that includes specific strategies they will complete to encourage faculty to adopt. 

The question I always ask them is: Does this strategy involve you directly asking faculty to adopt an OER? If the answer is yes, then you have a active/direct strategy, if the answer is no, then you have a passive strategy.

  • Having a display of OER textbooks on the campus. The faculty will see them and look at them and consider adopting them: Passive
  • Going to a faculty member’s office and asking them to pilot an OER:  Active
  • Hosting a faculty panel discussion about OER: Passive
  • Having a sign-in sheet at the above panel and following-up with each attendee afterward individually to ask them to adopt an OER: Active
  • Offering grants in exchange for adoption: Active

Combining Passive and Active Strategies for Results

The key is not to eliminate passive strategies, the goal is to mix both passive and active strategies in a way that creates momentum.

For example, this blog post is a passive strategy, but if I send it to people so they know the difference between the two types of strategies and then use that to help them incorporate both into a strategic plan, that creates momentum. If the protest/demonstration you hold drives PR and traffic to your website, you can use that traffic to ask them to sign-up for more information, sign a petition, etc. thus turning that passive strategy into a way for you to move forward with more resources and support.

The most important thing is that you identify and consider your combination of passive and active strategies and plan for effective results.