Posts filed under ‘PI CME’

Do We Have a Problem with our Problem Solving Behaviors?

In our drive to design CME activities that we hope will demonstrate impact or improvement on a professional practice gap we often jump to potential causes or even solutions before we fully understand the real nature of the gaps that give rise to presumed educational needs.


Continue Reading August 30, 2011 at 2:14 am 2 comments

Physian Performance and Quality – No Relationship?

“Performance improvement” CME

I found on a Blog called Trusted MD. It is syndicated by R. W. Donnell | Mon, 04/18/2011

It is a response to a comment by Daniel Carlat a few days ago.
about the emerging importance of PI CME.

He says, “I knew we were moving in this direction but I was not aware that “PI CME” was official. Dan Carlat blogged this yesterday. As one would expect he’s mainly concerned about industry getting in on the trend, but between the lines of his post I read a measure of concern about the whole idea of PI CME. I’m concerned too. Performance has little to do with quality, or good doctoring by any definition.”

Unbelievable!  What physicians do – their performance – has little to do with quality, or good doctoring”? I completely understand there are many determinants of quality and good “doctoring”. To assert that what physicians do -their performance- in patient care has no impact on quality is unfathomable to me.

April 19, 2011 at 8:18 pm Leave a comment


PI CME is gaining traction but there are still few physicians taking advantage of this learning format. Some physicians still say they have no idea what PI CME is. Others say they are too busy to engage in this form of CME because takes too much time or it is too much trouble. So why should we be diligent in offering PI CME and trying to increase the number of physicians engaging in this dynamic learning format? I can think of a number of reasons.

  • Improvement is a part of the fiber of the practice of medicine. Every physician I have ever met is continuously seeking ways to provide optimal patient care. They are constantly looking for ways to improve the outcomes their patients can achieve.
  • PI CME is physician centric. Yes it is “All about me”. Me as a learner. My practice. My patients,
  • PI CME is data driven. Physicians are scientists. Data are important. Data derived from their own practice and compared to “best practices” is informative and challenging. You change what you measure.
  • Engaging in practice improvement activities is required for Maintenance of Certification and is in the framework for Maintenance of Licensure. Accredited hospitals must engage physicians in improvement efforts in their own settings. Some third party payers are offering incentives for engaging in improvement initiatives that can demonstrate better patient outcomes.
  • PI CME is aligned with sound adult learning principles – physicians learn by solving problems. They have a need to know. This, among other principles, is core to adult learning. .

The AMA has a framework for offering PI CME credit. One of the best things the CME profession could do to support PI CME is to adopt a systematic, sustainable, repeatable approach to guide PI CME initiatives. With the emergence of Lean Healthcare and one of its central tools – A3 Problem Solving- we have a framework that is effective and efficient. We should embrace it as a new way of doing our PI CME business.

Integrating CME and Improvement – The New Normal

February 4, 2011 at 11:07 pm Leave a comment

Communities of Practice – A Framework for Learning and Improvement

One of the sessions at the 2011 annual meeting of Alliance for Continuing Medical Education that I was supposed to participate in was to report on the work of a “Community of Practice”. The session was canceled because an attempt to get a community established failed to materialize. So what are these things called Communities of Practice (COP)? Take a look at the graphic. It provides a good description of a COP.

COP’s are usually comprised of a group of individuals who find they have a common area of interest or a common concern. They build a trusted relationship with each other around the area of common interest and begin to share their unique knowledge and experience related to the issue. By doing so they soon develop a shared understanding and approach to the issue and build a collective knowledge base which informs their practice guiding how they approach the common area of concern. The end result is that the experience of the COP builds in each member a collective knowledge base that, when applied, improves their individual performance and can have a dramatic impact on improving the issue they were drawn together to address.

Think of all of the things happening in CME that might benefit from COP’s forming to explore issues, develop deeper levels of understanding, produce resources for all of us to use. Things like Maintenance of Certification, Maintenance of Licensure, Integrating QI and CME, PI CME, Utilizing Social Media in Healthcare and Physician Learning – and this just scratches the surface of possibilities.

COP’s are engaging, intellectually stimulating, and fun. Find one or start one. You’ll be glad you did.

Integrating Education and Quality Improvement – The New Normal

February 4, 2011 at 2:19 am 7 comments

Response to a Repsonse

I don’t know if any if you look at comments posted this Blog. Actually there aren’t many. But here is one I want to Share. It is from Brian McGowan who is with Pfizer.

Brian says:
“I had the pleasure of attending the IHI forum in December and the Alliance meeting in January and, though they are getting closer in terms of vocabulary, the lean concepts were at the core of the IHI and their process/performance improvement programs, whereas there may have been no more than 2 or 3 abstracts.

Yes, CME professionals can benefit from these concepts, but we need to embrace the expertise and progress made in other silos – first step is to get every CME professional to sign up for the IHI email list…and see what that organization has to offer.”

The Alliance did have 2 or 3 abstracts related to “lean’ principles but there were also a number of other sessions focused on quality improvement initiatives. To me this is an encouraging sign. I’d love to see the CME profession adopt a more common nomenclature and a common approach quality and quality improvement. Whether it is Lean, A3 Problem Solving, FOCUS, Six Sigma, or whatever. I think this would strengthen our effort to work with our quality colleagues. It would clearly have a positive impact on our efforts as CME providers to offer educational resources to healthcare professionals with the desired result of improved competence or performance of our customers and improved patient outcomes of those they care for.

Take Brian’s advice and get yourself on the IHI mailing list.

Thanks Brian.

Integrating Education and Quality Improvement – The New Normal

February 2, 2011 at 7:21 pm Leave a comment

“Lean” Finds it Way Into CME Offices

Have you heard of “Lean Manufacturing”? How about “Lean Healthcare”? If not you may want to take some time to learn a bit about it. “Lean” is finding its way into hospitals and health systems around the country.

Continue Reading February 1, 2011 at 2:37 am Leave a comment

Improvement Resources for the CME Professional

Here are reports on two improvement efforts you may find interesting. I’ll keep a watch out for these when I find them I’ll pass them on.

Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study.

Crit Care. 2011 Jan 25;15(1):R38
Mangino JE, et. al.

CONCLUSIONS: Developing a multi-center performance improvement project to operationalize ATS/IDSA guidelines for HAP, VAP, and HCAP is feasible with local consensus pathway directives for implementation and with quality indicators for monitoring compliance with guidelines.
Go here:

A Multifaceted Intervention for Quality Improvement in a Network of Intensive Care Units

A Cluster Randomized Trial
JAMA. Published online January 19, 2011. doi: 10.1001/jama.2010.2000
Damon Scales et. al.


Context Evidence-based practices improve intensive care unit (ICU) outcomes, but eligible patients may not receive them. Community hospitals treat most critically ill patients but may have few resources dedicated to quality improvement.

Objective To determine the effectiveness of a multicenter quality improvement program to increase delivery of 6 evidence-based ICU practices.

Design, Setting, and Participants Pragmatic cluster-randomized trial among 15 community hospital ICUs in Ontario, Canada. A total of 9269 admissions occurred during the trial (November 2005 to October 2006) and 7141 admissions during a decay-monitoring period (December 2006 to August 2007).

Intervention We implemented a videoconference-based forum including audit and feedback, expert-led educational sessions, and dissemination of algorithms to sequentially improve delivery of 6 practices. We randomized ICUs into 2 groups. Each group received this intervention, targeting a new practice every 4 months, while acting as control for the other group, in which a different practice was targeted in the same period.

Main Measure Outcomes The primary outcome was the summary ratio of odds ratios (ORs) for improvement in adoption (determined by daily data collection) of all 6 practices during the trial in intervention vs control ICUs.

Results Overall, adoption of the targeted practices was greater in intervention ICUs than in controls (summary ratio of ORs, 2.79; 95% confidence interval [CI], 1.00-7.74). Improved delivery in intervention ICUs was greatest for semirecumbent positioning to prevent ventilator-associated pneumonia (90.0% of patient-days in last month vs 50.0% in first month; OR, 6.35; 95% CI, 1.85-21.79) and precautions to prevent catheter-related bloodstream infection (70.0% of patients receiving central lines vs 10.6%; OR, 30.06; 95% CI, 11.00-82.17). Adoption of other practices, many with high baseline adherence, changed little.

Conclusion In a collaborative network of community ICUs, a multifaceted quality improvement intervention improved adoption of care practices.

Read More:

Here is a tool kit you might find useful. It uses an approach to QI called FOCUS. You may find this approach communicates very well with your constituents.

QI 101 Toolkit

American College of Cardiology PINNACLE NETWORK: Practice Innovation and Clinical Excellence.

The Toolkit can be accessed here:

Here is my latest mantra: Linking Eduction and Quality Improvement – The New Normal

January 31, 2011 at 1:21 am Leave a comment

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