A Call for a Standard Approach to PI CME
The American Medical Association has approved a framework physicians can use to engage in performance improvement and earn CME credit. The framework is useful but guidance for how to engage in effective performance improvement initiatives that will result in sustainable change is missing in the framework. In fact, the simplicity of the model may be a disservice to the physician wanted to engage in effective performance improvement efforts. But there is a solution. The solution is to adopt a nationally accepted standard for the implementation of PI CME initiatives. I think is a good idea.
There is a good argument to be made for encouraging the medical profession to adopt a standard approach to performance improvement and PI CME. With all physicians engaging in a standard approach to PI CME a coherent, common transferable set of skills is established that facilitates effective problem solving, encourages effective communication within and across practices and institutions, and fosters the transfer of innovations shown to improve the delivery of patient care.
A standardized system of performance improvement would contain the following elements:
• A logical thinking process
• Value for results as well as process
• The synthesis of ideas, distillation of issues, and visualization of processes
• Alignment with organizational and professional development goals
• A coherent approach to problem solving that could be applied consistently across all problem solving tasks
• A systems viewpoint
Most approaches to performance improvement encourage an approach where results are achieved through a process and utilization of tools that:
• Considers context
• Engages all the effected parties in an improvement effort
• Describes actual performance
• Defines desired performance
• Assesses the gap between current and desired performance
• Finds root causes
• Selects effective countermeasures
• Implements countermeasures
• Monitors and evaluates performance
• Standardize improvements
If you are familiar with the core of many improvement systems you know this process is rooted in the classic Plan, Do, Study, Act approach to improvement. This is a scientific approach to problem solving that healthcare providers are expertly trained to carry out.
Physicians can approach a PI CME activity the same way they approach treating patients. They use the same skills used in a basic clinical decision making process with their patients. The difference is that they are looking at the practice and not at an individual patient. In a PI initiative they will take a history and physical assessment of a part of their practice related to an issue of concern to determine the current situation; they will gather additional information to establish the root cause of the problem to get at the most likely the cause for not meeting desired performance standards; they will make a diagnosis based on these data; they will prescribe a way to resolve the problem; and then check for the effect of the treatment.
This process is almost a direct parallel to the steps taken in a performance improvement initiative. What is called for is a simple, logical approach to PI CME that every physician in the country can use to engage in performance improvement with the healthcare team. Such an approach exists. It is the standard approach used by Toyota manufacturing that every employee is trained to use. It is called “A3 Problem Thinking”. A3 thinking is a powerful approach to problem solving that creates a structure to implement the PDCA cycle. It requires those involved to engage in efforts to develop a deep understanding of a problem or opportunity, leading to insights on how to address the area of concern. It is an objective, data based, collaborative approach to improvement that can be taught to every healthcare professional on the care team. It will lead to a culture of improvement that is required to foster continuous quality improvement.
The A3 approach to problem solving can easily become the national standard guiding performance improvement CME.
I think CME providers adopting this approach to PI CME on a national basis will produce a CME provider with practical skills valued by the healthcare system, add value to our organizations and our physician constituents, and position the CME provider as a major player in the bridge to quality in healthcare.
I have started a training program for CME providers designed to introduce A3 thinking and its application to PI CME. Those of you interested in learning more about this can contact me by e-mail at firstname.lastname@example.org or post a response to this blog.