CME Must Adopt a Standard Approach To PI CME

January 22, 2010 at 5:53 am Leave a comment

I’ve Blogged on this before and probably will again. CME providers must adopt a nationally accepted standard for PI CME initiatives.

Industries have adopted  systematic, repeatable, sustainable approaches to improvement and have seen great success. Take Toyota for example. And in the US Ford motor company, Motorola, Ritz Carlton and many many others. And heathcare organizations across the country are getting on board by adopting a core value for consistently improving the services provided to patients entrusted  to their care. Read the book “The Nun and the Bureaucrat” if you want an eye opening account of improvement innovations in heathcare.

There is a good argument to be made for encouraging the medical profession to adopt a standard approach to performance improvement and PI CME. The continuing emergence of evidence based medicine suggesting standard approaches to patient care measured against acceptable guidelines are part of this very same phenomenon. Standardization reduces variation. Reduced variation results in stable processes. Stable processes can be improved with the result of more consistent desired outcomes. Unstable processes cannot be consistently improved.

If all physicians engaged 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.

The core of improvement systems is rooted in the classic Plan, Do, Study, Act cycle – a scientific approach to problem solving. And healthcare providers are expertly trained to carry out this scientific approach to problem solving. 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 take assessment of a part of their practice related to an issue of concern to determine the current situation; they 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 make a diagnosis based on these data; they prescribe a way to resolve the problem; and then they check for the effect of the treatment.

Performance improvement in healthcare are those disciplined, systematic, repeatable efforts engaged in by healthcare professionals and the healthcare system to perfect the work of patient care. These efforts are not random sets of activities. There are common elements in virtually every description of performance or quality improvement 1,2,3,4 that include:

  • Recognition of the importance of context.
  • A specific definition of desired performance.
  • A measured assessment of current performance
  • A careful analysis of the gap between current and desired performance.
  • A logical fact based assessment of the causes of the gap between the current and desired performance.
  • Carefully selected and designed interventions that address specific root causes of the performance problem.
  • Execution of the planned intervention(s).
  • An assessment of the impact of the intervention on current performance to assess the extent to which the desired performance has been achieved.
  • A monitoring and approval process throughout the entire improvement effort involving those affected by each decision made an action taken in an effort tot achieve the desired outcomes.

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.

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.


  1. Jimmerson, C. A3 Problem Solving for Healthcare. HCP Press. 2007.
  2. Shook, J. Managing to Learn. The Lean Enterprise Institute. 2008.
  3. Sobek, D. and Smalley, A. Understanding A3 Thinking. CRC Press. 2008
  4. Langley, G. et. al. The Improvement Guide. Jossey-Bass, 1996

Entry filed under: CME, Continuing Medical Education, Improvement.

Category 1 CME Credit Criteria Should be Changed Conjoint Committe on CME sets 2010 Goals

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