IF YOU'VE FOLLOWED this series so far, your CME unit has made assessing learner knowledge and performance improvement an important part of how you gauge the performance of your overall CME program. You're measuring the degree to which activity objectives have been met and physician practice patterns have been changed, and you're setting more rigorous standards for measuring the overall CME program. How do you keep the focus on the new culture?

The final step in leading change in your organization is anchoring the change in the practice of your CME unit. In Leading Change, Harvard business professor John Kotter says that your anchoring process must do the following three things:

1. Illustrate positive results

   Staff members need to see the positive results that these processes have on improving CME. When they understand that the data they secure are useful for needs assessment, process improvement, and to demonstrate the value of the CME function, they will become advocates and actively recommend enhancements to the process. When staff, faculty, and other stakeholders feel that they are having a positive effect on learners and their practices, it reinforces your unit's practices, especially if it is supported by the leaders and the organization.

2. Give verbal examples

   When the unit's members hear outcomes measurement success stories, they can see how the organization's practice is shifting. Describing the effect an activity has had on a particular population and being able to demonstrate knowledge gains of practitioners engaged in your activities validates the use of the data and begins to encourage people to continue that practice. This should be an ongoing process, not a one-time event.

3. Recognize staff, and recruit when necessary

   Recognizing staff for recommending and employing high-quality measurement practices with good results shows them that the norm of practice in the organization is changing. You may need to make staffing changes to anchor new practices in the unit, especially if incumbents do not share the vision and are not willing to embrace the new work. When hiring new staff members, make sure they understand that the culture of your unit values securing data to document results of learners' knowledge and practice. Hiring people who share the values of the culture is critical to anchoring practice in the culture.

It is important for the leader to recognize that changing the culture — the norms of behavior (actions) and shared values (concerns and goals of group) — is the last thing to change. Some think that the culture must be altered first. The fact is that the cumulative effect of the changes put in place is what re-molds the culture. If you follow the three steps outlined in this column, you will anchor the changes in practice and establish a culture that will champion those changes in the organization. Moreover, the culture shift will set the stage for a more dynamic and nimble enterprise dedicated to continuous improvement.

James C. Leist, EdD, is interim director, Alliance Center for Learning and Change; Robert E. Kristofco, MSW, is associate professor and director, Division of CME, University of Alabama School of Medicine, Birmingham, Ala.; Joseph S. Green, PhD, is president, Professional Resource Network Inc., Durham, N.C.

Lessons learned in anchoring change:

1. Remember that culture change comes last (after the change), not first.

2. Document the positive results of the change.

3. Consistently use stories to reinforce the successful.

4. Recognize and reward personnel for positive results.