>>SINGER: Hi, I’m Steve Singer, I’m the Director of Education and Outreach at the Accreditation Council for Continuing Medical Education.
>>MARIAN: My name is Kathy Marian I’m the Manager of Standards and Outcomes at the American Academy of Family Physicians.
>>SINGER: Hi Kathy, welcome.
>>MARIAN: Thank you Steve, how are you?
>>SINGER: I’m good.
>>SINGER: I’m good. Glad to have you here and I think what we’re going to talk about today is flipping the, flipping our assumptions about overall program sort of reflection, evaluation, improvement as part of our ACCME requirements. We have requirements that organizations, as sort of a value of accreditation, that they are reflective and that they learn and they improve over time, so that plan-do-study-act. And there are also process parts of that, the self-study process, the education and resources that we provide to providers sort of at a midpoint within their accreditation term to say, OK, it’s time to start thinking about reaccreditation, those sorts of things, but I think that a sort of a consequence perhaps, of those rules is a perspective that that reflection and improvement is an ACCME requirement as opposed to an organizational value. So, I’d like to have a conversation with you and sort of learn from your experience about what you’ve seen and what you’re seeing now and whether or not we can sort of flip that assumption around. So, do me a favor tell me what you’re doing now
>>SINGER: where you work and then we’re going to roll back the clock a little bit and look at where you came from.
>>MARIAN: I’m the Manager of Standards and Outcomes at the American Academy of Family Physicians and in that role I oversee the AAFP credit system as well as our educational design and delivery and the associated accreditation with the ACCME to be able to award the PRA Category 1 credit.
>>SINGER: OK. And before that, give us a little history of Kathy.
>>MARIAN: OK. Prior to coming to the American Academy of Family Physicians I was in higher Ed for about 12 years working with adult students. So, I would work with students who had returned to earn bachelors and masters degrees at several different universities.
>>SINGER: Ok. And as an educator within sort of a formal educational system that was also a system that was accredited
>>MARIAN: Right higher education
>>SINGER: different accreditation
>>MARIAN: right, exactly, higher education does have accrediting bodies where you have to demonstrate your programs compliance in order to continue to be an accredited institution.
>>SINGER: OK. So, similar kind of sort of regulatory environment
>>SINGER: so, relative to that, because we were talking before the interview about the, the comparison which you did there and which you do now, so tell us about what you did for that organizational accreditation with regard to the program level you know sort of this high level, how is the program evolving and improving over time.
>>MARIAN: OK. Historically in higher education the cycle of accreditation was ten years if you were found compliant. And so, about two years before that you would start gathering documentation, identifying report riders and gathering the data you needed to demonstrate why you
>>SINGER: so making your case.
>>MARIAN: making your case. Prior, probably about three to four years before I left higher ed they started a new program called AQIP which was an annual reaccreditation cycle. And so for a three year plan you would write your goals, your strategies, and your plan and then annually you would provide an update of what you were doing to demonstrate that you are aligned on that quality improvement plan. And if you ran into problems and you hadn’t reached some of those goals you explained why. But, your focus might have been on a higher priority that you business identified as you were going through the process. And so, as long as you continued on that cycle and demonstrated that you were making progress and you were aligning with the guidelines and policy around higher education you were able to remain an accredited institution of higher ed.
>>SINGER: Ok. Ok, so, the, so that perspective informed an approach that you’ve brought to your role at the AAFP. Right? So, tell us what you’re doing, or your involvement with your sort of organizational review at the AAFP. And then we’ll sort of connect that back to ACCME requirements this question about whether there’s more than one way to do this.
>>MARIAN: When I came to the Academy almost five year ago they had just received accreditation with accommodation and everyone was really excited because that meant we had six years before we went through the process again.
>>SINGER: You’re excited that you don’t have to go through the process, but also it’s a value
>>MARIAN: it is, it’s a very long
>>SINGER: but it’s interesting exactly sort of to the point here
>>MARIAN: right. The value of being an accredited provider is the core of our missionary and our drive. So
>>MARIAN: that’s not in question
>>SINGER: no, of course
>>MARIAN: it was more the process of what was needed to gather the information and the documentation and the preparation
>>SINGER: the successfully navigating that
>>MARIAN: and then successfully being able to say, hey we’ve got Commendation which provided value not only to our learners but to other that we work with within the CME environment.
>>MARIAN: And as a credit system it’s very important that we show adherence to the highest level commendation that we can achieve for our credit system.
>>SINGER: Sure, ok.
>>MARIAN: So, after I arrived coming from a different environment it took me a couple of years to understand CME, understand processes. I attended many of the ACCME’s Bridges to Quality as the role of our credit system and listened to the presentations several times and began to think, well how can we adapt and adopt all of these systems that we’ve put in place, but use those to tell our story. So, halfway through our reaccreditation cycle I decided that we would pull a team together and we would look at what we’d done so far. Let’s outline where we are in the process based on what we said we were going to do for improvement and then write a mini mock self study to address all the criteria that were expected and then do our own random audit of files and determine where the gaps were in those files and what the training we need to be able to provide. Because our CME department quality being able to support the needs of our learners and be relevant, being able to train our staff on how to comply, and then the process behind that is how we have to come up with tactical decisions to address the strategy of being a ACCME certified provider.
>>SINGER: OK. So, you’ve described sort of what I’m seeing sort of as two domains sort of defining this on sort of a broad context. So, you talked about this, this institutional review or sort of a interim review that you did internally that looked at the, materials, the files, stuff like that looking for from an administrative standpoint do we have what we need or what we will need for accreditation purposes going forward sort of to take a look at that in an interim fashion as opposed to sort of an all big cramming rush you know before the deadline. But in the midst of describing those administrative things you also sort of moved over and you were starting talking about things that didn’t sound like accreditation requirements. You were talking about value, and relevance to your learners. You were talking about I think faculty and the support that you give to them. So, in these sort of two areas and now, I’m going to reflect back to your, the academic background that you had. When you did that sort of yearly review was it also sort of across two areas, both looking sort of at administrative, have we crossed the T’s and dotted the I’s, as well as these sort of points of value?
>>MARIAN: I think so. I think strategy drives tactic. So, if our strategy is to be an ACCME accredited provider with Commendation for the value that’s providing, what are the strategies around doing that? What are the goals and metrics we need to put in place? So, those metrics then help to drive policy, help drive vision, help drive direction and then the file pull the tactics the pieces that have to be there to demonstrate that competency at that detail level need to be outlined. But, more importantly to that organizationally with education being one of our core pillars that is an organizational goal. Every year we set metrics around education for competence for demonstrating accreditation, being engaged in the external environment. And so, as those goals are set those are woven into the various rules that govern CME and then it’s our job to filter those into the fabric of what we’re doing.
>>SINGER: That’s a nice way of describing it because I think that you’ve described sort of an intersection between accreditation’s public trust in as you described being responsive to what medicine and patients and the public needs and bringing that into our requirements so that by satisfying our requirements we’re helping to sort of bring the system toward what the public and what medicine are looking for. And then you describe that, that your organization’s view of accreditation as a value is a way a marker of your organizations alignment with those same external sort of goals. OK. So, in, in a more tactical setting one of the things I’m wondering is the, you know, you mentioned that you’ve come to ACCME workshops and as we provide materials and resources and education to help providers successfully navigate let’s say the self-study process and all the things that we need to have and all the things that need to be brought forward, one of our goals has been to try to simplify and evolve those processes. And our hope is to find a middle ground where it becomes more difficult to tell the difference between your own narrative – your own sort of telling your story of how your organization is striving towards those values – and what we are looking for at accreditation in terms of what we are, what we need to see, sort of the evidence that we need to look at. So my question is that as your, as your processes have evolved at the AAFP have you found a was to simplify that process and evolve that process do you feel that it’s been taken on as a value or not there yet?
>>MARIAN: I believe that it’s been taken on as a value, but I also see it’s an evolutionary process. I think that it’s a continuation; you never really get to the endpoint. You’re constantly looking to say, How can I ensure the education is unbiased? How can I ensure that it has the highest quality? That it’s a relevant education? That it’s aligning with the changes in MOC, MOL? So, as those become important components of CME we need to work to make sure that our story that you mentioned engulfs that information and then as we’re telling our story we need to look around at the realm of compliance and say, are we compliant in the processes we have in place to do that? So we can demonstrate to our learners, to the community, and the legislative bodies that CME knows how to manage education to improve the health of the public.
>>SINGER: In the institutional or the organizational review that you do, how is it structured?
>>MARIAN: On an annual basis we, our board approves an organizational level of metrics around each of our four pillars: practice advancement, education, health of the public and advocacy. And through those metrics they filter down to our vice-president level, to our division level, to our department level, and then ultimately our staff level. And so, as those metrics are written they’re aligning with the different strategies to support the vision of the organization. And with it, education specifically CME providing, meeting the educational needs of our members to improve the health of the public, their families and the community is a key goal for us.
>>SINGER: But that sits sort of along side, so I understand now better, that sits along side the goal of ‘maintain our accreditation’
>>SINGER: And pursue excellence?
>>SINGER: OK. So, but, do you find that the, I understand that the definition of having to be prepared and sort of maintain what you need for accreditation is sort of an essential goal at its level, but do you find that because you have this organizational frame work which is bigger and broader, does that organizational narrative help you to tell your story to the ACCME?
>>MARIAN: Oh, most definitely. I think when we look at the categories 16 to 22, we can pull so many different examples of how our organization is demonstrating and embracing within itself those qualities and those criteria. I think in my opinion if we’re doing that well the tactic of the rest of the criteria and the Standards of Commercial Support follow in the process of the steps you have to do. So, they’re woven into our educational design and developmental process. They’re not there because they have to be there; they’re there because our members and our learners and our organization expects that we provide education that has that level of quality and rigor.
>>SINGER: Right. And I would suppose that it’s also, it’s possible other organizations, there, there, other CME professionals that are watching this and sort of thinking what does this mean or how do I apply this organization can also consider this idea that the definition or the distinction between organizational mission and these, you know, four pillars that you talked about and CME mission can sort of dissolve a little bit. That you can look at your, that one of the roles that you have is to support the overall organization’s mission and therefore as you’re reflective about how to improve you’re certainly looking at your educational programming you know, the things that you are doing that are part of educational function, but if that educational function is a core aspect of which organization does then the sort of the delineation between the CME program, sort of in a box, as opposed to the broader organization is not necessarily a distinction that we from accreditation need to, you know, that we don’t require or you know so that’s sort of an opportunity.
>>MARIAN: And I think one of the ways that w we’ve really helped integrate not just policy within the CME department or process is we’ve formed a CME strategy group which includes executives from around the organization in our different areas. When we talk about education, first of all in general, how we use CME to support members needs and address the gaps that they have, but also what other tools are around our organization that we can refer our learners to either through patient education or tools to support be it enhancement of patient centered medical homes or practice advancement
>>SINGER: so you’re
>>MARIAN: we come together as a community and see the learner as an entity that we want to support various things that the Academy does.
>>SINGER: Interesting, so you’re really imbuing it as a strategic asset
>>SINGER: kind of a approach. Thank you, Kathy.
>>MARIAN: Thank you, Steve.
>>SINGER: Appreciate you coming.
This is a transcript of Improvement – Insights from Higher Education.
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