Culture of Performance Improvement in Practice

The new administration has introduced uncertainty into healthcare education. CME and other forms of continuing education in the health professions have been influenced by the Affordable Care Act (“Obamacare”), and with expected changes to that legislation, educational practitioners naturally wonder about the effects on their field. Specifically, the ACA’s drive toward quality of care has pushed medical education toward performance improvement education, in which clinical performance metrics are used to point clinicians to learning that could help them improve their practice. The question on many healthcare educators’ minds is whether performance improvement education will continue to be an important model after the expected changes to the Affordable Care Act.

The answer at January’s annual meeting of the Alliance for Continuing Education in the Health Professions—the preeminent community of practice for continuing medical education (CME), continuing nursing education (CNE), and other forms of professional development in the allied health professions—was a resounding “yes.” Regardless of whether the ACA is eventually repealed, reformed, and/or replaced, performance improvement is deeply engrained in 21st-century healthcare CE. This was demonstrated in a number of presentations that I attended:

  • Laura Lee Hall of the American College of Physicians presented with Shunda Irons-Brown of Novo Nordisk and Marie Brown of Rush Medical Center and the ACP on a successful, inspiring performance improvement project they developed for practitioners of diabetes care. Dr. Brown’s use of live collaboration tools (GoToMeeting) for case study sessions was, I thought, an innovative use of available tools to engage busy clinicians in meaningful education.
  • At a presentation given by accreditors who regulate healthcare continuing education (Graham McMahon of the ACCME and representatives of the ANCC, ACPE, and AAPA[1]) the overarching message was that accreditors are focused on supporting educators’ efforts to innovate in the service of educational quality. Educators should expect to spend less time on bureaucratic procedure and more time on creating high-quality education experiences.
  • Theresa Frederick of Milwaukee’s Aurora Healthcare laid out her “MacGyver Approach” to performance improvement CME. A key takeaway from her presentation was that even small CME operations can justify PI projects if they emphasize the “bang for your buck” that performance improvement offers: the ability of a single performance improvement project to meet requirements for CME, specialty board maintenance of certification, and health system-wide quality initiatives.
  • A panel on learning management system implementation was naturally of interest to me. It included representatives of the American Association of Nurse Anesthetists (full disclosure: a Web Courseworks client), the American Society of Cataract and Refractive Surgeons (also a Web Courseworks client), the American Academy of Physical Medicine and Rehabilitation, and the American Society of Plastic Surgeons. The interactive panel was mostly devoted to the nuts and bolts of selecting and implementing learning management systems, but the questions from attendees showed that educators are constantly searching for technology that can support more innovative education. A question about whether LMS trends are restricting educators to shorter, lower-quality educational products was, I thought, particularly well placed.
  • Greg Lasko and Heather Dethloff of CHEST (the American College of Chest Physicians, a Web Courseworks client) presented on practical strategies that medical specialty society education departments can use to gauge the impact of their activities on practice, including CHEST’s innovative use of skills assessment and psychometrics.
  • Norman Kahn of the Council of Medical Specialty Societies spoke with Graham McMahon and Mira Irons of the American Board of Medical Specialties on a panel titled “Form Life-long Learning to a Culture of Performance Improvement in Practice.” Dr. Kahn pointed out that performance improvement CME is an accepted form of clinical practice improvement activity (CPIA) that increases clinician reimbursement under the new Merit-based Incentive Payment System (MIPS) rule for Medicare reimbursement.

The MIPS rule was propagated under Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a piece of Federal legislation that no one in the mainstream of American health policy is talking about replacing. As Dr. Kahn of CMSS pointed out, this means that there is a solid, nationwide legal foundation for performance improvement. By implication, this means that the repeal, reform, and/or replacement of the ACA won’t pull the rug out from under PI-CME.

But as we’re fond of saying at Web Courseworks, performance improvement is just good adult education practice: any educator in professional development should be constantly evaluating the role of their educational activities in professional practice. ACEhp 2017 demonstrated the healthcare education community’s commitment to that principle.

[1] ACCME: Accreditation Council for Continuing Medical Education. ANCC: American Nurses Credential Center. ACPE: Accreditation Council for Pharmacy Education. AAPA: American Academy of Physician Assistants.