ENGAGING PRIMARY AND SECONDARY STAKEHOLDERS IN CME:
A Model for Continuous Improvement in Healthcare Outcomes
Lisa Keckich, MS
As the CME industry looks to emerge as a driver of improved quality of care and patient
outcomes, comprehensive educational strategies reflective of the multifaceted healthcare
environment are essential to realize these goals. Such strategies actively engage diverse
stakeholders in healthcare and foster broad participation and collaboration to transform the
reach and redefine the value of CME.
While alliances are not new to the world of CME, limited financial and human resources, coupled
with short-term profitability targets and the demand for more immediate outcomes data has often
resulted in partnerships forged for convenience rather than value.
The resulting environment is one where collaborations are: 1) sought largely for endorsement
purposes and fail to define the strategic and mission-driven value for each organization beyond
financial remuneration; 2) fail to navigate the administrative and political barriers of each
organization to make truly impactful improvements; or 3) fail to leverage human or financial
resources outside of the organization to broaden the scope of delivery.
In order for CME to serve as a catalyst for improving patient health, providers must not only
redefine collaboration, but operationalize an approach for successful engagement of collaborators
and management of outcomes. The proposed framework creates a methodology to consider the
broader health implications of the planned CME; identify prospective partners and define value
for each stakeholder; assess the viability of the partnership relative to the goals and scope of
the educational initiative; and develop an implementation plan that optimizes resources and
mitigates risk.
OBJECTIVE
To create a roadmap to identify prospective partners who can enhance the delivery and outcomes
of CME.
METHODOLOGY
To broaden the impact of CME in healthcare delivery and patient health, improve the efficiency
and effectiveness of education delivery, and create educational platforms responsive to the
larger healthcare marketplace, CME providers must engage stakeholders who are in a position to
influence successful outcomes.
The value of these relationships includes both strategic and operational benefits, with implications
for not only clinicians and patients, but the opportunity to further public health interests.
Stakeholder Analysis
In order to assess the relevance and value a potential collaborator may contribute in furthering
the goals, objectives and impact of a CME initiative, a systematic evaluation of those
stakeholders must be undertaken. Such an examination will optimize the CME providers’
time and financial investment and ensure the right fit between partner and deliverables.
Timeline
Generate list of
all possible
stakeholders
Y
GROUP
A
Existing
Relationship?
Y
N
History of
Partnerships?
GROUP
N
GROUP
B
C
Group A offers the most immediate
opportunity and possibility for
collaboration with the least amount
of startup investment. Group B
offers the second most direct
opportunity, but providers should
anticipate additional time and
resources to create a dialogue and
establish a relationship. Providers
who wish to engage in any potential collaboration with organizations
in Group C should anticipate a
significant investment in time and
resources to secure.
In order to direct resources towards those collaborations which offer the greatest benefit to the
success of the education, compare the level of influence each partner holds relative to their
effectiveness as an organization.
Assessment of Influence
Rate each organization on your list based on the following criteria:
- Ability to engage internal stakeholders
- Ability to engage external stakeholders
- Ability to maintain political or public support
- Ability to influence healthcare policy
Planning & Implementation
Once all collaborators have agreed to partner conceptually, the greatest roadblock to success is
failure to adequately plan and implement the proposed initiative. To align with ACCME criteria,
CME providers will use their planning document to drive decision making and operationalize
the project; however, these steps alone may not be considerate of the required processes/rules
within each stakeholder’s system.
Therefore, it is recommended that as part of the planning process, the CME provider profile
each stakeholder based on similar sets of criteria. Organizational barriers imposed by rigid
cultures, employee beliefs, complicated decision making hierarchies and resource limitations
can affect performance and influence the success of the planned initiative. Overcoming these
barriers is a matter of interpreting these organizational conditions and intervening in a way that
is responsive and respectful.1
CME
Provider
Medical
Specialty
Society
Patient
Advocacy
Group
Hospital
Expected
Outcomes
CME program delivering L5 outcomes and
meeting MOC
requirements
MOC compliant
education for members
Published and measurable strategies
to improve QOL for
patients with XYZ
Improved hospital
compliance around
accreditation standards
and delivery of QI
Goals &
Strategies
To improve the perfor- To improve reimbursemance of physicians in ment of members who
the treatment of XYZ
treat XYZ and deliver
better outcomes
To create an iPhone
app where patients
can collect daily
data around XYZ
and transmit to their
physician
To meet standards
for Joint Commission
accreditation and
improve state funding
Resources
•
•
•
•
• Education Manager
(staff)
• Education Committee
(volunteers)
• Communications
Committee (volunteers)
• Lobbyist
• Membership Email
Blasts
• Membership
Newsletter
• Membership Facebook
and Twitter
• Project Manager
• Director of
Development
• Facebook and
Twitter
• Celebrity
relationships
•
•
•
•
Decision
Making
Processes
• Task DecisionsProgram Manager
• Content DecisionsMedical Director
and Faculty
• Policy DecisionsCompliance Officer
• Task Decisions – Staff
• Design Decisions –
Committee
• Policy DecisionsBoard of Directors
• Task Decisions –
Project Manager
• Financial
DecisionsDirector of
Development
• Policy DecisionsBoard of Trustees
• Task Decisions –
QI Officer and CME
Manager
• Policy DecisionsCompliance Officer
• Content DecisionsDepartment Head
and CME Manager
Technology
Document Sharing
Web Portal
PI CME Portal
Membership Intranet
Website
Intranet
Satellite TV
Live Case Recording
Equipment
Culture
Fast paced
Flat hierarchy
Long workdays
Volunteer driven
Several competing
political factions
Consensus driven in
decision making
Self-described
“family”
Informal decision
making structure
All materials must be
“green”
Unknown
Assessment of Organizational Effectiveness
Rate the effectiveness of each organization on your list based on the following criteria 1:
- Life-cycle stage (e.g., start-up v. established organization)
- Availability and skill of resources (e.g., volunteer v.paid staff)
- Organizational size and complexity
- Degree of bureaucracy/assessment of power alignments and decision making processes
- Purpose: for profit v. non profit
- Technology capabilities
- Organizational Culture
High
Prioritize who is critical to the success of
the initiative, based on a high level
of influence and high assessment of
organizational effectiveness. The results
should be plotted on a chart for easy
identification 2:
High Priority
Collaborations
Influence
INTRODUCTION
Low
High
Low
Step 1
Scan the environment
and compile a listing
of all possible stakeholders who may have
an interesting the
outcomes of the
education
Step 2
Divide the list into two
groups—those with
whom you have an
existing or prior
relationship and
those where no
relationship exists
Step 3
For those prospective
partners where no
relationship exists,
determine whether there
is a history of them
partnering with other
CME providers
The result is 3 groups:
Group A: Stakeholders with whom you have partnered with in the past
Group B: Stakeholders who have demonstrated a commitment to working with other
CME providers on external education/collaborations
Group C: Organizations with no prior experience in external collaborations with CME providers
REFERENCES:
1. Harrison, Michael I. Diagnosing organizations: methods, models and processes. 1994. Sage Publications.
2. Ruhe, Mary C. Stakeholder analysis in health services management. Accessed on 2/12/11.
http://www.case.edu/med/epidbio/mphp439/Stakeholder_Analysis.htm
Acknowledgements: Caryn Lobel, MD, Mindi Daiga, MBA
Medical Director
Program Team
Digital Strategist
Compliance Officer
Organizational Effectiveness
Approaching Stakeholders
Once a list of high-impact collaborators are identified, the value for those stakeholders and
the objectives and expected outcomes of the education must be clearly defined:
1. Identify decision-makers within organization and gauge level of access to those individuals
2. Create a rationale for engagement
a. Demonstrate how proposed education aligns to stakeholders’ organizational priorities
and mission
b. Define value for the stakeholder at the organizational and constituent level; Examples:
i. Organizational Level: revenue, ability to influence policy, ability to improve levels of care,
ability to control healthcare delivery costs
ii. Constituent level: enhanced education, improved reimbursement practices, improved
access to care
c. Describe expected outcomes and measures of success
d. Provide examples of how similar collaborations have been successful
3. Describe proposed relationship
a. Roles and responsibilities
b. Access to information
c. Resource allocations/requirements for each organization and proposed timing
d. Levels of ownership and control/oversight
e. Mechanisms for systems integration (technology, shared staffing)
f. Financial commitments and/or revenue projections
Disclosures: Lisa Keckich, MS has no relationships to disclose
QI Officer
Compliance Officer
CME Manager
Department Head
By conducting this type of analysis prior to commencing the project, the CME provider can
improve the ongoing efficiency of the implementation, appropriately manage the expectations
of each stakeholder, and ensure individual goals are being met.
Once completed, the analysis is considered when mapping out ongoing steps which include:
1. Establish an internal communications plan and mechanism for reviews and approvals that is
considerate of the profile completed for each stakeholder
2. Create a project roadmap and outline collaborator’s tasks at each milestone
3. Recognize a process for contingency planning
4. Design an outcomes methodology and define measures of success
5. Create an external communications/awareness plan
CONCLUSION
Financial and capacity limitations restrict the number of collaborations that can
be pursued each fiscal year; however, by earmarking resources to engage in
1-2 large scale initiatives annually, providers have the opportunity to diversify
funding streams, improve the efficiency and effectiveness of the education being
developed, deliver more sophisticated outcomes considerate of both CME criteria
and public health variables, and influence healthcare practice and policy.
©2011 The Academy of Continued Healthcare Learning