>> SINGER: My name is Steve Singer, I’m the director of Education and Outreach at the Accreditation Council for Continuing Medical Education.
>> PETERSON: Hello, I’m Marilyn Peterson Director of Continuing Medical Education for Texas Health Research and Education Institute.
>> SINGER: Marilyn, thanks for joining us, tell me a little bit about the organization that you work with.
>> PETERSON: I work for Texas Health Research and Education Institute and with the research medical arm of the Texas Health resources. And Texas Health is based in Arlington, Texas, which is between Dallas and Fort Worth and we’re one of the largest non-profit faith-based healthcare systems in the country. And we are the largest in North Texas for patients served the number of patients served. We have over 24 hospitals and additional outpatient facilities. And it serves a 13,500 mile area, so, that’s about thee size of the state of Maryland
>> SINGER: Big System.
>> PETERSON: So, it’s a big system and we have 5,500 physicians on staff over that and
>> SINGER: Wow.
>> PETERSON: The majority of them are volunteer physicians, but 500 are employed by Texas health physician group.
>> SINGER: So, how is CME organized there and what’s your role?
>> PETERSON: We have 14 staff in CME. And we do serve a whole system. We have two locations that we, we use as our bases and we go out from there just to serve the whole system. I’m the director of continuing medical education; we also have a director of curriculum development and distance learning. Then we have two CME curriculum development specialists, four CME program specialists, I call it my career ladder,
>> SINGER: Yeah.
>> PETERSON: And then we also have assistant CME program specialist, two administrative assistants and a department assistant. We also have two media technicians, who serve for our online CME. They’re not officially CME employees but they are employees of the Institute.
>> SINGER: Yeah.
>> PETERSON: So
>> SINGER: So it’s a robust system, a robust system, you have a lot of staff but you have a lot to do.
>> PETERSON: Correct
>> SINGER: OK. So, you see CME within your system as an integral part of helping to improve physician practice, make care better.
>> PETERSON: Definitely, yeah.
>> SINGER: So, let’s, if you look at the, the, sort of the past, I’m sure that you have a planning process for putting together your CME activities. Were there things in your planning process that you saw that you were doing in the past, that you wanted to sort of choose as a target or change or improve?
>> PETERSON: We definitely went through the process of changing our, what we call our activity development worksheet, where we ask the questions that really focuses on what are we really trying to achieve? What are we trying to change, what does that look like? Address barriers, all the different pieces that go into the planning process. We were really good at logistics, in putting on programs, but we hadn’t been that involved in the content planning. We did the basic requirement and objectives and such in the past, but we really want to get into making a difference with the content of the programs. And so, that’s what we would look at in our meetings with the staff. We would ask them about, do they really understand what knowledge and competence means and performance and patient outcomes meant, because when those terms were brand new, it was new to everybody.
>> SINGER: And, and they, when you talk about they are you talking about the CME staff or are you talking about the, the because there’s two groups
>> PETERSON: There’s two
>> SINGER: There’s two groups maybe, are
>> PETERSON: There are.
>> SINGER: there’s a group of CME staff that work for you with you to help facilitate this and then there’s the, the clinical people, right? The clinical staff the physicians and other health professionals that you’re working with the help develop these programs is that
>> PETERSON: that’s very true.
>> SINGER: Correct?
>> PETERSON: Very correct. And we did go through the process with our staff and then with the, the clinical content planners as well. So, it was, and all along we built that process for both groups. We would, would teach the staff things, then it would come back ad take and review it and say OK we can do this better, this could be done a little bit better or I don’t think we’re asking enough about what we’re going to change, why are, what are we going to evaluate? And then we’d help them tell the planners as well, about that change that we need to make or to look at to make our programs better.
>> SINGER:OK. So, you knew at an early time it seems that your staff needed to take a like a facilitating or a consultative role in this, right?
>> PETERSON: In fact, we call them like journalists, they need to be doing research about the background of the content of the program. A good journalist will do a lot of research and try to figure out what’s going to be the issues that we’re going to be looking at and they go to the meetings and they ask lots of questions. Journalists will ask just you know, how and why and where and what, what are the barriers
>> SINGER: Right.
>> PETERSON: So, that’s what we encouraged them to do. They don’t have to know all the clinical content, but they do have to be good at asking the questions.
>> SINGER: This is interesting, you’ve taken the process and from a different perspective so that it seems that your, your planning staff for the staff that are facilitating taking this consultative role
>> PETERSON: Right.
>> SINGER: Are, the onus is on them to sort of draw out and help to facilitate the discovery of what’s the problem that we’re trying to address, how are we going to address it with education? How will we know if we’re effective? You know, those sorts of things. So, in, in your staff those people what you describe as the journalists, what’s the name of that role?
>> PETERSON: We had, originally we had CME programs specialists for the name, was the name of the role, and when we asked if they wanted to take on the curriculum development aspect of the role as well. So, we all came together explained to them what would be needed in that role and they all said yes we want to give it a try we want to become curriculum development specialists, as well. So, we tried that for a couple of years and we found that some people were better at it then others. They would take the time to do the research before, their applications were really good, you could just tell that some people were doing really good at it and the others were stressed. Because they were really good at being process people , making sure things were right.
>> SINGER: Right, so the interviewer and the facilitator, but you know it’s, that’s a good point. And you mentioned before that sort of a career ladder, right?
>> PETERSON: Right.
>> SINGER: And it’s interesting that you’ve seen in this improvement process not only the opportunity to not only improve the value and the effectiveness of what you’re offering with, you know, CME in your system, but, also, this concept of helping to develop and evolve the staff that you’re working with. OK. So, the program specialist, curriculum specialist I understand that there some, you know, folks who’ve, who’ve taken on both of those roles and others who are more specialized. Something that we talked about before the interview is you said that you told these people not to show the form and the form, just for our audience, is like a planning form an intake form. And you instructed them not to show the form to the people they were working with, explain that a little bit.
>> PETERSON: We do have the form with all the questions for the planning process it’s interesting the old forms had all the logistical questions, but now we start with content only and we don’t even have logistical questions on our form anymore. So we asked them to ask the questions and they interview the planning committee and they’ll come do the first stab at filling out the form and then they’ll present it again to the committee, or send it by email and have them review it to make sure we got all the clinical content correct. We even encourage our staff to record the sessions, because of the terminology that might be used that they might not be familiar with or not be able to catch. So, they can go back to their office, create the form based on their notes and the recording
>> SINGER: Along the way in making these changes, I would imagine that at an endpoint, tow, three years later it’s clear to see what’s changed, but did you have a way of knowing, did you have a way of seeing you know, sort of as you were going what kind of progress you were making and changing, the way in which your staff was interacting with the faculty?
>> PETERSON: Well, I could see on the planning form that they would submit. I would review every single planning form that goes before our CME subcommittee that reviews and approves our program. And I could see where they were making improvements in on the form of answering the questions and really getting into the meat of what we’re looking for in the planning process. So, and I could also look at places where I could see there were weaknesses. And we could address it at the next PI meeting for instance we have with our staff. So, that was our cycle of being able to review what we were doing and to be able to say, OK what area are we going to work on next on the planning form to help develop our skills in and getting that information from the clinical planning committee. So, it’s been a good process.
>> SINGER: So, with this new process where they’re, they’re you know, as you said they’re talking the fact that they’re recording gives your staff sort of the opportunity to do heavy lifting of understanding the intricacies of what the interviewee is looking for and sort of on your own time without necessarily putting a burden on those clinical staff to fill out a lengthy form or do that sort of thing. What is your evidence of of how this has been received? Like how do you, how do you evaluate this process, to know that this process is working well for you and what feedback have you gotten from the folks that you’re working with? Both your staff and the clinical.
>> PETERSON: It’s mixed, review from the clinical folks. We have some that have really embraced it and have seen the value add that CME’s had by asking these questions and having them really think about the content of these programs. We have some people who are champions now and really embrace it. And then we have others who still want to do the old CME, let’s just do a lecture, because they want to do a lecture. So, we’ve had some good successes and then we still have some places where we need to do further work. So, it’s a continuing process.
>> SINGER: And it’s interesting are you the, the one’s who have become champions so I’m assuming those are physicians or other health professionals that you’ve been working with have they, have they taken a role with other programs? Are you utilizing them or they still, they sort of stay where they are and?
>> PETERSON: They sort of stay where they are, with the health system the way it is they pretty much within their own hospital
>> SINGER: Yeah.
>> PETERSON: We have started planning some programs jointly across the system like in a specific area, like neuroscience or whatever where they do come together. But you’re right, we haven’t taken advantage of them across the system.
>> SINGER: OK, so another question. You said that you report to the quality department or the chief quality officer?
>> PETERSON: Our president reports to the chief clinical and quality officer
>> SINGER: And how have you communicated to them this change in this process are they aware of what’s been under development ? What’s been changing?
>> PETERSON: They are aware. We have regular meetings with them.
>> SINGER: yeah.
>> PETERSON: So, they know what we’re up to and what we’re changing and they see the value of CME for the system. In fact, we are involved with what they call high impact performance indicator, which is what they call HIPPIs and it’swhere there’s projects for the system where our director of curriculum development beyond the planning committees for those system initiatives and we involve CME where it’s appropriate for education within that HIPPI area. So, we
>> SINGER: That’s exciting. So what, again this process, this improvement process, in our Criteria 12 through 15, but really it’s Plan, Do, Study, Act. And you had the old process, you looked at what was effective and maybe what could be more effective. You made changes you sort of returned and through these meetings that you had working with your staff talking with your staff you sort of looked at hat’s working what’s not working. You mentioned that you have some signs of success and also, some resistance to change. Just in terms of your engagement with other parts of your system and you know, then lastly you’ve shared this clear value that’s evolving that’s sort of developing in what your leadership sees and what they’re looking to from CME. So, what advice would you give to other CME staff, you know, the staff that’s in your position either in a system that more resembles where you started you know, before this development and change or perhaps in a system that is smaller, a small hospital, or a specialty society that might not have sort of the same breadth of staff resources and interactions?
>> PETERSON: I’d say take the time to look at your processes. Set aside the time, we have the two and half hour meeting once a month that makes us sit down and look at what we’re doing and to step back a little bit. So I say, calendar it, because otherwise we’re so busy we don’t take the time to make the change. So, put that into your schedule and see what you can do what needs to be improved, what needs to be changed. I think, just to make small changes at a time, it doesn’t have to be big changes. I feel like we’re never doing it enough, but yet I look back and see where we were and where we are now and through small steps we got we made a lot of progress, just by making minor changes all along, tweaking our processes. We’ve made great leaps in what we’ve done, but it didn’t seem like much at the time. So those are a couple of things.
>> SINGER: Great. And is there a specific, is there a specific outcome that that you’ve seen something that comes to mind as a result of this you know, of the programs that you’re doing and the sort of these revised processes that that appears to you to be a clear win with patients with physicians?
>> PETERSON: I think of one department that we work with in one of the hospitals where they need to have continuing medical education for their accreditation for their trauma accreditation and they used to think of CME as just a burden going through the planning process they didn’t care for it at all, but we had one of our curriculum development specialists that went in there and she asked the questions and she actually engaged them through their one time program and their regularly scheduled series and they looked at the curriculum for the whole piece of what they were doing. And she won them over and they just embraced her, because they were really being helped in what they were offering and what they needed to do for their own purposes. So that was a real win for our staff and for that clinical program.
>> SINGER: So, Don Berwick for the Institute for Healthcare Improvement talks about joy being an important part of working in healthcare. And you have expressed such a specific focus on developing your staff, do you in this process of improvement that you’ve participated in from you know, looking at the old way engaging facilitating and now sort of where you’ve arrived, do you see, do you see joy in your staff? Do you see that they’re, that they’ve been empowered or what are they getting from the way in which these processes change?
>> PETERSON: The one’s that have embraced the role have done great and they can see how they’ve changed and how they’ve grown and I think most of it’s in the process working in continuing medical education want to make a difference in healthcare and they see that they have a role in helping to make a difference for their families, patients, because they’ve helped determine what needs to be presented in these programs So. I do see joy.
>> SINGER: Thanks for joining us.
>> PETERSON: Thank you for having me.