When leaders at the Alliance for Continuing Medical Education announced at the organization’s annual conference in January that it would be expanding its focus beyond certified CME to include healthcare-related continuing education and continuing professional development, participants dropped their iPhones and riveted their attention to the dais. What outgoing president, Jann Balmer, PhD, director, CME at University of Virginia School of Medicine, was outlining for the organization, which until now had been mainly focused on providing certified CME for physician learners, sounded nothing short of transformational.

The new vision, new mission, and eight strategic commitments she unveiled are designed to move the organization beyond an “accreditation-only, medical-only, and education-only” mind-set and toward one that will truly improve healthcare outcomes. The buzz at the conference could be boiled down to: “This is huge! The Alliance is totally reinventing itself!”—with all the excitement and, for some, trepidation that comes along with a radical shift.

Why Now?
The move, which likely will include a name change to reflect its new direction (see “New Mission, New Name,” below), is a direct response to the rapidly changing healthcare—and healthcare education—environment. As the Alliance’s board of directors began to work on its 2011–2014 strategic plan, it realized that it needed to do more than tweak the strategic imperatives of its prior plan, says George Mejicano, MD, the Alliance’s new president, who is associate dean for continuing professional development with the University of Wisconsin School of Medicine and Public Health. While advancing the profession of CME, helping providers transform knowledge into performance, and helping CME professionals connect with each other are still important, the board concluded that these goals no longer were sufficient to meet the needs of today’s continuing healthcare education professional.

After all, today’s environment looks very different from even five years ago. Quality and performance improvement are on the front burner as quality of care continues to lag even while spending soars. Educators are tasked with proving that what they’re doing is making a difference in patient care. Maintenance of licensure and certification also now are more focused on quality and performance improvement, and commercial support of healthcare education is under increasing scrutiny by everyone from legislators to The Wall Street Journal.

Then there’s the trend toward making education interprofessional, rather than providing siloed activities for different provider types (something that was endorsed in the Institute of Medicine’s “Redesigning Continuing Education in the Health Professions”). The Accreditation Council for CME, the American Nurses Credentialing Center, and the Accreditation Council for Pharmacy Education also showed they are on the interdisciplinary bandwagon when they released a joint accreditation process to make it easier to provide accredited education across the physician/nursing/pharmacist spectrum.

The Alliance itself had gone through some growing pains since its last strategic plan went into effect five years ago. Membership, conference attendance, and exhibitor attendance all spiraled down with the economy and, like the economy, are just now trickling back. Still, the association launched a batch of new programs and services—including the CME professionals’ competency areas and new certificate programs based on those competencies.

After a year of environmental scanning, discussions, and review of programming, the board started to outline a plan for the future. In June 2010, the leadership met in Charlottesville, Va., for its summer board meeting. Balmer, who was president at the time, surveyed the board members to fine-tune the agenda, and hired a strategic planning consultant to ensure the retreat would achieve the desired results. The outcome was a vision, mission, and eight strategic commitments that the board believes will enable the Alliance to reach out to new members in medical informatics, quality and performance improvement, and those who provide continuing education not only for physicians but also for nurses, technologists, pharmacists, and other healthcare-related professionals. (See the sidebars below mission, vision, and commitments.)

Radical Shift or Logical Next Step?
While many at the conference saw the move as a radical departure from the Alliance’s previous course, Balmer says that the new mission’s alignment around interdisciplinary education, advocacy, and Alliance-level collaboration with organizations involved in continuing healthcare education is really just “ratcheting up to the next level the work we’ve done the past several years, a formalization of what’s been happening.”

As for the expanded focus beyond certified CME, Balmer points out that the Alliance has historically been a diverse and inclusive membership organization. Adds Mejicano, “We’re not abandoning physicians, but we want to explore interprofessional and transprofessional healthcare education—how to teach people as teams, and what skill sets will be needed to provide team-based education.” At a recent board meeting, Damon Marquis, executive director of the Joint Council on Thoracic Surgery Education Inc., compared the Alliance’s recent move to knocking down the fence around a gated community.

“Certified CME is too narrow a model for today’s environment,” says Mejicano. “If we’re really trying to make improvements in patient care central, which I believe we are, it’s one lever to move us forward, but it’s not the only one.” He cites as one example the Food and Drug Administration’s ability now to require a Risk Evaluation and Mitigation Strategy from manufacturers to ensure that the benefits of a drug or biological product outweigh its risks, which some believe could open up a new market niche for CME providers. “If certified CME is a barrier to collaboration with drug and device companies to put out a safety message to clinicians worldwide, that barrier needs to come down. We need to put patients first.” Another sign of the times: There are now schools offering a doctor of nursing practice degree, which in some jurisdictions might come with prescribing authority. “If we’re only doing continuing medical education, we’re not addressing the educational needs of all those populations—nurses, pharmacists, nutritionists, dentists, all those involved in patient care.”

Some members have expressed concern that, by expanding, the Alliance will dilute its influence and offerings. To which Mejicano replies, “Healthcare is a team sport. If you think about how patients experience care—who’s giving the reminder to come to the appointment, who’s checking the patient in, the clinician, of course, then there may be someone giving a vaccine or handing out patient-education materials, there may be interaction with specialists or a handoff to hospitals and nursing homes and long-term care facilities—this isn’t a Marcus Welby model anymore.”
The rise of social networking technology is yet another reason for the change, he says. “Patients are rating doctors on Angie’s List and giving each other links to information—some is good, some frankly is not—on Facebook, LinkedIn, and Twitter. The idea that only one’s physician is the sole source of expertise is a fallacy.”

So far, say Mejicano and Balmer, the reaction to the new vision, mission, and plan has been about 90 percent positive. The exceptions, says Mejicano, include members who worry they’ll be left behind, particularly those who work in small community hospitals. “We have to find a balance that will address their needs while still moving toward the future.”

Advocacy and Collaboration
Two other key aspects of the Alliance’s new mission are more obviously continuations of its past work: advocating for the continuing healthcare education profession, and collaborating with related organizations.

While it’s not explicitly stated in the eight strategic commitments, Mejicano says that advocacy cuts across all eight of them.

“There were many times when something critical of CME would come out and people would say, ‘There’s no response coming from Birmingham’ [where the Alliance is based].” The advocacy committee has already made strides to provide a voice for the CME community by responding to the release of the American Medical Association Council on Ethical and Judicial Affairs’ CME funding reports, the Council of Medical Specialty Societies’ Code for Interaction with Companies, and the questioning of commercial support by Sen. Charles Grassley, R-Iowa, and other legislators, as well as through developing proactive positions.

Collaboration will be as important to the Alliance’s future as it is to that of its members, and Mejicano says the new plan is to be more proactive about it than it has been in the past. “We need to find ways to reach out to other organizations in a way that lets us set the agenda instead of react to the agenda,” he says. “We already have strong connections with the Society for Academic CME, for example. Now we want to reach out to organizations such as the ACPE to learn how we can better serve the pharmacy education community.”

Time to Be Nimble
The new vision, mission, and strategic commitments have been announced, but how it will all be achieved is still up for discussion. “I have to emphasize that it’s a work in process,” Mejicano says. The next step will be to engage all the membership. On March 3, the board reconvened in Chicago for another retreat, this time also bringing in the staff liaisons, the committee chairs, and another designee from each committee to brainstorm ways to put the new plan into practice. “We need to build out the actual nuts and bolts of what it means to model innovative leadership, for example,” says Mejicano. “What does this mean for the conference committee? Or the advocacy committee? Do we need any bylaw changes? We’re hoping to really engage the membership through the committee structure.”

The Alliance also realizes that it has to be more nimble than it has been in the past to keep up with—and preferably get ahead of—all the changes its constituents are going through. One key factor will be a new Web site it plans to launch in March. The interactive site, which will be linked to a new association management system designed to better support member services, will allow members to create wikis and communities of practice on an as-needed basis. “It won’t just be a member section with a listserv; the current member sections in many ways are historical artifacts,” says Mejicano. “While it’s important to get together with people in similar roles, there are other ways to stratify the membership. You could do it by experience levels, by geography. … We never really had a way to support that kind of community-building before, but now we will.” The plan is to track what members do on the site to help shape what the Alliance does in its advocacy efforts, and so it can develop products and services to serve these communities of practice.

While the specifics are still being worked out, one thing seems sure: The Alliance is dedicated to staying on its new course—and to adapting to new ideas when they arise. “It reminds me of that saying by the hockey great Wayne Gretzky,” says Mejicano. “We need to skate where the puck’s going, not where it’s been.”

For full background on the strategic plan—the environmental analysis, approach, outcomes, and implementation plan—along with an appendix that includes some ideas on how to put it all into practice, go to the Alliance’s Web site, acme-assn.org.

Sidebar: New Mission, New Name
The Alliance for CME will be considering changing its name to reflect the organization’s new vision, mission, and strategic plan. “We are being deluged with ideas for new names and logos,” says George Mejicano, MD, the Alliance’s new president, who is associate dean for continuing professional development with the University of Wisconsin School of Medicine and Public Health. “It’s going to require a thoughtful process to move forward, and eventually a bylaws change.” Still, he says, “I would be shocked if it doesn’t happen.”

Sidebar: The Mission
“The Alliance is a community of professionals dedicated to accelerating excellence in healthcare performance through education, advocacy, and collaboration.”

Sidebar: The Vision
“The Alliance is a recognized leader and trusted partner that exists to close gaps in healthcare performance by translating the best science and knowledge into effective continuing professional development.”

Sidebar: The Strategic Commitments
1. Expand the focus of the Alliance beyond certified CME
2. Broaden the focus of the Alliance to include healthcare related continuing education and continuing professional development
3. Be visionary and proactive in strategically aligning the Alliance with the emerging healthcare environment while remaining sensitive to current needs
4. Model innovative leadership to shape the future
5. Actively develop strategic relationships with other healthcare organizations
6. Build a strategy to be the recognized voice for CPD in the health professions
7. Be the professional home for health professionals in CPD
8. Advance the field of CPD through research and other scholarly activities

Sidebar: What Dissenters Say
Donald Harting, MA, CCMEP, a medical writer with Imedex LLC in Downingtown, Pa., voiced a concern that several others expressed at the unveiling of the Alliance for Continuing Medical Education’s annual conference in San Francisco in January: That the Alliance’s expansion beyond certified CME and physician-focused education providers could cause the organization to lose its focus. “If we try to be all things to all people, we’ll burn ourselves out and leave a poor impression on others,” he says.

“Why not stay tightly focused on continuing medical education? To broaden our focus to ‘continuing professional development’ invites input from and collaboration with such a broad spectrum of other professions (lawyers? accountants? social workers?) as to become almost meaningless.” Instead, he suggests that the organization could expand by becoming more international while remaining an organization for CME providers.

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