Accreditation in a Rural Setting: Exploring Problems in Practice
Steve Singer, ACCME Vice President for Education and Outreach, interviews Niles McCall, Education Coordinator at Rehoboth McKinley Christian Health Care Services in Gallup, New Mexico, about accreditation in a rural setting.
>>SINGER: Hi, my name is Steve Singer, I'm the Vice President for Education and Outreach at the Accreditation Council for Continuing Medical Education.
>>McCALL: Hi, I'm Niles McCall, I'm the Education Coordinator at Rehoboth McKinley Christian Healthcare Services in Gallup, New Mexico.
>>SINGER: Hi, Niles. How are you?
>>McCALL: I'm doing fine, thank you.
>>SINGER: Thanks for being with us today.
>>McCALL: My pleasure.
>>SINGER: Today we're going to focus on your experience making a difference using accredited CME in a rural setting. So let's start by having you tell us what's the place in which you work?
>>McCALL: Okay. I work at Rehoboth McKinley Christian Hospital in Gallup, New Mexico.
>>SINGER: In Gallup, New Mexico?
>>SINGER: Okay. And you're originally from New Mexico?
>>McCALL: I'm originally from New York...
>>SINGER: From New York. So...
>>McCALL: And I migrated to Philadelphia, and the Carolinas, and then end up in New Mexico.
>>SINGER: Alright. And tell us about the role that you have at Rehoboth?
>>McCALL: Okay. I'm education coordinator. I coordinate all education with nursing or CME for providers, or in-services, webinars and so forth for all of the staff at the hospital and the clinics.
>>SINGER: Okay. And you have a large staff?
>>McCALL: In my office, there's me.
>>SINGER: Just you. Just you. Okay.
>>McCALL: Just myself. Yeah, that's right.
>>SINGER: So you're sort of running the show.
>>McCALL: That's right.
>>SINGER: Okay. So you have a specific activity, a specific initiative that you wanted to talk about. So help set it up for us and then I'll ask you some questions about it.
>>McCALL: Okay. Even in a small rural hospital with less than 70 beds, you can do a lot of things for your providers and for your staff. So one of the things that we do, especially since we're in rural territory and we're surrounded by Native American tribal entities, is we have to educate our providers and our staff on how to interact with patients from tribal backgrounds. So that means we have to have some unusual things to help educate them. So for example, we conducted a Navajo CME sheep camp, where we actually met in the mountains between Arizona and New Mexico. We invited providers and doctors to come for the weekend, and they learn about Navajo health care practices and beliefs. So we talked about everything from the butchering of sheep to herbal remedies, to other cultural things related to the Navajo culture. And this was to educate the providers on how to interact with Navajo patients when they came in the door.
>>SINGER: Okay. And connecting it back with our accreditation criteria in a way, we talk about, foundationally, focusing our education on practice gaps or problems in practice for practitioners, for physicians and other health professionals. So related to this, it seems an appropriate sensitivity that when you're in the rural setting to understand the needs of the population that are part of who you care for. Were you aware of particular practice gaps or things that should be happening but weren't happening, or for certain gaps in practice among your providers?
>>McCALL: Yeah. Well, we discovered these gaps through patient satisfaction surveys, where patients were saying, "This doctor doesn't understand my culture, doesn't know how to interact with me, doesn't understand my beliefs." We discovered it through... Even through near misses, significant errors, mistakes that providers were making when they're interacting with patients, not understanding what kind of herbal treatments they had, or not understanding why they weren't compliant with taking their medications. So even through errors and things like that, through our quality office, we discovered that there was a need for education in this area.
>>SINGER: Okay. So again, you're really pushing on this that “it's just you” perspective here. I'm seeing that you're sort of the... You're the center of a sort of a strategic effort. So you mentioned the quality department. Is the leadership of the hospital aware of this effort? Is this something that they have been part of as a focus?
>>McCAL: Well... Oh, yeah. And of course, they support the CME program, but they're also aware of the errors and the needs and the problems with the patient satisfaction surveys, so they're... Mostly the administration is acutely aware of the needs and the gaps there. What they constantly need reminding is that the CME office, which is myself in this case, can be a part of meeting that need by offering the education and so forth. So they may come to me and say, "We need to do something." So now it's up to me talking maybe with the rest of the CME committee...
>>McCALL: Or with other providers, "What can we do? What would you suggest?" And usually, when we talk together, somebody will say, "Hey, I know what we can do. I know some experts in Navajo culture for example, on herbal treatments and so forth, if we could just to get together with them. Well, why don't we do it for a whole weekend?" And I'll say, "Well, we can provide CME credit for the whole weekend." So now you have a Navajo sheep camp.
>>SINGER: Oh, okay, okay. So talking about the people who were the experts or the people that you work with, in planning the activity, and I guess conducting the activity you said in the mountains...
>>SINGER: Did you collaborate? These experts, are these people from that community? Or how did you find these people?
>>McCALL: Well, I actually found them through referrals from providers.
>>McCALL: We also have... We also collaborate with another hospital across the street, an Indian Health Service Hospital, so it's a governmental entity. So we do a lot of collaboration with them. They only accept Native American patients. So through the patients and through other referrals, we got a hold of experts in herbal treatments. They're usually Navajo, even the person responsible for talking about the butchering of sheep. Why is butchering of a sheep important to healthcare beliefs? What is it that's important about a sheep in traditional Navajo culture that a doctor needs to understand in relating to a patient?
>>SINGER: Fantastic. So as you conducted the activity, something again connected to our accreditation requirements, is we design activities in order to try to change something to sort of move the ball down the field. In terms of the impact, were you able to see impact? Or how did you look at the effectiveness of this intervention that you did to try to repair this gap with your providers with respect to the control competency?
>>McCALL: Well, we got feedback from the providers who attended this, but we also kept track of patient satisfaction surveys over the next few months to see if there were any comments or less comments about physicians not understanding their Navajo patients. Of course, I also keep track working with the quality office. Are there any complaints, or mistakes, or errors, or anything related to patient care? But it's an ongoing process. We'll have to do it again because we get new providers. We get locum providers. We have new providers coming in. So we'll have to continually do this as new providers come in. So it's not even a one single event. It will probably occur again next summer and next summer.
>>SINGER: Right. So it's really very ongoing in trusting this challenge in a rural environment.
>>McCALL: Yeah. And a census related to patient satisfaction and also patient safety, I constantly... Well the education office is responsible for printing out the patient satisfaction surveys. So I'm actually seeing the surveys and the comments, the five different surveys we have to have for a hospital system. So I've been keeping an eye on the comments and on our scores, where do we need improvement, which is a good way to plan future education events. And also working with and sitting on the quality committees when they talk about certain kinds of errors or near misses or other significant events whenever they come up, I'm also in a good position in that role as well.
>>SINGER: You really position yourself to be an integral part of the team.
>>McCALL: Yeah, exactly.
>>SINGER: Fantastic. Thank you very much for being here.
>>McCALL: Oh, it's my pleasure.