Called Out By Kopelow

July 25, 2008 at 8:32 pm Leave a comment

Well seems my last Blog “ACCME Should not Adopt Proposed Criteria – Yet” was read by at least one person. I got a call from Dr. Murray Kopelow , Chief Executive of the ACCME saying I should “put my money where my mouth is”. If you read my Blog I suggested that improvement science might have some tools that would be helpful in understanding the kind of variation ACCME is seeing in accredited provider non-compliance with the standards for commercial support. ACCME reports a10% non-compliance in this area. What prompted my suggestion was the proposed criteria from ACCME that defines what conditions should me met for commercial of individual CME activities. Here they are.

1. When educational needs are identified and verified by organizations that do not receive commercial support and are free of financial relationships with industry (eg, US Government agencies), and

2. If the CME addresses a professional practice gap of a particular group of learners that is corroborated by bona fide performance measurements (eg, National Quality Forum) of the learners’ own practice; and

3. When the CME content is from a continuing education curriculum specified by a bona fide organization, or entity, (eg, AMA, AHRQ, ABMS, FSMB), and

4. When the CME is verified as free of commercial bias.

Alternatively, these conditions could provide a basis for a mechanism to distribute commercial support derived from industry donated pooled funds.

These conditions are additive folks. All would have to be met in the eyes of ACCME for commercial support to be appropriate. If adopted every accredited provider would only be able to accept commercial support if all four conditions were present.

Ok. So the literature review commissioned by the ACCME suggests that no empiric data exits to support the contention that commercially supported CME is biased. It may be but there are no data to demonstrate that proposition. There is a 10% non-compliance rate. Why? Before new conditions are proposed shouldn’t we understand the causes of the non-compliance and try to address those? Simply piling on new rules and regulations seems to me to be a response driven by a “quality assurance” model not a “quality improvement” model. Perhaps ACCME does know the major causes of non-compliance and are not sharing the information. Their privilege I suppose.

I digressed. So what did I provide in response to the challenge issued by Dr. Kopelow?

Murray,

I appreciate that at least one person is reading “Conversations in CME”. You asked that I send you some resources from improvement science that I think might useful in efforts to improve the work of the ACCME. It would be presumptuous of me to take on a task that large. However, to the point I made in the Blog. There are tools on improvement science that can be used to look at systems and processes that are instructive of the performance of those systems and processes. The specific issue I was addressing was whether there is a need for additional conditions promulgated by the ACCME to “regulate” commercial support for CME. My underlying question was “Has ACCME looked at the issue of non-compliance with the ACCME Standards for Commercial Support SM to identify the major causes of non-compliance?”

I assume there are leaders at the ACCME who are familiar with the classic literature in Quality Improvement like that of Juran, Shewart, and Deming. Further I assume those same people are familiar with a the straightforward book on quality “The Improvement Guide: A Practical Guide to Enhancing Organizational Performance” by Langley et. al. Of course there is literature and resources available related to Six Sigma and LEAN that I find very helpful. You might find the websites www.qualityamerica.com, http://www.managementhelp.org/quality/quality.htm, and http://mot.vuse.vanderbilt.edu/mt322/library.htm#Module%202. I find the Vanderbilt “Quality Library very useful. There are some resources in the management help site related to Total Quality Management that I think provide thoughtful resources concerning the creation of an improvement culture as a management style.

One of the Seven Basic Quality Tools http://www.asq.org/learn-about-quality/seven-basic-quality-tools/overview/overview.html) is the Pareto Chart, a simple bar graph showing which factors are more significant than others. It is useful when:

  • analyzing data about the frequency of problems or causes in a process.
  • there are many problems or causes and you want to focus on the most significant.
  • analyzing broad causes by looking at their specific components.
  • communicating with others about your data

One way to look at the issue of non-compliance with the commercial support standards is with this useful tool. Based on the results of this analysis, decisions could be made about which factors to pursue as improvement opportunities. Other tools of quality like root cause analysis using a cause and effect diagram might also be useful as the improvement effort moves forward.

So this is what I meant when I said I thought there were tools in improvement science that could be useful to ACCME. These are tools that quality improvement efforts in the health care setting use all of the time. These are tools that CME providers need be conversant with if there are to be successful integrating some of their efforts onto quality improvement. These are the tools I encourage the ACCME to use in its efforts to continuously improve the accreditation system.

Floyd Pennington, PhD

President, CTL Associates, Inc.

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Entry filed under: ACCME, Accreditation, CME, CME Issues, Continuing Medical Education, Physician Continuing Education.

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