INTRODUCTIONAs the CME industry looks to emerge as a driver of improved quality of care and patient outcomes, comprehensive educational strategies refl ective 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 redefi ne the value of CME.

While alliances are not new to the world of CME, limited fi nancial and human resources, coupled with short-term profi tability 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 defi ne the strategic and mission-driven value for each organization beyond fi nancial 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 fi nancial 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 redefi ne 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 defi ne 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.

OBJECTIVETo create a roadmap to identify prospective partners who can enhance the delivery and outcomes of CME.

METHODOLOGYTo broaden the impact of CME in healthcare delivery and patient health, improve the effi ciency 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 infl uence successful outcomes.

The value of these relationships includes both strategic and operational benefi ts, 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 fi nancial investment and ensure the right fi t between partner and deliverables.

The result is 3 groups:Group A: Stakeholders with whom you have partnered with in the pastGroup B: Stakeholders who have demonstrated a commitment to working with other CME providers on external education/collaborationsGroup C: Organizations with no prior experience in external collaborations with CME providers

REFERENCES: Harrison, Michael I. Diagnosing organizations: methods, models and processes. 1994. Sage Publications. 1. Ruhe, Mary C. Stakeholder analysis in health services management. Accessed on 2/12/11. 2. http://www.case.edu/med/epidbio/mphp439/Stakeholder_Analysis.htm

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 poten-tial collaboration with organizations in Group C should anticipate a signifi cant investment in time and resources to secure.

In order to direct resources towards those collaborations which offer the greatest benefi t to the success of the education, compare the level of infl uence each partner holds relative to their effectiveness as an organization.

Assessment of Infl uenceRate 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 infl uence healthcare policy -

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 profi t v. non profi t -Technology capabilities - Organizational Culture -

Prioritize who is critical to the success of the initiative, based on a high level of infl uence and high assessment of organizational effectiveness. The results should be plotted on a chart for easy identifi cation 2:

Approaching StakeholdersOnce a list of high-impact collaborators are identifi ed, the value for those stakeholders and the objectives and expected outcomes of the education must be clearly defi ned:

Identify decision-makers within organization and gauge level of access to those individuals1. Create a rationale for engagement2.

Demonstrate how proposed education aligns to stakeholders’ organizational priorities a. and missionDefi ne value for the stakeholder at the organizational and constituent level; Examples:b.

Organizational Level: revenue, ability to infl uence policy, ability to improve levels of care, i. ability to control healthcare delivery costsConstituent level: enhanced education, improved reimbursement practices, improved ii. access to care

Describe expected outcomes and measures of successc. Provide examples of how similar collaborations have been successfuld.

3. Describe proposed relationshipRoles and responsibilitiesa. Access to informationb. Resource allocations/requirements for each organization and proposed timingc. Levels of ownership and control/oversightd. Mechanisms for systems integration (technology, shared staffi ng)e. Financial commitments and/or revenue projectionsf.

Generate list of all possible

stakeholders

Timeline

Y N

GROUP

AGROUP

CGROUP

B

Existing Relationship?

History ofPartnerships?

Y N

ENGAGING PRIMARY AND SECONDARY STAKEHOLDERS IN CME: A Model for Continuous Improvement in Healthcare Outcomes Lisa Keckich, MS

CONCLUSIONFinancial and capacity limitations restrict the number of collaborations that can be pursued each fi scal year; however, by earmarking resources to engage in 1-2 large scale initiatives annually, providers have the opportunity to diversify funding streams, improve the effi ciency and effectiveness of the education being developed, deliver more sophisticated outcomes considerate of both CME criteria and public health variables, and infl uence healthcare practice and policy.

Planning & ImplementationOnce 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 profi le 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 infl uence 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

By conducting this type of analysis prior to commencing the project, the CME provider can improve the ongoing effi ciency 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:Establish an internal communications plan and mechanism for reviews and approvals that is 1. considerate of the profi le completed for each stakeholderCreate a project roadmap and outline collaborator’s tasks at each milestone2. Recognize a process for contingency planning3. Design an outcomes methodology and defi ne measures of success4. Create an external communications/awareness plan5.

CME Provider

Medical Specialty Society

Patient Advocacy Group

Hospital

Expected Outcomes

CME program deliver-ing L5 outcomes and meeting MOC requirements

MOC compliant education for members

Published and mea-surable strategies to improve QOL for patients with XYZ

Improved hospital compliance around accreditation standards and delivery of QI

Goals & Strategies

To improve the perfor-mance of physicians in the treatment of XYZ

To improve reimburse-ment of members who 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 Medical Director• Program Team• Digital Strategist• Compliance Offi cer•

Education Manager • (staff)Education Committee • (volunteers)Communications • Committee (volunteers)Lobbyist• Membership Email • BlastsMembership • NewsletterMembership Facebook • and Twitter

Project Manager• Director of • DevelopmentFacebook and • TwitterCelebrity • relationships

QI Offi cer• Compliance Offi cer• CME Manager• Department Head•

Decision Making Processes

Task Decisions- • Program ManagerContent Decisions- • Medical Director and FacultyPolicy Decisions-• Compliance Offi cer

Task Decisions – Staff• Design Decisions – • CommitteePolicy Decisions- • Board of Directors

Task Decisions – • Project ManagerFinancial • Decisions- Director of DevelopmentPolicy Decisions- • Board of Trustees

Task Decisions – • QI Offi cer and CME ManagerPolicy Decisions- • Compliance Offi cerContent Decisions- • Department Head and CME Manager

Technology Document Sharing Web Portal PI CME Portal

Membership Intranet Website IntranetSatellite TVLive Case Recording Equipment

Culture Fast pacedFlat hierarchyLong workdays

Volunteer drivenSeveral competing political factionsConsensus driven in decision making

Self-described “family”Informal decision making structureAll materials must be “green”

Unknown

High PriorityCollaborations

High

Low

Low High

Organizational Effectiveness

Infl

uenc

e

Acknowledgements: Caryn Lobel, MD, Mindi Daiga, MBA Disclosures: Lisa Keckich, MS has no relationships to disclose ©2011 The Academy of Continued Healthcare Learning

Step 2Divide the list into two groups—those with whom you have an existing or prior relationship and those where no relationship exists

Step 3For those prospective partners where no relationship exists, determine whether there is a history of them partnering with other CME providers

Step 1Scan the environment and compile a listing of all possible stake-holders who may have an interesting the outcomes of the education