A Checklist Approach to Reading Interventions

By Robert Ruth

Ed Week Teacher

What does helping students learn to read have in common with saving lives in hospital intensive care units? A simple but important concept that allows both to be more predictable.

For the last five years, I have been coordinating a tutoring program for students who are having difficulty learning to read. Students from kindergarten through 5th grade are referred to the program by their classroom teachers and receive instruction for 20 or 30 minutes to learn decoding skills as well as vocabulary, reading comprehension, and writing. Instruction in decoding skills develops the ability of the student to read words quickly and accurately, which supports reading comprehension. We teach eight of these decoding skills, beginning with learning the sounds of the letters and continuing on to strategies for decoding multi-syllable words.

About two years ago, I became concerned because some of our 4th and 5th graders were not making adequate progress in reading comprehension, and when they read orally, their decoding was weak. Upon further investigation, it turned out that they were not proficient in one or more of the decoding skills. Once we taught them the skills they needed, their comprehension improved.

While wrestling with how to ensure that other students would be proficient decoders long before the 4th grade, I read an article in The New Yorker by the surgeon Atul Gawande that gave me insight into my dilemma. The article described a problem in hospital intensive care units where a recovering patient develops an infection because one or more of the lines supplying food or drugs is contaminated. Such infections can be fatal and although there has long been a procedure for insuring that lines are sterile before and after insertion, the fidelity in doing the procedure depended on the memory of the I.C.U. staff. Then in 2001, Dr. Peter Pronovost of Johns Hopkins Hospital developed a checklist for inserting lines into patients, and it was implemented in one I.C.U. and monitored for 27 months. The results were hard to believe—the line infection rate went from 11 percent to near zero, and an estimated eight lives were saved. All from faithfully using the checklist when doing a line insertion—rather than relying on memory alone.

From the I.C.U. to the Classroom

After reading this article, it occurred to me that although we do in-depth assessments twice ... 

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Robert Ruth currently teaches at Alice Fong Yu Alternative School, a K-8 school in the San Francisco Unified School District, and has taught reading for the past 10 years. He is focused on finding methods that make it easier and quicker for students to become skilled readers. Before becoming a teacher he worked in the telecommunications industry.