Do you really know if your doctor -- or child's teacher -- is doing a good job?

There are few things more important to society than educating children and providing healthcare to families. If either fails, the economic and social impact is devastating.

Yet do we know whether our doctors and teachers are doing a good job?

Persistent blind spots in these critical fields hurt all of us. Thankfully, efforts are under way across America to change this.

Healthcare reform bills passed by both the House and Senate (and now on hold) include nearly $100 million to develop healthcare performance measures. The Obama administration's Race to the Top education grants require that teacher evaluations be based on "multiple measures."

Performance measurement is not the stuff of campaign commercials. Yet in a down economy, there is growing interest in getting the most out of shrinking budgets, so a "measurement movement" may be in the making.

In teaching, there has been a remarkable absence of measurement. Evaluations are typically done by a principal or assistant principal who may not use defined measures. Instead, they often make judgments based on observations of teachers at work – a highly subjective process fraught with charges of unfairness.

Many experts agree that standardized tests fall short in evaluating teaching and learning; it's like looking through a keyhole to identify the totality of what students learn from their teachers. Recognizing these limitations, The Bill & Melinda Gates Foundation invested $45 million to develop "fair" and "reliable" measures of teacher effectiveness. Its two-year national enterprise is evaluating 3,700 teachers using an array of measures, including videos of teachers interacting with students, student surveys, examples of students' work, more tests given more often, and an assessment of a teacher's ability to know when a student just isn't "getting it."

Performance measures in healthcare are increasingly common. More than 500 are used daily by health professionals to assess everything from hand washing to mortality and readmission rates. But the number and deemed "fairness" of measures are ultimately much less important than whether they lead to improved patient care and student learning.

Where measures matter most: lives of patients

The way to get to excellence is to measure performance along the way, says Don Berwick, CEO of the Institute for Healthcare Improvement (IHI). If that sounds easy, it's not. Mr. Berwick says healthcare measurement too often generates fear that either paralyzes or games the system. That's why he showers accolades on organizations like Palmetto Health in Columbia, S.C., that face bad news and improve.

Dr. Shawn Stinson, vice president for clinical quality and patient safety at Palmetto Health, says corporate leadership and hospital staff were shocked in 2006 to learn that the mortality rate for their patients was high. "We had in our minds that we were ... all above average. It shook us up to find out that we weren't," says Dr. Stinson. Stung but determined, Palmetto Health leaders set a daring goal to cut mortality rates by 20 percent in three years. They accomplished the goal in 18 months and continue to improve by relentlessly focusing on measurable results and by refining the practices that led to those results.

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