Performance Improvement CME

Are You Systematically Engaged in Performance Improvement in Your Continuing Medical Education 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.

During the recent meeting of the National Task Force on CME Provider/Industry Collaboration Dr. Norman Kahn, Jr., Executive Vice President and Chief Executive Officer of the Council of Medical Specialty Societies made a compelling presentation on “The Important Role of CME in Impacting Patient Care”. In the presentation Dr. Kahn gave 12 reasons why the field of CME should move to “Performance Improvement CME.”

1. Physicians can actually show improvements in quality measures in their practices.
2. Evidence-based clinical practice guidelines actually move from “dust covered shelves” into real practice.
3. Physicians will be involved in CME activities that actually improve patient care, countering recent criticisms of CME that doesn’t change practice.
4. PI-CME is worth a lot of CME credit per activity, decreasing the burden on physicians to meet required CME credits.
5. PI-CME is expected to qualify for Maintenance of Certification Part IV credit in all specialties.
6. PI-CME is designed to qualify for Maintenance of Licensure, as MOL, is implemented each state soon.
7. PI-CME enables physicians to be eligible for Pay for Performance in many programs currently, and more to come (CMS-PQRI, CO, NC, PA, others). .
8. PI-CME is what practices will report when public reporting is required.
9. CME providers will be a part of, if not leading, change that is coming anyway.
10. PI-CME creates a “Culture of Improvement” in medical practice, where physicians are continually measuring and improving the care they deliver, with documented improved outcomes.
11. PI-CME fulfills the two primary tenets of professionalism: putting patients first (outcomes) and voluntary self regulation (minimizing external regulation).
12. PI-CME may mitigate against threatening government inquiries into CME (Senate Finance and Aging Committees recently.

Perhaps one of the most compelling gains suggested by Dr. Kahn for physician participation in PI-CME was “improved quality of care within one year”. Most PI-CME initiatives will last less than one year during which time physicians will be engaged assessing the care they deliver, measuring against national benchmarks, comparing their performance with peers and documenting improvement over time.

I recently did a podcast with Dr. Kahn where we discussed PI-CME. You might find it interesting. Click here.

The ACCME considers CME as being synonymous with practice-based learning and improvement.

* Activities are linked to practice-based needs (Criterion 2)
* Content of CME matches the scope of the learner’s practice (Criterion 4)
* Measurements of change in competence, performance or patient outcomes will be available (Criterion 11)

The ACCME requires that all CME be directly involved in performance improvement. That doesn’t mean all CME providers have to offer learners education designed to meet the AMA format of PI-CME. But accredited providers are required to show a report of the evaluation data and information about changes in physician learners’ competence, performance and/or patient outcomes.
All accredited CME providers are now required to be squarely in the health care quality improvement business. To be effective we must:

* learn improvement “science”.
* understand the tools used in improvement initiatives.
* find partners to work with that are in the health care quality improvement business.
* create cultures of improvement in our own CME operations.
* Transform our overall CME programs into improvement focused operations.

Will CME lead, follow, or get left behind? If CME is ineffective in this challenge someone will supplant us and do do the job.