WHETHER YOU NEED to re-engineer your office to address future continuing medical education opportunities, assure regulatory protection for your CME unit and its organization, avoid marginalization of your CME function in the overall organization, or address other needs, it won't happen unless you assemble a quality team that can lead the way, according to Harvard business professor John Kotter. This means identifying individuals with the position, power, expertise, credibility, and leadership to contribute to, or benefit from, the CME function; in other words, the stakeholders:

1. Organizational leaders

   Look for influential leaders who work outside of your CME unit but who are a part of your organization. Identifying a credible leader who will be able to persuade the overall organization as to the value of CME — for example, CME supports the organizational mission, improves the quality of care provided, and even protects the organization against regulatory infringement — is what this coalition-building process is all about.

2. Physician learners and their practice members

   Learners are key stakeholders in the CME change process, especially if your CME efforts involve expanding toward practice-based learning and improvement, self-assessment, and improved outcomes. Select practicing physician learners who are influential innovators, or early adopters of change, who can bring reality to educational vision and application, and who can be advocates for the necessary changes in CME practice.

   And don't stop with physicians — you may want to involve other members of the healthcare team, even if the physicians on your coalition balk at first. However, a nurse or pharmacist may hold the critical perspective that will enable you to lead the change necessary for the future of the practice/system.

3. Faculty

   The faculty represent a major resource for content expertise as well as learning support and facilitation. Be sure to select key faculty leaders for your cause, because they need to lead change among the faculty themselves to support future CME practice.

4. Internal/external partners

   Build partnerships with those in your organization who can help to launch new initiatives. For instance, if you want to begin to address quality improvement, then quality-improvement units might play a role. Commercial supporters, consultants, technical experts, and even patients could be part of the coalition, depending on what changes your CME unit wants to make.

Also, consider linking the coalition actions to your accreditation self-study process. Since one of the imperatives of accreditation standards is continuous improvement, the coalition that is leading change in your CME unit needs to contribute to your self-study and improvement process. You have a win-win situation as long as your focus is on leading constructive change and improvement in your CME unit and not only on compliance with accreditation standards.

Joseph S. Green, PhD, is associate consulting professor, Department of Community and Family Medicine and associate dean of CME, Duke Office of CME, Duke University Medical School, Durham, N.C.; James C. Leist, EdD, is interim director, Alliance Center for Learning and Change, and associate consulting professor, Department of Community and Family Medicine, Duke University Medical School; Robert E. Kristofco, MSW, is associate professor and director, Division of CME, University of Alabama School of Medicine, Birmingham, Ala.

Key Elements in Leading Change

1. Find the right people

2. Create trust

3. Develop a common goal

4. Link coalition to accreditation self-study