Abstract
The purpose of this qualitative study was to understand how one secondary school principal created the necessary conditions for teachers to engage in interdisciplinary teaching that led to the inclusion of health-related skills and professions in all academic disciplines. Students expected cross-curricular connections during daily lessons. Teachers required sustained opportunities to learn about interdisciplinary teaching, as well as to understand how to integrate health-related skills and professions into their respective academic disciplines. Guidance and support provided by the school principal served as a catalyst for instructional change.
Keywords
Introduction
School leaders face complex problems daily with managerial tasks, instructional support, and more. Complex problems often involve many variables and cannot be corrected by simply implementing a routine or process. When an initiative is complex, individuals affected by the change usually need ongoing opportunities to study, see demonstrations, practice, and time to learn from each other. This has been studied extensively by Hall and Hord (2015) who concluded that systemic change requires 3 to 5 years. Individuals need to understand what the change initiative is and/or entails, how it relates to what they already know, and/or how the change will benefit the students whom they serve.
“Successful large-scale reform is built on shared experiences, trusting relationships, personal and social responsibility, as well as transparency” (Hargreaves & Fullan, 2012, p. 151). One person’s expertise is not enough to solve a problem. Knowledge needs to be built between/among leaders and teachers and coordinated to maximize impact learning (Fullan et al., 2018). As a school leader, one needs to be open-minded and reflective, ask questions, and be willing to see things from different perspectives instead of a lens of certainty or familiarity (Didau, 2020). What’s the vision? What are the long-term goals? What short-term goals will be set to monitor long-term progress? Clarity and purpose (Michel & Brookhart, 2026; Fullan et al., 2018; Robinson, 2023) can bring about energy for change. And with clarity and purpose, “all layers of the school and organizational context can learn together, enhancing the likelihood of deep change” (Le Fevre et al., 2020, p. 63).
Leaders understand that teacher professional learning involves an interaction between new knowledge and skills and what one already knows and can do (Hasbrouck & Michel, 2022; Robinson, 2023). And they understand that “Deep knowledge is essential to being responsive to the specific needs of learners” (Le Fevre et al., 2020, p. 15). Many experts (Michel & Brookhart, 2026; Fullan, 2014; Vanblaere & Devos, 2016) emphasized that school leaders make the biggest impact when they participate as a learner, model their learning and expectations for others, and create the conditions for change to occur. By being visible and present, leaders cultivate leadership in others as they “lead with compassion, listen with the intent of understanding, and hold the humanity of their teachers sacred” (France, 2021, p. 37). They are doing and seen doing “that which they expect or require others to do and should expect to have their own practice subjected to the same scrutiny as they exercise toward others” (Elmore, 2008, p. 67). It’s well-known that a one-way flow of information rarely results in sustained changes to practice (Hargreaves & Fullan, 2012) and, when faced with diverse student populations, leaders and teachers need to be able to see and understand things differently (Le Fevre et al., 2020, p. 4).
In this paper, we describe how one secondary school principal created the conditions for teachers to engage in interdisciplinary teaching that led to the inclusion of health-related skills and professions in all academic disciplines from eighth through twelfth grade. The principal was tasked with leading efforts to recreate the learning experiences for students who attended a health professions high school. The revised vision, set by the local school board and community, focused on interdisciplinary teaching where all teachers, not just elective teachers, included health-related skills and professions in their respective academic disciplines. We wanted to understand the role of the principal that led to the achievement of this revised vision.
Background Information
The study site, given the pseudonym Texas High School (THS), is located near the United States and Mexico southern border. According to records maintained with The Texas Tribune (2024), in 2024, there were 31 full-time teachers and 375 students. Nearly 95% of the student population identified as Hispanic, and other racial or ethnic groups included White and Asian. Close to 60% of students attending THS were labeled economically disadvantaged, meaning students were eligible for free or reduced-price lunch, and 10% were classified as bilingual, 17% gifted and talented, and 2% special education. Nearly half of all eleventh or twelfth graders took at least one advanced placement AP or international baccalaureate exam and, in 2024, 100% of students who were enrolled at THS in ninth grade received their high school diploma within 4 years. Most of the teachers at THS were classified as Hispanic (n = 25) with the remaining six teachers being White. Approximately 60% of teachers have a bachelor’s degree and 30% have a master’s degree, and the average number of years a teacher has been employed by the school district is 11 years.
When constructed over a decade ago, THS was to be a school where curriculum and instructional practices could be adapted to provide students with cross-curricular learning experiences that focused on health-related skills and professions. Students would be exposed to a rigorous curriculum to develop 21st century skills, engage in hands-on experiences, use technology to encourage collaboration that was reflected in the medical industry, and have access to professional healthcare advisers and facilities to deepen their learning. From its inception, THS teachers had the flexibility to implement various instructional programs or curricula. A few teachers incorporated project-based learning into their subject area curricula; elective teachers taught health-related skills and professions, yet most teachers taught their curricula as prescribed by a publishing company or as directed by district curriculum specialists. This meant that few teachers outside of electives incorporated health-related skills and professions in their respective academic disciplines.
Although it was known that many teachers from non-elective teaching assignments didn’t regularly include these skills or professions in daily lessons, this became clearer when schools were closed due to the COVID-19 pandemic. The shift to remote learning resulted in students spending more time accessing PowerPoint presentations, listening to lectures, and conducting or engaging in few, if any, experiments or hands-on learning. When students returned to school in the spring of 2021, social distancing requirements resulted in more personalized learning using electronic devices, individualized completion of assignments, and few opportunities for students to work together. Students often sat passively at a desk while a teacher taught a lesson, took notes, and had few, if any, opportunities to make connections to real-life, society, or the workforce.
This didactic style of teaching was problematic for local community members, mostly parents or guardians of children attending THS, because a major reason they wanted their child to attend THS was for the experiential, real-life learning experiences. With pressure from community members, senior leaders at the district office and school board members revisited the original school vision. They decided that a reset was necessary, and set a goal that all teachers, regardless of academic discipline expertise, would include health-related skills or professions in their lessons and that they would be expected to work with colleagues to develop cross-curricular health-related units.
The problem with reimagining this new vision was that teachers, aside from elective teachers, had college degrees in their respective academic disciplines (e.g., English, science, social studies, mathematics) and not in health-related skills and professions fields. Although there are secondary schools that specialize in health careers, we couldn’t find specific exemplars where all teachers, regardless of academic discipline expertise, were expected to include health-related skills and professions in their lessons. We also struggled to find studies regarding the development and implementation of interdisciplinary units that were specific to health-related skills and professions in a secondary school and where all teachers were expected to incorporate these skills or professions into their daily lessons. Given these problems, we wanted to understand how this revised vision could come to fruition. Our main research question was:
What does a school principal need to know and do to create the necessary conditions to achieve the vision?
Literature Review
Interdisciplinary teaching is an educational approach that integrates knowledge and methods from multiple academic disciplines to address complex issues (Holley, 2017). This method allows students to see the relevance and application of their knowledge in real-world contexts and foster deeper understanding of content being taught. By breaking down traditional subject silos, interdisciplinary teaching promotes critical thinking, creativity, and collaboration, and equips students with skills to approach complex problems from many perspectives (Dewey, 2021).
Principal leadership is considered a precondition for implementing interdisciplinary teaching (Braskén et al., 2020). A principal must be able to create the conditions for teachers to be able to transition from individualistic school culture to cross-curricular teacher collaboration (Hargreaves, 2019). This includes leading learning and development, establishing goals and expectations, ensuring quality teaching, resourcing strategically, and ensuring an orderly and safe environment (Robinson, 2011). The principal must also be able to communicate the vision for interdisciplinary teaching, work with teachers to develop a shared understanding of the vision, allocate necessary resources, and monitor implementation (Soini et al., 2016).
Whole-school curriculum coherence can only be achieved by talking to colleagues in other subjects and developing a clear vision of what we want our students to be able to do by the time they leave school and enter the world of work (Wilkinson, 2010, p. 4).
For example, Sund and Gericke (2020) described how science, social science, and language teachers used a framework to plan a cross-curricular unit that focused on reading, writing, and presenting findings related to recycling. This framework included what would be covered in each subject area, including what students would read and write about; how each teacher would deliver their content that promoted individual student development; and why students should learn the content, including how students would demonstrate their learning through a mixture of reading and writing.
To achieve interdisciplinary teaching, there needs to be a concerted effort to bridge the gap between the school and real-world experiences and to make learning meaningful and connected to what students find interesting (Gore et al., 2022; McPhail, 2018). This is true whether the focus is concept-based links (e.g., diabetes) or content-based connections within an academic discipline (Mäkiharju & Hilli, 2024). For interdisciplinary teaching to be successful, careful planning (e.g., what is the goal, how will learning be organized between/among subjects, how will progress be measured), respect for each academic discipline (i.e., learn about and make connections with what one knows and doesn’t know), agency for individuals to be co-creators, and a willingness to participate (i.e., voluntary—rather than imposed) (Rönn-Liljenfeldt et al., 2023; Wilkinson, 2010) are necessary.
Leadership
When studying the link between leadership and learning, Leithwood et al. (2004) concluded that leadership is “second only to teaching among all school-related factors in its impact on student learning” (p. 3). Grissom and colleagues (2021) found that “the impact of an effective principal has likely been understated with impacts being both greater and broader than previously believed: greater in the impact on student achievement and broader in affecting other important outcomes…” (p. ix). Not only has research shown that principals can impact student learning, but they also play a key role in leading change. “All major research on innovation and school effectiveness shows that the principal strongly influences the likelihood of change…” (Fullan, 2007, p. 95). Although many forms of leadership exist that relate to the role of a school principal, we drew on instructional, shared, and emergent leadership, as well as concepts from enabling leadership.
Instructional Leadership
An instructional leader is expected to act as a “lead learner in the school and model lifelong learning by sharing what he or she has read lately, engaging in and encouraging action research, and implementing inquiry groups among the staff” (Fullan, 2002, p. 18). A school principal is expected to have sufficient pedagogical and content knowledge to offer useful feedback that stimulates reflection (Louis et al., 2010). The principal must demonstrate what they value (Leithwood, 1992; Louis & Kruse, 1995) while also focusing on instruction, learning, and pedagogy (Hallinger, 2003; Louis et al., 2010; Vanblaere & Devos, 2016). They must also set goals for differentiated, sustained professional learning to meet individual needs that are structured to be collaborative, experiential, interactive, and engaging; organized to include time for reflection and inquiry; connected to an educator’s day-to-day work with students; and connected to broader policies and/or reform efforts. (Gore et al., 2022).
Shared Leadership
Shared leadership starts with a common belief system where decision-making prioritizes the success of students. Shared leadership involves horizontal, lateral influence among team members (Pearce & Sims, 2002) where voice is given to others when making decisions and where there is a concerted effort to remove obstacles when focused on achieving a goal. The inclusion of others’ voices promotes a sense of ownership than can lead to individuals being more engaged and committed. This can also result in the identification of new, innovative practices because teachers feel their expertise and contributions are valued. Shared leadership fosters professional growth and development as individuals are often encouraged to develop new skills and perspectives that have the potential to directly benefit their teaching practices and enhance student learning.
Emergent Leadership
Different individuals emerge as leaders, for different purposes, and at different times. Specific to this study, this included
Leadership emerges when group members exhibit leadership influence over other team members (Schneier & Goktepe, 1983). Similar to shared leadership, emergent leadership captures the horizontal leadership influence that stems from team members rather than vertical leadership where influence might come from a single person (Schneier & Goktepe, 1983; Zhang et al., 2012).
Enabling Leadership
Enabling leadership is a component of complexity leadership theory that is concerned with the need to engage individuals from all parts of an organization, as well as to deal with the tensions that might arise between administrative and adaptive leaders. This has been applied in many organizational contexts; however, it hasn’t been studied extensively in schools. Kershner and McQuillan (2016) highlighted the need to disrupt the status quo as a precursor to adaptive change. Boylan (2018) concluded the need for teacher-led professional development. Toh (2016) found the need to develop ecological awareness, encourage collective reflexivity, create alignment, and build capacity to forge coherence. And, in 2021, Ho et al. examined how leaders in Singapore schools planned for and supported the implementation of a mathematics innovation using the three roles identified as entangled forms of leadership (Uhl-Bien & Marion, 2009):
Ho et al. found that these three leadership roles provided
a useful framework for practitioners to make sense of the different kinds of leadership required to support innovation, learning and adaptability, how stakeholders in various positions can enact such leadership, and how such leadership practices interact and reinforce one another across ecological levels (p. 34).
Using the concept of enabling leadership, Lusiani and Langley (2019) studied how the perspectives and ideas of individuals from lower levels of an organizational hierarchy connect with that of top-level managers or senior leaders. They concluded that to construct strategic coherence three bundles of practice were needed. This included fueling, shaping, and entwining:
Fueling mostly relates to adaptive leadership and shaping and entwining relate mostly to enabling leadership. Engaging stakeholder groups can bring about a coherent, cohesive plan between/among all individuals. Individuals are involved in developing shared goals, aims, and mission; organizing and coordinating knowledge and work; and committing to learn together to benefit the organization (Drath et al., 2008).
Concluded by Uhl-Bien et al. (2007), leadership is not only a position; it’s also an “emergent, interactive dynamic—a complex interplay from which a collective impetus for action and change emerges when heterogeneous agents interact in networks in ways that produce new patterns of behavior or new modes of operating” (p. 299). These new patterns or modes of operating are achieved through new learning, innovation, and new patterns of behavior and require exploration, new discoveries, and adjustments (Heifetz, 1994; Heifetz & Laurie, 2001). They are adaptive challenges or problems that are complex, and unpredictable in the sense that they often include many variables.
Successful long-term strategies are those that emerge from the continuous, complex interactions among people. As a result, leaders need to stop trying to control individual outcomes and instead shift their focus to the interactions with the intention to create the healthy conditions for people to self-organize around relevant issues. (Brown, 2011, “Complexity Leadership: An Overview of Core Concepts and Frameworks” section)
Method
This qualitative case study employed interviews and observations. The first author of this paper, with nearly three decades serving in instructional leadership and coaching roles with schools across the United States and internationally, led this project. He had a prior relationship with this school district and previously provided differentiated, sustained professional learning for instructional coaches; assisted in the development of processes to integrate fine arts in all classrooms in one elementary school; supported the development of integrated mathematics and science units in a middle school; guided high school teachers in lesson study cycles; and helped district supervisors organize structures and processes to implement learning walks. He had not, however, provided support for teachers or the principal at THS. The second author is a qualitative researcher and senior lecturer at a university in the United Kingdom. He has authored several peer-reviewed journal articles and much of his research focuses on lesson study. He assisted with coding transcripts, creating concept maps, and identifying themes. The third author is the principal at THS. She provided insights into the campus culture and took part in data collection and analysis as an observer. At the time of this study, she was a doctoral student who was interested in and wanted to learn more about qualitative research.
The first author’s prior experiences throughout the district allowed him to establish strong working relationships with various stakeholder groups that were built on trust, mutual respect, and belief in supporting learning at all levels. These relationships, including those with some members of the district’s institutional review board, were critical as he had direct access to individuals who could assist when completing the necessary protocols for conducting research. Within 2 weeks of submitting the required protocols, the study was deemed exempt as there was minimal risk for participants.
During the fall of 2021, the first author scheduled a virtual Zoom meeting with the principal and assistant superintendent. This meeting included an overview of the proposed project, revised vision for THS, and goals. This meeting also included general information about teacher experiences, student subgroups, and curricula used in all academic disciplines. At the conclusion of this meeting, it was decided that the first author would conduct focus group interviews with students to understand their current experiences in relation to what they expected when applying to attend THS. Findings from these focus group interviews would then be shared with the principal and department leads to determine next steps.
Participants
Approximately 2 weeks after the initial meeting, the principal and first author met with five department leads during one school day. Four teachers taught core subject areas (English, social studies, science, mathematics) and one taught an elective (medical terminology). This group discussed the purpose for this study, research questions, participants, and timeline. They reviewed student achievement data from end-of-year state exams and discussed what was known about current teacher instructional practices.
During this initial meeting, the group identified 25% of all ninth-grade students (n = 20) to take part in student focus groups. Purposeful sampling (Patton, 2002) was used to select students to participate in focus groups as this study was exploratory in nature and not focused on generalizing findings to a larger population. We wanted to identify students who had varying degrees of knowledge or experiences in relation to our inquiry, and this included students who (a) had varying levels of academic achievement, (b) represented an equal number of boys and girls, (c) were new to THS in ninth grade or started at THS in eighth grade, and (d) represented a balance between those who had already chosen a health career pathway (e.g., pharmacy technician, dental assistant, medical assistant) or those who were still undecided about their pathway. Because department leads had daily opportunities to interact with ninth-grade students, they had firsthand knowledge of students’ backgrounds.
By the end of this initial meeting, this group also confirmed participation by teachers who were willing to take part in the development of a cross-curricular unit that would focus on integrating health-related skills and profession in all academic disciplines. These volunteers, all teachers of ninth-grade students, included three department leads (English, social studies, electives) and two non-department leads (mathematics, science).
One week after the initial in-person meeting, focus group interviews commenced. Consent forms were collected from each participant, and each participant was informed that they could decline participation at any time during the project. Participants were also informed that pseudonyms would be used if/when quoting any material from the interview. The first author conducted student focus group interviews to learn about their reasons for applying to attend THS and to learn whether their expectations aligned with their experiences. On this same day, the five department leads took part in a focus group interview. The goal with the department leads was to learn about their individual instructional practices and to understand what knowledge they had, if any, regarding instructional practices that were implemented by their colleagues who taught in their same departments.
During follow-visits to the school, the remaining 26 teachers took part in focus group interviews (i.e., five teachers from electives, three English teachers, four mathematics teachers, four science teachers, four social studies teachers, two foreign language teachers, four ancillary teachers) to learn about their experiences when teaching at THS, including their knowledge of health-related skills and professions. These additional focus group interviews would allow all teachers to share their insights about the revised vision, including their knowledge of interdisciplinary teaching and health-related skills and professions. In total, 31 teachers and 20 students took part in focus group interviews.
This project took place from 2021 to 2024. The timeline of events is included in Table 1. The ongoing communication with students and teachers provided new knowledge throughout this study. New learning about health-related skills and professions, new knowledge of cross-curricular instructional practices, new insights from student experiences, and new opportunities for the principal to lead change.
Timeline.
Data Collection
This qualitative study explored descriptive notes from observations and interview transcripts to understand the role of a principal when assisting teachers with linking health professions education pathways (i.e., electives) to wider curriculum subjects like English, mathematics, social studies, science, foreign language, and/or ancillary subjects such as digital arts. Interviews explored teacher knowledge of health-related skills and professions, as well as their knowledge of cross-curricular teaching and learning. Interviews also explored student experiences during daily lessons in all academic disciplines.
Semi-Structured Focus Group Interviews
Reflective, semi-structured focus group interviews engaged participants in dialogue, allowing each individual to offer personalized thoughts and experiences. Teacher focus groups consisted of 5 to 6 teachers per group and lasted approximately 30 minutes. Twenty students, 4 groups of 5 students each, took part in focus group interviews that lasted approximately 30 mineach. All focus group interviews took place in the school conference room and were led by the first author. Interviews were digitally recorded, transcribed within 2 weeks by the second author, and uploaded to a Google Drive. Transcripts were coded within about 2 weeks of when a focus group occurred. Department leads had an opportunity to review and reflect on our summaries of the transcripts throughout this project.
Focus groups allowed the first author to interact with more individuals at one time and allowed him to engage in dialogue with students and teachers, working to understand what was said and what was not said (Grondin, 1995). This provided a richer source of data as the teachers and/or students communicated with one another, making them aware of things that they may not have thought about previously and, for some, leading to a mutual understanding or common meaning (Weinsheimer, 1985). And, at times, dialogue provided an opportunity to expose or clarity varying viewpoints.
Interview questions were pre-determined and asked participants to share experiences and thoughts (Patton, 2002) about the inclusion of health-related skills and professions in all academic disciplines and were open-ended to allow for maximum input. Students were asked:
What was your reason(s) for wanting to attend THS?
When you see the school name on the side of the school building, what do you think of?
What were your expectations for classes that you would take at THS?
As a ninth grader and having attended THS for 1 year, what have you experienced?
How do your expectations compare to your actual experiences at THS?
Because a career in a health-related profession can involve complex situations and work that involves different stakeholder groups (e.g., doctor, nurse, patient), we asked students if their classroom experiences included opportunities to:
apply/make connections between/among health-related concepts or skills to society or everyday life;
use problem-solving processes (e.g., analyze given information, devise a plan, determine a solution, justify my reasoning, and evaluate the reasonableness of my solution);
use various tools or resources to show how to solve a problem in more than one way;
communicate findings to a problem and respond to how other students solved a similar problem (e.g., ask questions, challenge a solution, provide feedback);
display and justify their thinking using written or oral communication; and/or
share misunderstandings and ask for help.
Students responded to these questions using a four-point Likert Scale, and responses were tabulated during each focus group interview. For example, when attending a class at THS, I am expected to connect learning to a health profession:
Always: I Sometimes: IIIIIIIIIII Rarely: IIIIIII Never: I
These same questions were asked in 2024, near the end of this study. This data was included in our analysis and is reported in our findings.
Following the student focus group interviews in 2021, the department leads were given preliminary findings that were generated from the student focus group interviews. The department leads were then asked:
What are you learning from the student feedback?
What do you think this learning means for THS teachers?
How can teachers respond to what students expect?
What do teachers need from the school principal for change to happen?
All teachers were asked:
What made you apply to teach at THS?
When applying to teach at THS, what did you think the curricula would include? Please provide an example(s).
What, if anything, do you know about cross-curricular teaching and/or health-related skills and professions? Please describe in as much detail as possible.
What are your thoughts about the integration of health-related skills and professions in all classes (e.g., benefits, fears)?
Responses to these questions provided insight into what they needed if they were to be successful with incorporating health-related skills and professions into their lessons.
Observations
During the second in-person visit, the principal escorted the first author to classrooms to observe instruction. The goal of the observations were to learn how, if at all, health-related skills and professions were being included during instruction (e.g., did students have an opportunity to read about health-related skills or professions, conduct an experiment related to a health-related skill, present findings from their experiment) and/or whether students were given opportunities to apply skills (e.g., communication) that could be used when faced with complex situations or when interacting with others.
Teachers were informed 2 weeks prior to the observations taking place and, observations, lasting approximately 10 minutes per classroom, took the form of a non-participatory role. The focus of conducting observations was to learn more about theories-in-use. That is, did data collected from interviews align/relate with what was happening in classrooms. For example, a teacher reported that they always included a connection to a health-related skill or profession yet, when observed, made no connections. Or students reported that they only experienced connections to health-related skills and professions in their elective class, and this was confirmed when observing.
While observing, the first and third author captured field notes—describing what students were seeing, hearing, or doing during a lesson. These notes were shared with the second author via a Google Drive folder.
Data Analysis
Throughout this project, the goal was to engage participants in dialogue to learn about their experiences. Data was collected and analyzed throughout the study—constantly creating meaning with new data. Merriam (1998) stated that the “right way to analyze data in a qualitative study is to do it simultaneously with data collection” (p. 62). After each focus group interview, links to the audio recording files were shared with the second author. He transcribed each recording and then uploaded the transcriptions to a Google Drive folder. The first author reviewed each transcript for accuracy and to ensure that any identifiable information was removed. He then shared the transcripts with the other authors.
When reading the transcripts the first time, the first and second author engaged in inductive coding. Double-coding was used by these two authors: independently reading each transcript in their entirety, identifying themes in the data, and highlighting any quote(s) they thought related to a theme to discuss during a follow-up conversation. For example,
I had always had a desire to be in the medical field, especially coming from a middle school like STEM where they introduced you to that at such an early age. I’ve always had an interest, and I thought it would be a great way to kind of solidify that interest and make sure it was something I really wanted to pursue.
The first author highlighted “desire to be in the medical field” and inserted the comment “career decision.” The second author highlighted “especially coming from a middle school like STEM” and commented with “curriculum—building on STEM.”
After reviewing all the coded transcripts, the research team met via Zoom to discuss their codes, as well as patterns that were emerging from the data. During these meetings, differences in coding were resolved through discussion until researchers reached a shared understanding. The team then developed concept maps, see Figure 1 for an example, to show relationships between/among patterns. Vision, in the largest font, was one theme that emerged from the collected data, and data confirmed that different stakeholder groups contributed to the vision. As can be seen from this concept map, teachers were drawn to THS because of the principal’s leadership, students appreciated being listened to, and external leaders relied on the principal to achieve the vision.
Concept map.
After discussing codes and themes that emerged from the first read, the team discussed how findings related to Lusiani and Langley’s (2019) practices of strategic coherence: fueling (deciding on initial actions when starting a new initiative or project), shaping (interpreting meaning from different fields of knowledge and structuring a plan of action), and entwining (making connections and building relations with others, both horizontally and vertically, and creating meaning as data is collected). Thus, after the initial coding, the research team decided that the first and second authors would reread and recode each transcript following Lusiani and Langley’s practices. As they recoded, they noted how different stakeholder groups (i.e., external, school leader, elective teachers, classroom teachers, students) provided and/or received leadership via the Enabling Leadership Framework. Returning to the quoted material earlier in this section, the first author recoded Carol’s response to “fueling,” and the second author added “or shaping (ambition into reality?).” During the next research team discussion, the authors clarified the new codes they added and worked together to come to an agreed upon code.
Validity
Two authors had experience working with the district, the first author and school principal; however, as stated earlier in this manuscript, the principal was a doctoral student, and her participation in this study was to learn more about and better understand qualitative research. We still, however, had to deal with potential biases. Our assumptions were that (a) the teaching of health-related skills and professions in all academic disciplines rarely occurred, (b) most teachers lacked the knowledge to teach these skills and professions, (c) students had little to no voice in what was taught in each classroom, and that (d) non-elective teachers did not believe it was their job to teach health-related skills and professions. “For bias, what is important is to understand how you are influencing what the informant says, and how this affects the validity of the inferences you can draw from the interview” (Maxwell, 2005, p. 109). We wanted to be as accurate as possible with how we described and explained and did our best to counter bias by expecting each research team member to read and code transcripts prior to working together to generate themes. By identifying our assumptions, we brought to the forefront personal biases that we needed to be aware of throughout this study.
Focus group interviews were conducted by the first author, and standardized procedures were followed. An interview guide was used during student and teacher focus groups, and the same questions and procedures were followed for each group respectively. All feedback was accepted from participants, and it was assumed that all individuals provided their honest perspectives. To mitigate potential influence and ensure open conversation, the principal was not present during these interviews. Participants were made aware that data would initially be handled by researchers who were not employed by the school or district and that all data would be kept in strict confidence to ensure responses were not linked to any one individual.
Multiple sources of data from teacher focus groups, student focus groups, and observations were reviewed and analyzed by the first author. The second author, one who had no knowledge of the research site, reviewed and analyzed the data next, and their interpretations were compared. The triangulation of data and approach to analysis assisted in determining if the data collected appeared to represent the teaching of health-related skills and professions in all academic disciplines. If discrepancies arose, then we had plans for the first author to return and clarify their experiences. Fortunately, this was not necessary because the data remained consistent. And by digitally recording each focus group interview, we had reliable access to what interviewees said. We shared our interpretations with teachers and students to ensure that the data collected was accurate. We also had access to observation data to compare verbal responses with field notes to validate the findings.
Results
From our inquiry, we concluded that (a) vision builds environment, (b) environment brings about professional challenge, (c) support with professional challenge brings collaboration, (d) collaboration enables cross-curricular teaching and learning, and (e) sustaining cross-curricular teaching and learning becomes a responsibility for everyone. What students expected from THS differed from their actual experiences and, to achieve the vision set by the school board, the principal needed to create an environment where teachers had ample time to learn about and expand their knowledge and skills of health-related skills and professions and give students and teachers agency to decide on ways to improve the student experience.
The elements included in Table 2 highlight some of the data that was collected from different stakeholder groups over time and that supported our conclusions. These elements evolved and developed further each time we met and highlight actions taken by each stakeholder group. What is unclear is exactly how this evolution took place. The lack of clarity could be due to (but not limited to) the amount of time spent onsite by the researcher team, daily informal/formal interactions between/among departments and grade levels, or maybe the complexity within the environment (e.g., internal and external personnel). What we do know is that change was likely due to many factors.
Elements.
Note. THS = Texas High School.
Continuous analysis using codes from the Enabling Leadership Framework revealed that both structural and ecological approaches to leadership (i.e., student and teacher agency) were key to enabling teachers to talk and collaborate. This included a principal who encouraged teachers to be curious, try new things, and share ideas with others; a principal who was present and involved in discussions; a principal who structured opportunities for teacher talk to develop; and a principal who encouraged students to speak freely about their experiences. And a subtheme underpinning the collaboration between/among teachers was using shared digital objects (e.g., Google Drive, Excel spreadsheets) to further enhance the quality of teacher interactions.
Data collected also shed light on how the elements from the Enabling Leadership Framework were ever changing due to continuous input. Table 3 shows some of the input that various stakeholder groups (SB—School Board, SL—School Leader, T—Classroom Teacher, E—Elective Teacher, S—Student) contributed to fuel actions toward understanding student experiences and to gain a deeper understanding of what teachers knew about health-related skills and professions and/or cross-curricular teaching and learning.
Elements Connected to THS.
Note. THS = Texas High School.
The fueling actions were shaped and reshaped because of the pilot unit and the interdisciplinary projects that were developed throughout this project. Regular feedback collected from students and teachers (entwining) brought about new learning and/or ways to develop interdisciplinary units that included health-related skills and professions.
Fueling Leads to Shaping
When applying to attend THS, students expected that their teachers would design and deliver engaging lessons that were health-related:
“I expected classes to be medically focused and really hands-on.”
“I expected classes to be more challenging than a traditional high school, and I also expected it to be more medically based.”
“Classes will be challenging and medically based. They will be hands-on to really make you feel engaged as if you’re in a medical school.”
Teachers understood what students were asking for yet many acknowledged that they needed to understand how to act on this feedback when they lacked knowledge of health-related skills or professions. For example, how do you incorporate health-related skills or professions in all academic disciplines and across all grade levels? What does it look like to include health-related skills and professions in geometry?
Shaping Leads to Entwining
If THS was going to achieve the revised vision, all teachers needed to be open to connecting and conversing with colleagues who taught in different grade levels and who taught different subjects. And they would have to be willing to act on student feedback to execute the redesign. This would require time and direction. The principal had to understand others’ experiences, knowledge, and identity and then use these to enable leadership.
Leadership
What we learned throughout this project was the importance of a principal who was willing to lead. A leader who was flexible, present, and curious; built trust; showed empathy; and involved diverse perspectives in decision-making. At THS, the principal’s espoused theories aligned with her theories-in-use. She (a) studied and learned from others, (b) valued the input from teachers and students, and (c) was an active participator and contributor during conversations. Students and teachers noticed:
“Every morning when the announcements end, the school principal says to be prepared to put yourself at the front of the line.”
“I’m just thankful to be here. The staff doesn’t just care. The principal doesn’t just care about the students and about the grades. They care about the students in general. They put a bunch of thought into what they do at the school.”
“After initially starting to teach at THS, I saw the faith that administration had on us [health science teachers] to put out what we know, our knowledge in the industry, and share it with kids.”
Vision
To achieve the intended vision, the principal needed to be a key influencer who assisted teachers in navigating internal and external pressures. She found herself, as France (2021) suggested, “Zooming out to the system level and first asked: What systemic constraints are wearing our teachers down? What procedures, policies, or pedagogies are we using or proposing that are unsustainable?” (p. 37). Internally, teachers understood what students expected from their schooling at THS; however, planning with teachers from other academic disciplines was new and how to include health-related skills and professions during daily lessons was a different way to plan. Externally, the principal had to maneuver demands from district department curriculum specialists who expected THS teachers to follow prescribed curricula, implement district-wide initiatives, and/or participate in district-wide professional development that was not always aligned to the THS vision. If THS was going to redesign instructional practices to include health-related skills and professions in all academic disciplines, then these external pressures had to be dealt with. As Hirsh and Killion (2007) stated:
When central office staff relinquishes to school-based leaders key decisions about a school’s goals and the pathway to achieving those goals, interventions are often more focused on the unique nature of the school and its students and staff. When teachers’ voices shape the nature of professional learning, their learning is deeply connected to their classroom work, students’ learning needs, and the curriculum they teach. (p. 39)
Teachers needed time to work together internally without external pressures to conform.
Environment
A positive culture includes getting to know your people, growing them, allowing them to be heard and have voice in decisions, having safe spaces to take risks and to be vulnerable, sharing confusions, asking questions, and knowing that they can trust others. During the spring of 2022, after implementing the cross-curricular diabetes unit, ninth-grade students were interviewed to learn about their experiences. Students shared that there was some redundancy in activities and that some of the connections to health-related skills and professions seemed forced. For example, one teacher who did her best to make a connection between diabetes and geometry without a deep knowledge of health-related skills or professions. Students were, however, pleased by the teachers’ efforts. Students said:
“I would first give them [teachers] props and say thank you because it’s honestly been a really great change. It’s made the school really feel like a medical school even more than before. We’re learning more now with the way they are teaching and getting a lot more information.”
“I would give them [teachers] props as well because it’s not easy to think of a whole lesson plan based around medicine. Most teachers don’t really have any background knowledge in the medical field.”
“Thank you for changing lesson plans to fit our needs.”
This feedback was shared with teachers, and it was encouraging to them that their students were noticing their attempts to include health-related skills and processes across academic disciplines.
During the 2022 to 2023 school year, teachers from all grade levels and academic disciplines worked together to design interdisciplinary projects. In one class, students studied how diseases and vaccines changed throughout history, in another class they wrote health-inspired poems and read medical stories, and in another class, they applied infection rates when graphing. When interviewing students from the original focus groups, now tenth graders, one student said:
“Last year, we were just doing diabetes, but this year it’s like doing different things in every class. You see that change [in instruction] is more natural, not so repetitive.”
The evolution of the redesign was becoming more apparent as student feedback was collected and teachers adjusted their instruction.
During the 2023 to 2024 school year, quarterly cross-curricular projects were planned (see Table 4), and students appreciated that their input was valued and used.
“We can help the administration improve what we are learning and how we are learning it because it is a different experience for them. They are not just in charge. We are learning what they’re trying to teach us, and the interviews help them get an insight into what we are learning and how they can help improve our learning experience at THS.”
Teachers started to notice changes when meeting with grade level and/or department colleagues:
“I know that in our grade level meetings we’ve been more conscious and more intentional in implementing and relating the health-related field or the topic that we chose for that quarter and our curriculum.”
Quarterly Cross-Curricular Projects.
Teachers also started to notice changes in their instructional practices and were becoming more creative in how they made connections between their academic content and health-related skills and professions. For example, while studying the skeletal system in anatomy and physiology, students created a cast for a broken bone of their choice and wrote about the incident. In English, students chose a bone, used modeling clay to create a character that represented that bone, and then wrote a narrative essay.
Enabling Agency
Establishing and adhering to a clear vision helped build a school environment where students felt heard, and teachers felt empowered to act on student expectations. As teachers from across grade levels and departments cooperated with each other, collaborative relationships formed. These relationships led to deeper conversations about creating meaningful experiences across academic disciplines that focused on incorporating health-related skills and professions in all classrooms. Teachers had a sense of ownership and empowerment to create experiences based on student expectations and feedback.
Teachers were recognized and valued as “drivers for school improvement, as opposed to being the targets of improvement….to explore issues and determine resolutions through shared inquiry, reflection, and dialogue” (Donohoo & Velasco, 2016, p. 6). Participants owned the inquiry as they worked together to make design decisions, draw conclusions, and connect learning to outcomes. They listened to student feedback and continued to seek feedback from their colleagues to learn about new ideas and/or approaches to make learning relevant to health-related skills and professions. In essence, teachers interrupted their habitual ways of teaching (Priestley & Drew, 2019) because of this new knowledge they were gleaning.
Although agency was evident when teachers had ownership, students also demonstrated agency. Students shared their expectations for THS, provided feedback after teachers implemented cross-curricular projects, and had choices in when completing projects. One student said:
“Not only are they [teachers] taking the extra step to incorporate medical into their assignments, but they are also willing to answer our questions to make sure that we are understanding…It’s just very personal. I also appreciate that the school is asking all these questions, interviewing students, and actually making a change.”
Discussion
Exploring leadership and its impact on teacher and student talk is important as it helps us refine the enabling factors which support collaboration between/among teachers. This article shows how, in one high school, a range of leadership considerations needed to be made to support teacher talk. The principal needed to plan for and consider how teacher and student talk might be enabled structurally and ecologically within their school. Vision built environment, environment brought professional challenge, professional challenge brought collaboration, and collaboration enabled interdisciplinary teaching.
The use of the Enabling Leadership Framework to analyze the collected data provided insights and opportunities to redefine and reshape individual views. Dialogue allowed the opportunity for participants to take risks, share opinions, express feelings, and push others to deeper conversation. And the inclusion of student feedback brought about many insights. This study advances Schoots-Snijder et al.’s (2025) findings to explore the “sustained impact of curricular interventions promoting study agency over extended periods” (p. 20). We learned that no one agent fully “owns” any practice in a school setting; the key practices of constructing coherence happen in interaction among a plurality of individuals and artifacts. Practices clearly implicate practical skills and competences–skillfully enacting the practice by answering questions and co-orienting toward integration of their ideas into the formalized frameworks. And these frameworks are themselves clearly co-constituting this practice.
To enable dynamic capabilities associated with the adaptive process, leaders must create a learning culture in which individuals can speak openly about knowledge requirements and take steps to implement knowledge in support of firm goals (Cepeda & Vera, 2007). Leaders must be able to recognize potentially valuable experiments happening at all levels, within and outside the organization, and to encourage and motivate all units and external collaborators to actively participate in experimenting to identify novel solutions within the ongoing functioning of capabilities (Salvato, 2009). The collaborative nature of this redesign allowed interactions to take place between and among various stakeholder groups (e.g., students, teachers, principal). Individuals throughout THS were seeing that “change is sustainable when it is initiated by teachers—within a supportive professional learning community” (Donohoo & Velasco, 2016, p. 19). Sustained professional learning focused on the school’s vision led to growth in teacher knowledge and skills, including ways to incorporate health-related skills and professions in all classrooms. As sustained professional learning continued, teacher practice changed as did student experiences.
Findings from this study helped us to understand what is required when embarking on systemic change. Snyder and Snyder (2023) posed the question, “Where do we begin the quest to reach whole system coherence?” We learned that where a system begins to reach whole system coherence is with vision. This finding is supported by Shibiru and Bekele’s (2024) literacy review titled, Leading Change and Innovation Effectively in Secondary Schools.
When studying interdisciplinary teaching that could lead to the teaching of health-related skills and professions in all academic disciplines, we learned that “Effectively facilitating improvement in education demands keeping students at the center of all improvement efforts” (Le Fevre et al., 2020, p. 121). Students input and feedback was essential in understanding what needed to change (Mannion, 2025). Their insights and contributions led to the understanding that one thing that needed to change was internal visioning to guide sustained professional learning and not external pressures from some individuals in the central office. Although the latter might emphasize the need for standardized curricula and/or hierarchical decision-making, this approach would’ve maintained the status quo and likely hindered the collaboration and innovation that occurred (Haddock et al., 2020; Hardman, 2012).
Findings from this study also build on Adelman and Taylor’s (2007) four phases to consider when planning for systemic change. These phases included: Phase 1—Creating Readiness, Phase 2—Initial Implementation, Phase 3—Institutionalization, and Phase 4—Ongoing Evolution. Creating readiness included sharing the vision and purpose for more interdisciplinary teaching, building knowledge, creating interest, and identifying early adopters. The initial implementation phase included the design of one interdisciplinary unit focused on diabetes. The institutionalization phase involved scaling up participation, including grade level quarterly project discussions and planning, additional time learning from elective teachers, and academic discipline discussions about ways to make connections with health-related skills and professions. The final phase focused on ongoing evolution, continuously adjusting and improving interdisciplinary units based on observations and feedback. If interdisciplinary teaching was to be the norm, then there needed to be a plan at the onset to engage others who could maintain and sustain the teaching of cross-curricular units.
As we reflected on this study, several things surprised us. This included systemic change and sustainability, principal involvement, importance of student voice, and teacher leadership. We were also surprised by the lack of participation from some central office personnel. First, systemic change takes focus, time, and commitment. We shared earlier in this paper the research findings from Hall and Hord (2015). That is, change takes a minimum of 3 to 5 of years for everyone in the system to change. This studied lasted approximately 3 years, 2021 to 2024, and, of as late 2025, THS continues to adjust and implement interdisciplinary units even with teacher turnover. Those experienced with interdisciplinary teaching serve as advocates for others, introducing and modeling interdisciplinary teaching and health-related skills and professions for new teachers to sustain what they started several years ago. Second, the school principal stayed involved throughout this study and maintained a focus on achieving the vision. This could have been partly due to wanting to learn more about qualitative research; however, the fact that she continued to model what was expected, including her own learning, and creating the conditions for teachers to engage in sustained professional learning, demonstrated her investment to achieve the vision. Third, student insights regarding coursework and reasons for wanting to attend THS led to a shift in teaching practices. Although many teachers were surprised by the feedback from the first student focus groups, they did not shy away from the challenge. Our fourth surprise was the teachers’ willingness to adjust their teaching to best meet student needs even though some may have been anxious about the new learning they would need. At the end of this study, teachers developed 19 quarterly, interdisciplinary units that a student would experience if they attended THS from eighth through twelfth grade. A fifth surprise was how elective teachers took on leadership roles. Although most possess a technical degree only, not an education degree, they were instrumental in teaching others about health-related skills and professions, including ways to incorporate these skills and professions into other academic disciplines. A final surprise was the lack of engagement or knowledge by instructional specialists who were employed at the central office level; individuals who serve as leads for the various academic disciplines. Although teachers from THS were expected to attend districtwide professional development, these sessions were geared for all secondary schools in the district. Yes, teachers were provided resources from these instructional specialists, yet many of these resources were specific to academic disciplines and not related to interdisciplinary teaching or health-related skills and professions. It could be that instructional specialists did not know how to provide support, did not have time to learn about other academic disciplines, or had other responsibilities that took them away from being more involved. Regardless, this sheds light on the role of central office instructional specialists when it comes to a school vision. How, if at all, do central office staff work together to personalize their support for the individual schools whom they serve?
Limitations
As with any study, there are potential limitations. This study included one high school along the United States and Mexico border and findings may not be generalizable. However, given our approach, many schools, whether primary or secondary, could realize the importance of setting a clear and staying focused on a vision and involving others when making decisions. Additionally, there are school districts (e.g., charter, magnet, individual schools within the district) who promote a specialty area (e.g., STEM, health) that might find the results of this study helpful in their course offerings or curriculum development.
Personal biases or interpretations can be limitations as can time constraints. We used standardized interview protocols, had external researchers analyzing the collected data, and shared of findings with teachers to best mitigate our personal biases and interpretations. Regarding time constraints, we could have spent more time collecting additional data from all teachers to better understand the changes they made to their instructional practices. This could have included (but not been limited to) learning more about how they increased their knowledge of health-related skills and professions or interdisciplinary teaching, how they used their time when meeting with colleagues to plan, or how individuals decided how they would adjust their instructional methods. Had there been more time or had we planned for additional input, we could have also scheduled time with instructional specialists from the central office to better understand their roles with the redesign at THS. This could have included (but not been limited to) understanding their knowledge of interdisciplinary teaching, their knowledge of content to teach in a high school classroom, or if the local school board and community expected them to have a role in this redesign.
Conclusions
Although this study took place in one high school, expecting all teachers to teach interdisciplinary units focused on health-related skills and professions adds to existing research. This study adds value to practice as a common focus on including health-related skills and professions across academic disciplines led to a deeper understanding of how teachers could work together to design cross-curricular experiences for students. This study sheds light on how a clear vision can lead to focused, sustained learning opportunities for all teachers in a school. In this case, ongoing opportunities for teachers to learn about interdisciplinary teaching and health-related skills and professions, see demonstrations, practice, and receive ongoing support from colleagues (Blank & Alas, 2010; Joyce & Showers, 1982; Timperley et al., 2014). Unfortunately, too often, schools provide few opportunities for individuals throughout the system to learn about and implement a new skill or practice or do not follow through on change initiatives. This can often be the result of an unclear vision or plan.
Bob Tschannen-Moran (2010) concluded years ago that teachers often resist those who try to force them to change; they don’t resist making changes. If considering a change or programming redesign, it seems important to set and stay focused on the vision. Involve others. Start with a pilot group of individuals who want to experiment and develop new skills. Address challenges and celebrate successes along the way. Use pilot teachers as leaders who expand the redesign with others and who can inspire change from within. Know what you want to achieve. Take time to learn from students. They can provide insight into what’s unknown, and can influence the organization, society, and pedagogy (Fullan et al., 2018).
Footnotes
Acknowledgements
The authors thank students and teachers for their insights and contributions, as well as the local school district for allowing us to conduct this study.
Ethical Considerations
This research project was approved by the Harlingen Consolidated Independent School District’s Office of Data Governance and Outcomes on February 23, 2023.
Consent to Participate
Each participant was (a) made aware of the purpose of the research, duration, and procedures; (b) made aware that their participation was voluntary and that they could decline or withdraw from the research once participation began; and (c) given a consent form to sign. This study included normal educational practices and curricula, and only anonymous disclosure of responses are included in the manuscript to maintain confidentiality.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article:
Data Availability Statement
All data generated during and/or analyzed during this study are available from the corresponding author on reasonable request.