Shared decision making (SDM) as an element of educational reform promises enhanced quality outcomes and appeals to educators who see virtue in the idea of people coming together to plan what is best for themselves and their students. Analyses have shown, however, that school councils implementing SDM rarely tackle operational classroom decisions or school decisions that impact on the classroom. The case can be made that hospital reform or restructuring contains several elements that are identical to elements that are central to contemporary school reform. Hospital reform efforts are called continuous quality improvement (CQI). Contemporary reform is an effort to create more flexible, responsive organizations that achieve better results. Both hospitals and schools now employ strategies to involve parents and families to assist in their efforts. Both institutions have tried to become more personal places, more client-centered, more interdisciplinary, and more decentralized. While CQI has been viewed by some physicians as an attack on their profession, a movement to improve patient care by local creation (as opposed to commercially or medical speciality board-prepared) of standardized best practice care plans (called critical paths) has been more acceptable to physicians and concurrently achieves CQI goals. This critical path approach could be used to reorient educational reform. (Contains 56 references.) (JDD)