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06.27 Better Collaboration Needed Among Nurses and Physicians

Thursday, June 27th, 2013 | Will Friedman, Ph.D. and David Schleifer, Ph.D.

The United States faces a looming physician shortage that threatens to deepen once the Affordable Care Act is fully implemented. This is a well-documented issue worried over in policy circles, around the dinner table and within the medical community, and discussed in a recent New York Times Sunday Dialogue. Yet it may be that the physician shortage is just one part of the problem when it comes to the supply of medical professionals in this country.

Nurse-practitioners can provide many medical services, especially in primary care and women’s health, and could therefore help fill the doctor shortage gap. Moreover, as provisions of the Affordable Care Act move forward, nurses will be increasingly called upon to improve care coordination, help reduce medical errors and avoidable rehospitalizations, and improve transitions and handoffs.

However, some research suggests that an existing nurse shortage will grow more acute, both because nursing education programs do not have sufficient capacity and because many nurses are reaching retirement. And relying on nurses to deliver care for less money assumes that nurses should be paid less than doctors.

Furthermore, in the 2010 National Survey of Registered Nurses, only one in ten nurses reported having an excellent relationship with a physician (link opens PDF). In fact, since the survey began in 2002, that figure has never been higher than 11%.

During recent deliberative focus groups with members of the public around the country, we heard many participants talk about their experiences with a lack of coordination among doctors, nurses and pharmacists. Such experiences, they felt, had put their health or their families’ health at risk and cost them money. The groups strongly supported helping medical professionals coordinate care.

The task therefore becomes not only to increase the number of doctors and nurses, but also to empower nurses to work effectively and collaboratively alongside other medical professionals. Such an approach can not only help address the need for more medical professionals but also seems relatively acceptable to members of the public.

Want to learn more about public views toward measures to make health care more cost-effective? Keep an eye on this space, or contact Megan at mdonovan@publicagenda.org and we will email you the findings of our research when they are available.

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06.21 Civic Leaders: Inspiring Engagement and Empowering Communities

Friday, June 21st, 2013 | Christopher DiStasi

"Once the light goes on about civic engagement – once you understand what your power is – it never goes out, and that is what we're counting on."

Often, people do not believe that they can make a difference when it comes to the decisions that shape their communities. But, when they are shown otherwise, many are ready to jump on the chance to get involved.

This is what we heard from the heads of twenty California nonprofits that organize and advocate in traditionally disenfranchised communities – immigrant, poor, and minority. We spoke to these civic leaders about their efforts to improve the public’s voice in government for our recent project on civic engagement in California.

Community members often don’t consider that they can solve the problems they see around them by organizing and engaging with government.

"They definitely are aware that, for instance, they don’t have a park in their neighborhood. … What they’re not aware of is the systemic change that’s possible. They might think, 'Oh, well, I could drive across town to the park.' That’s how they might think of solving the problem on an individual basis. Because they haven’t had the involvement and the training in thinking systematically."

Civic leaders tell us that immigrant communities often have preconceived notions about what they cannot do or change based on political cultures in their home countries, along with trepidation about engaging with a foreign system. Meanwhile, native-born individuals often assume that efforts to address local problems through government just don’t go anywhere, and that time is better spent on other pursuits.

These “myths and taboos” must be confronted to “demystify” engagement before nonprofits can begin teaching community members about the practical side of engaging with government, civic leaders told us.

Some civic leaders' organizations host small group discussions with locals concerned about a particular issue. Others told us that sharing “small victories” often does the trick.

"[We] create the space for them to experience change and experience a win. Oftentimes inviting that person … to a community forum with the decision-maker, where the decision-maker agrees to something, or inviting them to a … ribbon-cutting ceremony of a wellness center that we just won at a school in their neighborhood will help move that individual who doesn’t believe that people are willing to listen and that their voice doesn’t matter."


“Once the Light Goes On” – Generating Leadership Through Engagement

In engaging people who often assume they are not factored into government decision-making, civic leaders and their organizations bring voices to the table that were not previously there. These voices have valuable perspectives and – perhaps most importantly – are often the only ones who know about or understand the particular problems facing their neighborhoods, towns, cities and communities.

Perhaps the most common benefit of awakening the civic impulse, a number of leaders told us, is its potential to produce new, dedicated civic and community leaders, and even public officials.

"[Our organization] has put out literally hundreds of leaders, and they are on city councils. They are on boards and commissions. … We trained them on the importance of civic engagement, on the importance of economic policy and on healthcare policy … and how they could get along with their colleagues and how they work with the city."

Civic leaders are counting on the power of positive experiences with civic engagement to keep community members involved– and to show them, especially those inspired to lead, that neighborhoods, towns and cities are made better by greater public involvement in government.

Read more from our interviews with the heads of nonprofits working with traditionally disenfranchised communities, and from our statewide survey of over five hundred civic leaders, in our new report, “Beyond Business As Usual: Leaders of California's Civic Organizations Seek New Ways to Engage the Public in Local Governance.” Also, take a look at our other report on the state of civic engagement in California, “Testing the Waters: California's Local Officials Experiment with New Ways to Engage the Public.”

Quotes were recorded from in-depth interviews with leaders of organizations that engage traditionally disenfranchised communities. Read more on the Methodology here.

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05.20 Improving Public Engagement in Local Government

Monday, May 20th, 2013 | Public Agenda



Want to print this infographic? Click here.

While it's no secret that Americans tend to hold federal policymakers in disregard, they are much more likely to trust their local city or county officials. Local officials are close to home, and local government is often only so far as the next public hearing or city council meeting.

Local officials recognize this connection between their constituents’ trust and government’s proximity to the people. New research in California by Public Agenda suggests that, in communities across America’s most populous state, local officials are interested in engaging citizens in more thoughtful, robust and inclusive ways.

The research includes a survey, interviews and focus groups with local, elected and nonelected public officials throughout California, as well as with leaders of community-based and civic organizations. What these leaders and officials have to say offers important considerations for public engagement in communities around the country.

Nearly 8 in ten California public officials say they're interested in learning about public engagement practices that have worked elsewhere, and 85 percent report that their views toward public engagement have changed since their careers began. Many say they have come to understand and value public engagement more over time.

Yet both local officials and civic leaders see hurdles to improving their efforts to engage residents in public decisions. Sometimes officials and civic leaders-- potential partners in engagement-- disagree about the root of the problems they face.

Regardless, local officials and civic leaders share concern for a disconnect between the public and local decision makers, and desire greater public participation and stronger collaboration. The research suggests some avenues for improvement.


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05.09 How to Break the Cycle of Millennial Discontent in Politics

Thursday, May 9th, 2013 | Megan Rose Donovan

Young America’s current view of government does not bode well for the future of our democracy. According to a new Harvard poll of 18-29 year-olds, these so-called millennials are becoming more polarized, more distrustful and more cynical about politics than in previous years.

The difference between the way young Democrats and Republicans view the President has never been more dramatic than in the last six months, the poll release said. The President’s approval rating among young Democrats is 85 percent, versus 11 percent among young Republicans. This divide has been growing in recent years, with the gap widening by 11 percentage points since last year.

Millennials also consistently rated the country’s institutions poorly. Only 22 percent would trust the federal government (as a whole) to do the right thing, and just 18 percent would trust Congress. The president and Supreme Court garnered a bit more trust (39 percent and 40 percent, respectively), with the military rated most trustworthy (54 percent said they would trust them to do the right thing).

Cynicism for the political process as a whole has increased at a rapid pace. The poll found that nearly half of millennials (48 percent) don’t believe their votes will make a real difference, up from 29 percent just a year ago.

While this study does raise myriad reasons for concern and action, the picture is more complicated and less gloomy than it suggests. Millenials have high rates of volunteerism and political activism, and they are arguably masters at networking and collaboration. Some say that this combination may actually break down the partisan divide.

Still, Harvard's survey does merit a genuine discussion of ways we can keep division, distrust and cynicism from taking hold.

So how could we counteract it? Perhaps by first examining the causes we can identify some solutions and find a more favorable prognosis.

Possible Causes for Division and Discontent Among Millennials

One potential source for growing cynicism among the young may be the lack of progress when it comes to our lagging economy. The consequences of our current weak economy have been felt acutely by the young, who also face the ballooning cost of higher education, often staggering student loan debt, the reality that a degree or credential is increasingly required for employment in any field, and the ill fortune of belonging to a generation that will not be better off than their parents. While college graduates seem to have weathered the recession well, they are often underemployed or working jobs below their skill level. For young people without a college degree, the unemployment rate is much higher.

Meanwhile, these underemployed and unemployed youth watch as policymakers avoid making the important decisions necessary to setting this country on a viable economic path. No wonder this group is so frustrated by the current political system.

In general, this generation hasn’t seen progress on most major reform movements in their lifetime. People’s political attitudes often coalesce at the beginning of their adulthood, when they enter the political process, said Trey Grayson, Harvard’s director of the Institute of Politics, which means that millennials could already be conditioned to doubt and distrust.

Shortfalls in the civic education that young people received (or failed to receive) in secondary school may be a contributing factor as well. Civic education can foster pride in the democratic process, encourage active citizenship and build a constituency of inspired leaders for tomorrow. However, signs indicate that students' civic mastery is faltering, and, nationally, our education system's emphasis on civic education has dwindled.

Outside of formal schooling, young people have few opportunities to develop civic skills. In fact, we can likely attribute millennial polarization in part to the political isolation they experience socially. Only 12 percent of millennials surveyed said that their most recent significant other had different political beliefs from their own, and 72 percent reported that all or most of their friends share their politics, according to the Harvard Crimson. Birds of a feather tend to flock together, sure, but homogenization of social groups doesn’t typically encourage the types of critical discussions that have to happen in order to come to terms with tough issues.

It may be the case that the Internet and other digital tools can help improve civic engagement and encourage political activities that bring people of differing politics together. As of yet, however, such technology has failed to broaden the reach of engagement beyond those who are already civically active. Furthermore, research indicates that online commenting tends to negatively affect civil discourse and reduce objectivity.

Improving the Outlook for Millennials and our Political Future

Whatever the myriad for the younger generation’s increasingly polarized, distrustful and cynical attitudes toward public life, there are no clear and simple solutions. Here are some principles previously discussed in our work that we believe are likely to help:

We've also seen many instances where community leaders help citizens engage in thoughtful, civil dialogue with people diverse views. Such conversations often have a marked effect on participants, who come away understanding why others have views counter to their own, accepting that there are no easy answers, and seeing their political opponents as people instead of caricatures. Can such a model be used in the higher education classroom to instill a respect for civil dialogue in our nation's college students?

These ideas are certainly not exhaustive. Do you have any others?

Concentrating on ways to shift the political perspective of our future leaders will be a continuous process. Yet not doing so may let them succumb to deep, lifelong polarization and will be detrimental to the health of our society. Let’s get a jump on them while they're young.

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04.19 When Engaging Parents in School Reform, One Size Does Not Fit All

Friday, April 19th, 2013 | Jeremiah Hess

Those of us who operate in the K-12 education arena talk a lot about how important parents are to a child's education and to making schools better. Secretary of Education Arne Duncan remarked last year: "Promoting a community culture, where educational improvement is everyone's responsibility, is our great national mission." And parents can play a key role in promoting and sustaining that culture. But what will it take to tap into parents' full potential as partners in education improvement?

From our past research it seems clear enough that parents want schools to serve their children well and don’t believe those schools can do it alone. Our new survey of parents in Kansas City, summarized in the report “Ready, Willing, and Able,” adds a wrinkle: parents differ (often dramatically) in how they seek to be involved, and school leaders who are serious about making parents partners should be prepared to meet them where they are.

In this new research, we identified three groups of parents, each unique in preference and readiness to get involved:

Potential transformers stand out as the group most likely to brave the bureaucracy of school policymaking.

These parents tell us they are perfectly comfortable to act as advocates for broader school reform. They are ready to contact district officials and the media to discuss local school problems and to represent parents on committees that shape school policies. In our current study, 3 in 10 parents fell in this group.

Still, very few have actually been involved in these ways. Providing real opportunities for them to get more involved—and supporting their efforts to organize themselves—is an important step towards unearthing parents’ power in school improvement.

We think they’d get the support of other parents, too: even though the majority of parents don't feel comfortable getting involved as transformers, two-thirds in our survey believed that parent advocates have the ability to make a difference.

Reaching parents can’t stop there, though.

School helpers are a second group of parents with more to give.

When you need support in more traditional parent roles in a school—help for teachers in the classroom, volunteers for an event, or more support for a PTA—these are the parents to find. Though school helpers leave advocacy and school policy matters to others, all of these parents feel they could be doing more for their school– an obvious call, we think, for leaders to track these parents down.

Even reaching the school helpers doesn’t exhaust a principals’ and teachers’ options.

Help seekers deserve some special attention.

These parents are concerned about their own child’s learning and seem particularly hungry for more support from schools in helping their child do well. They aren’t likely to respond to calls for collective action, and probably won’t have the time or inclination to volunteer more at their school. Yet every single one of these parents told us there was still “work to be done” teaching their child to do their best in school, and teachers and school leaders are likely to make progress with them by supporting those efforts at home.

Utilizing parents as a powerful resource

In total, these three groups (a full 78 percent of parents surveyed) are a valuable yet untapped resource for diverse, powerful and effective parent engagement. To draw on these parents more effectively, leaders must understand that different parents will respond to a different set of appeals. Our report provides some specific strategies for each of the groups the research identified.

Yet, some principles for parent engagement are universal. For example, education leaders should begin engaging parents by listening to them and understanding their needs. Clearly communicating what exactly a school, a district or a particular teacher needs from parents to succeed is also important. As one Kansas City father told us:

"Parents don’t understand that their presence makes a difference. Schools aren’t getting that message out. Even when my school was going through its worst times, they didn’t get the message out that they needed help from the community."

There’s hope, though: parents are by no means hostile to their schools. In fact, parents across the country have told us—for this and other studies in the past—that they don’t think of their child’s school as just a service provider; they value its place in their community, trust their teachers and respect principals who return phone calls. In the Kansas City region, 77 percent of parents felt that their principals and teachers were well-connected to their communities, and just over half said they wouldn’t leave their school “even if money was not an issue”).

In spite of their concerns and complaints, parents want their schools to succeed and are aware that they need to be part of that success. For school leaders, developing relationships at this level is always possible, and it’s an ideal first step towards creating Secretary Duncan’s “community culture.”

But we think that transformers, school helpers, and help seekers can be found in any school, and we hope that the pressures of constant change haven’t made education leaders forget about simply making parents feel welcome. As one mother reminded us:

“I love it when teachers thank me for coming. I love it when the principal says, ‘Glad to see you. Hope to see you again.'”

Leaders should only remember that with parents, just as with students, one size doesn't fit all.

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03.25 Faculty Voice in College Credit Transfer

Monday, March 25th, 2013 | Alison Kadlec, Ph.D.

A recent piece by Jon Marcus from the Hechinger Report, "Stopping the Clock: Colleges Under Fire Over Transfer Credits That Don't Count," does a great job of drawing attention to a serious problem facing higher education today, especially in the consideration it pays to the insights I have heard from college students during focus groups on the issue. However, my colleagues at Public Agenda and I are troubled by one of the premises of the piece.

While faculty "hubris" and "snobbery" may account for some portion of the problem students face as they seek to transfer credits, it would be a mistake to dismiss faculty concerns in the absence of systematic efforts to improve skillful and thoughtful assessment of learning outcomes.

In nearly every focus group I've conducted with transfer students, some portion of the participants (usually 10-30 percent) tell stories of courses at open-enrollment institutions that should not have been allowed to transfer because they were of such low quality. These students talk about feeling like they're being set up for failure, and one even said to me, "I'm glad that class didn't transfer because I would have definitely failed the next level."

If even 10 percent of community college courses are watered down to the point that transfer students are set up for failure when they seek to continue their education at a more selective (and typically more expensive) institution, then we need to begin having in earnest the conversations about the real tensions between a mission focused on access and one focused on success.

Faculty Face a Multitude of Challenges

Through dozens and dozens of conversations with faculty at community colleges in several states, I've heard their daily struggle to find a way to help catastrophically underprepared students advance to the next level. A majority of these faculty members are adjuncts without a voice in, strong support from or deep ties to their institution.

I've also heard faculty at non-selective four-year institutions describe the "daily compromise" they make as they attempt to balance meeting students where they are while setting expectations to help them get to where they need to be. One memorable faculty member at one of the nation's largest community college systems echoed many others in saying, "I used to teach calculus, but now spend most of my time trying to figure out the best way to teach how to add whole numbers."

The challenges faculty face on the issue of academic transfer go beyond the pressures that come with underprepared students. Transferability of credits across institutions will ultimately depend on the ability of faculty to do something they've never been trained or supported to do before: determine how to effectively assess learning outcomes and then actually do it.

In a focus group last week at a non-selective four-year institution in Ohio, one faculty member brought this challenge into focus when she asked her colleagues at the table, "Do you think part of the problem is our training? I went to a very good Ph.D. program, and I never once heard the word assessment or learning outcomes." For all the training and knowledge that college faculty accrue and possess, they are never formally taught how to be teachers or how to reliably assess what their students should know and be able to do.

It's Time to Change the Conversation

Community colleges and non-selective four-year institutions have hard conversations ahead of them about the relationship between access and success. If simply making it possible for students to enroll is not enough - if institutions have a responsibility to pay attention to who succeeds, who fails and how we know - then it's time for new kinds of conversations that move beyond finger pointing at any one group.

The tendency of experts to caricature faculty as shameless egotists obscures the more serious issues at work, and it ignores the fact that any meaningful and lasting success in higher education reform will require the knowledge, expertise and commitment of faculty.

It's too easy, and even a little lazy, to blame faculty egotism for such a complex and systemic problem, and doing so won't help bring faculty to the table. It's time for the conversation to change so that we can all get down to the real work ahead of us.

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03.21 Top Grades in High School May Not Mean an Equal Chance at Success

Thursday, March 21st, 2013 | Jean Johnson

For low-income students—even those with top grades and high test scores—the chance to excel in higher education can be derailed from the get-go, before the ink is even dry on their high school diplomas. For these students, outshining your high school classmates still doesn’t mean you’ll end up at a top college, according to new research from Christopher Avery of Harvard and Caroline Hoxby of Stanford. That makes us wonder about the role high school guidance counselors play in helping low-income students apply to college and whether these students are getting the advice and support they deserve. Based on Public Agenda’s work in this area, it seems very likely the guidance system is coming up short.

According to the new study reported in the New York Times, only about a third of high-achieving high school seniors from low-income families enroll in "one of the country’s 238 most selective colleges." It’s not that these highly promising students aren’t admitted—most never even apply. In sharp contrast, more than three-quarters of high-achieving students from affluent families attend one of these top schools.

And these students would seem to be a college admission officer’s dream. The researchers focused on students with an A-minus average or higher who had scored among the top 10% on college admissions exams like the SAT or ACT.

Like most good research, the Avery-Hoxby study raises a challenging set of questions for educators and the public at large. Experts responding to the report mentioned lack of knowledge about financial aid and lack of role models as some reasons why these top-achieving students from poorer homes don’t attend selective colleges.

Public Agenda’s study, "Can I Get a Little Advice Here? How an Overstretched High School Guidance System Is Undermining Students' College Aspirations spells out some specific problems facing these (and other) students.


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03.06 On Opinions of Online Education:
Hit “Refresh”

Wednesday, March 6th, 2013 | Christopher DiStasi

The face of higher education is changing rapidly, and Public Agenda is working hard to help education leaders, faculty, students, policymakers and employers better navigate these complex changes.

One of the biggest developments in higher ed is online education. While public opinion on online ed is becoming more positive and the sector is growing, our research and other organizations' show that serious questions and uncertainties remain.

As of late last year, almost half of adults (48 percent) say an online degree “provides a similar quality of education as compared to traditional colleges or universities,” according to researchers at Northeastern University. Just a year and a half earlier, less than a third of adults (29 percent) thought the educational value of online courses is equal to that of classroom learning, according to a Pew poll.

This shift comes in light of impressive growth in the percent of all Americans who have taken online courses for credit. In 2011, 16 percent of Americans had taken an online course for credit, up from 6 percent in 2001, according to Pew. Among just those Americans who have at least some college education, more than a quarter (26 percent) have taken online courses for credit—a number that rose 13 percentage points just between 2005 and 2011.

And Pew’s 2011 data confirms what we would suspect: that those who have taken an online course are more likely than those who have not (by 12 points) to say its educational value is equal to that of a classroom class. Furthermore, most chief academic officers agree; more than three quarters say the learning outcomes of online instruction are the same or better than face-to-face instruction, according to a 2012 survey.

But, on the question of quality, some important stakeholders, including higher education faculty and employers, may remain unconvinced. Nearly 60 percent of faculty said they felt "more fear than excitement" about the growth of online education in a 2012 survey.

And employers tend to favor candidates who obtain their degrees in a traditional face-to-face setting over ones who completed a degree online, notes Nikolaos Linardopoulos at Rutgers University in a recent review of literature on the topic. However, employers ultimately consider the format of an applicant’s instruction—whether online or in-person—secondary to factors like the reputation of the institution from which the degree came, according to the author.


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02.26 Accountability and Public Schools

Tuesday, February 26th, 2013 | Allison Rizzolo

A Closer Look at How Parents and Teachers Think

Fifteen years ago, federal, state, and local officials started pursuing a broad range of reforms to ensure more accountability in the nation’s public school system. They hope this can improve and restore trust in our nation's public education system.

Yet the public's confidence in public schools is at a historic low. How can this be?

New research from Public Agenda and the Kettering Foundation suggests that parents and education leaders may think about and define accountability in critically different ways. "Will It Be on the Test?" raises important questions about the trajectory of education reform and whether the way we think and talk about "education" is too narrow.

Most parents – and most Americans generally – applaud the goals of the accountability movement. They say the movement responds to some of their genuine concerns and welcome some of the changes it has instituted, such as raising academic standards and promoting students only when they have mastered needed skills.

Still, they see it as sorely lacking in fundamental ways. To them, accountability provides too few answers to problems they see as pivotal. These problems include too many irresponsible parents, too many unmotivated students, too little community support, and messages from society that undermine learning and education.

Parents also think the accountability movement places too much weight on standardized tests when there are many other factors to consider when judging the effectiveness of schools. And they fear it overlooks the importance of local schools as a community institution.

These competing definitions sometimes clash, especially when districts—in an effort to be more “accountable”—decide to close under-performing schools.

However, one of the most important messages of the research is one that leaders may find encouraging: parents do not believe schools can do it alone.


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02.19 Public Agenda Launches New Website

Tuesday, February 19th, 2013 | Allison Rizzolo

Welcome to Public Agenda's new website!

We hope you find the new site brighter, cleaner, and easier to navigate. Be sure to check out our story, who we are, what we do, where we work, and the services we offer.

Our blog, On the Agenda, also has a new, fresh look.

If you are looking for a specific report or discussion guide, our advanced search page will give you the help you need.

Did you know we've been around for nearly 40 years? That's a lot of time to accumulate a lot of important resources! We offer all of these resources for free. We hope that you'll considering donating to Public Agenda so we can keep up our important work.

It's possible we've overlooked something in the transition. If you are looking for something and cannot find it, let us know. If you are looking for our online issue guides, we have updated a number of them for our Citizens' Solutions Guides. Old issue guides that have not been updated are archived.

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