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>>SINGER: Hi, I'm Steve Singer. I'm the Vice President for Education and Outreach at the Accreditation Council for Continuing Medical Education.

>>HANNIG: Hi, I'm John Hannig. I'm the CME Chairman at Salem Hospital in Salem, Oregon.

>>SINGER: John, thanks for joining me. You've been at Salem Hospital for how long?

>>HANNIG: I've been there for 10 years.

>>SINGER: For 10 years.

>>HANNIG: Been the Chairman of the CME Committee for about seven years now.

>>SINGER: Okay.

>>HANNIG: Or we call the CPD Committee – Continuous Professional Development. We changed our name to reflect the reason for education of physicians: To change their performance, not to just give them new knowledge.

>>SINGER: Not just information, okay. And along that theme, you and I talked before the interview that you sort of volunteered to become involved. That you were told you needed to volunteer for something, so you chose CME? Congratulations. And when you first became involved, the organization was sort of undergoing its accreditation review?

>>HANNIG: Right.

>>SINGER: So you came through, flying colors.

>>HANNIG: Yes.

>>SINGER: You've gotten commendation. Congratulations. So tell me just a little bit sort of from where you sit now. You're in an organization that is functioning in a way where CME is valued and is a strategic asset for achieving organizational change from the very top. Tell me, how did you get there? You weren't always there.

>>HANNIG: We weren't always there. There was not an engagement between the medical staff, the administration, the hospital board, and the rest of the healthcare team aligning the strategic goals of quality, and safety, patient outcomes, financial responsibility. They all had similar goals, in that, they wanted to take good care of their patients, but how to get there, they had different ideas. And so the hospital said, "We need to align them." And they came to the CME Committee and said, "How can you help us? How can you help us design programs that will involve the engaged physicians to improve their leadership, improve their performance, and therefore filter that down to the rest of the healthcare team, with physician-led."

>>SINGER: Now how did... What you just said, "They came to CME to ask for help." That's very interesting to me because it might not occur to everyone to do that. I'm interested to know, how did that specifically happen? Like who...

>>HANNIG: The Chief Medical Officer at the time came to, actually not to me as the Chairman, but to the person who was the coordinator of the CME, the woman who was coordinating our CME program, and said, "We're thinking about designing a course-work called 'The Physicians Leadership Institute', which is going to invite leaders from across the country in healthcare, in quality, in safety, and had involved physicians on the healthcare team. And what would that look like?" And what we came up with was a combination of didactic, performance change, and then a performance improvement project for the 30 to 40 people who attend this course.

>>SINGER: This is...

>>HANNIG: We designed it.

>>SINGER: Okay, but it's interesting, because what you're describing from Salem's standpoint is separate. It's not saying, "Oh, we're having readmission issues," or, "We're having this, like a specific issue," but rather saying, "We will do better as an organization if the leadership, the clinical leadership is trained in the methodology of how to improve." And that is quite an investment. It's not cheap to do that, correct?

>>HANNIG: No, no. It was a huge investment by the administration and the board because we're a community hospital, has a responsibility to provide financially responsible healthcare. And so the board has to approve this expense, and it has to be shown that it's effective. And by the changing of the performance of the physicians and the healthcare team, it's going to improve patient satisfaction, it's going to improve outcomes and quality, and as we discussed earlier, the Joint Commission, the CMS, the third-party payers are all looking at pay-for-performance and outcome and patient satisfaction. So this process of education for the physicians and the entire healthcare team all supports that. And it's physician-led, it's supported by the administration with these... For example, we currently have the Joint Commission Core Measure on VT Prophylaxis. In other words, preventing pulmonary embolisms on every patient who comes into the hospital.

>>SINGER: From blood clot.

>>HANNIG: Right, from blood clot, which is one of the number one killers of hospitalized patients. So the hospital says, "We're not doing as good a job as we should. How are we going to fix that?" And so they came to the CME department and said, "If we put together a team of people doing this, and we have five physicians working on this project, and four nurses, will you be able to design a process and be involved in a process to accomplish the goal, provide CME credit for those involved?" And so over a course of about a four-month period of time, we're working on that, I happened to be the physician lead, would prove my own CME credit for this. So that's just one example.

>>SINGER: Okay, so but... One of the sort of essential moments was the CME coordinator having the wisdom and the insight to be able to say, "Yes, we can help you to do this." It's interesting to recognize also that the domain of that education goes across different practice domains. It's not just clinical medicine, it's also professionalism and teaching and the methodology of how to lead and improve.

>>HANNIG: At the Physicians' Leadership Institute, which is the coursework, we have experts from across the country coming on and doing a didactic lecture on quality, patient safety, patient engagement. How do we sit down with our patients and actually physically talk to them, how do we do our counselling, how do we enter the room, how do we sit, how do we do all those things that make a patient feel comfortable with the care we're giving. And how do we communicate with the team? How do we become a better team member? How do we communicate? One of the coursework involves a questionnaire that we do on ourselves, that we evaluate, "How are we communicating as a team member?" Answer a list of questions

>>SINGER: Reflective self-assessment

>>HANNIG: Yes, we're self-reflecting. And then we send that out to 10 or 12 members of our team, asking the same questions. And we wind up with, "What are we currently doing well? What should we be changing? And what should we start doing?" And we answer those questions and it comes back in a graphic form that tells you exactly where you are, and then you repeat that six months down the line to see if what you have done has changed, so it's measuring it.

>>SINGER: And it's what you're describing is not a destination.

>>HANNIG: Right.

>>SINGER: It's sort of a continuous... Like you said, continuous professional development, but it's a continuous process of having the educational service within the institution be sort of an educational home, a partner for helping not just clinicians, not just physicians, but nurses and others to sort of improve and reflect over time.

>>HANNIG: Absolutely. The entire health care team is involved. And it has been a cultural shift at our hospital. It's not just physicians telling the team what to do and how to do it, it's the entire team being empowered to say, "This is what we need to do to effect change, to improve patient outcome, to improve the entire performance of the team." And then everyone who works on that goal then gets credit for it, and it only helps our patients, it's measurable in performance change. If we set it up within the activity to say, "This is what we want you to change in your performance, we want you to use this policy and this procedure and this flow and then we're going to come back and we're going to check six months from now and see if you've done that." And then the hospital employs, as you know, hospitals employ a lot of people, Salem Hospital is the largest employer in the city, employs people that that's all they do. They go into informational services and they pull out the data that says how often was that change implemented. And the hospital thinks that that's worth the investment for the ultimate goal, which is quality care, patient safety, patient outcomes and financially-responsible healthcare.

>>SINGER: So this integration between education and the hospital's sort of strategic leadership sounds like it's working well. And it also, without anything else, satisfies the ACCME's requirements.

>>HANNIG: It satisfies the physicians' expectations, it develops new leaders and it can be applied for maintenance of certification and the maintenance of licensure, which is getting much more stringent in terms of actual performance changers. And so all of that can apply and so it's working for us.

>>SINGER: Yeah. What advice would you give to others that have not reached this level of integration and sort of success about where to start or how to...

>>HANNIG: I think I would have them start with addressing the administration and their medical officers and the CMOs, their CFOs, in saying, "We need to work together to accomplish your strategic goals." Acknowledge that the administration at the hospital really has some goals, but we need to work together. And do more than just provide grand rounds. You can do that, which is great.

>>SINGER: But they can look to you for effective change.

>>HANNIG: Right, yeah. And change performance, change performance of the team. Change the culture.

>>SINGER: Thank you so much, John.

>>HANNIG: Happy to be here.

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This is a transcript of Working Together: How CME Empowers Teams and Builds Leadership.

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