Are You Systematically Engaged in Performance Improvement in Your CME Operation?

My brother has worked industry for over 30 years. Many of those years he has been directly engaged in improvement initiatives. Now, in his own business, he works with many types of enterprises, including healthcare, helping them identify and engage in ways to improve their operations. He also teaches these skills to students in a business college in the Midwest.

In training situations he is fond of asking those in attendance, “How many of you had a perfect day at work yesterday? A day in which everything went perfectly where there were absolutely no problems, no issues, zero hassles”. You know, not one person has ever raised their hand saying that was my day. Then he asks this, “How many of you went to work yesterday with the intention of doing a bad job?” Again, no one raises their hand. Then he asks, “How many of you are engaged in a conscious effort to improve or start improving something that went wrong at work yesterday?” Again there are no hands raised. What does this say about how we approach our work? Everyday we can count on something going wrong. We do not go to work everyday intentionally to do a bad job. Yet, everyday we do nothing systematically to improve our work world.

Our customers, those we serve in CME, are required to engage in improvement efforts to earn CME credit. They have to be engaged in efforts to improve their capability to practice (competence), their actual performance, or the health status of the patients they care for. As an ACCME accredited provider we have to measure those improvements.

Most CME providers I talk to are not engaged in a systematic, sustainable, repeatable effort to improve their own CME operation. What better place to learn how to develop improvement skills in our customers than to engage in improvement efforts in our own CME operation?

Here is an invitation. My brother (the one I mentioned earlier) is going to work with me on this. We are looking for five people interested in learning, and then participating in a four month pilot test of a systematic sustainable, repeatable approach to improving their CME operation. It is also an approach you can teach physicians to use in PI CME or any improvement initiative in their practice setting. We will learn this approach by participating in a series of four one hour discussions on Go To Meeting. No charge to you. After the orientation, we will use a page created Facebook to communicate our progress, ask questions, share experiences, and, ultimately share our outcomes. If you would like to participate in the pilot project contact me at ctlassoc@mindspring.com.

I firmly believe that if we adopt this approach to improvement we can transform a CME operation, we can provide physicians an effective approach to improvement efforts in their practice, and we can generate data demonstrating that our CME program is a strategic asset in our organization.

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.

From My “For What It Is Worth Musings” About PI CME

A thought.

There is a need for serious conversation about what we mean by PI CME and what is required of PI CME to have any lasting impact in improving the delivery of healthcare. It is no longer enough simply to consider how physicians learn – an emphasis promulgated by the adult educators (and I am one) far too long. While an understanding of how physicians learn is important, it is not enough. The end product of learning – knowing- is not enough. Physicians know how to do far more than they actually do in providing care.

The more important question is where physicians learn. Physician learning takes place at three levels. First, it occurs in the physician-patient interaction where care is being provided. Second, it occurs in the organizational systems and work processes that comprises practice settings. And third, it occurs in the socio-political-economic systems that frame healthcare delivery. These are each sub-systems of our larger, very complex healthcare system. Change occurring in one subsystem requires change in other subsystems. That is how systems work.

If structured in a way that acknowledges learning occurs in these subsystems PI CME can have a major role in effecting change in physician competence and performance in complex health systems. I believe this. I also believe that CME professionals need to understand improvement theory and the tools used to effect improvement in complex health systems. PI CME offers the CME professional a way to add tremendous value to their organization. We need to step up and take advantage of this opportunity.

Can PI CME Effect Permanent Change? Maybe- Maybe Not!

For permanent change to occur in the practice of medicine there must be a change how the work of patient care is done. Performance improvement and systems based thinking are two sides of the same coin. KNOWING IS NOT ENOUGH.

CS2Day PI CME and Handheld Projects

Interested in hearing about four different approaches to PI CME? How about the use of handheld technology to support physician patient care. The CS2Day collaborative smoking cessation program includes these types of activities. Listen to Dr. George Mejicano describe these activities and some of the design features put in to measure the effectiveness of these efforts.

ABMS Adopts New MOC Standards

The ABMS has adopted a new set of standards designed to enhance physician qualifications assessed through its Maintenance of Certification® (MOC) program. The new standards outline and set timelines for officially adopting several MOC program elements, including:

* Documentation that physicians are meeting continued medical education (CME) and self-assessment requirements
* Evidence of participation in practice-based assessment and quality improvement every two to five years
* Completion of a patient safety self-assessment program at least once during each MOC cycle .
* Assessment of communication skills as a standard for all physician diplomates with direct patient care – using a Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient survey (or other COMMOC-approved survey), and an approved peer survey.

The national movement toward performance measurement includes evidence of practice changes to improve quality in the practice process or structure of patient care. These standards suggest many opportunities for CME providers to serve our physician constituents by offering a robust PI CME program.

Let’s Not Forget the “Performance” in PI CME

Should we encourage the physician participating in a PI CME initiative to engage in a dialogue in the practice setting around what is the right thing to do to meet expectations?

Do we have the skill set to do that or do we need to develop that skill set? Not a rhetorical question.

PI CME: The Unintended Outcome?

If you have been following this blog for a while you know I have a particular interest in “Performance Improvement CME”. Recently I have done several podcasts with CME professionals engaged in providing PI CME to their constituents. One striking outcome is being reported almost universally in these efforts. When physicians or groups of physicians engage in an effective PI CME initiative they not only make significant changes in their performance, they report they are learning a systematic approach to improvement they can replicate in other improvement efforts.

Not one of the CME providers I talked with indicated this was an outcome they intended. But to me this is an outcome as valuable as the intended performance changes in patient care. CME providers are teaching skills that are transferable to many different improvement interests. Perhaps we should consider physicians gaining this skill as an intended outcome of our PI CME efforts. It does mean we have to be very deliberate in teaching “improvement science” which may require some professional development of our own.

What do you think?

PI CME: The Wisconsin Experience

Listen to this conversation with Beth Mullikin, MS, Outreach Program Manager for the Office of Continuing Professional Development in the University of Wisconsin School of Medicine. If you are interested in PI CME I think you will find it very informative. Beth has a number of resources used to monitor PI CME initiatives and she is willing to share them. You can contact her at eamullikin@wisc.edu.

CS2Day PI CME and Handheld Projects

Interested in learning about four different approaches to PI CME in a smoking cessation initiative? How about a handheld project that prompts heath care providers on next steps to take in caring for the patient who smokes? Listen to my conversation with Dr. George Mejicano as he gives a description of these initiatives. He also describes some things in the outcomes evaluation that will be very instructive when choosing an approach to PI CME.