One of the most critical mistakes CME leaders can make is to think that they can implement change by themselves — you need a qualified team empowered to take action.

If you've already created a sense of urgency for change, organized a coalition to develop a vision, created a vision, and communicated strategies that will make the vision a reality to the other team members, you have already begun to empower people to act. But there still will be obstacles. Here's how you can overcome them.

1. Remodel the organizational structure

   A typical CME unit provides meeting planning and CME certification services. If a new vision for the unit focuses on physician learning in the office setting, the existing structure and staff skills will need to be refocused on needs assessment, modified interventions, and evaluation in the practice setting using data. Revising the organizational structure and job functions to implement practice-based learning and improvement is a key component to empowering broad-based action for the new vision.

2. Provide continuing growth opportunities

   You may need to assess your staff's skills and modify them to meet the new vision's needs. For example, to link CME activities to physician learning needs, staff may need to learn to use data that assess physician performance in the office setting. The leader needs to determine if staff understand the kinds of changes this new focus will have on their work and what skill sets each has — and determine the willingness and readiness of staff to learn new things. Leaders then must make it possible for staff to learn what they'll need to learn.

3. Integrate support systems

   Human resources could craft new job descriptions and titles, provide evaluation and performance appraisal expertise, and offer incentives for new staff responsibilities. Information technology professionals can consult on technology applications, and Web design and implementation. Include your support systems in your “guiding coalition” to facilitate broad-based action by the staff.

4. Provide support for change

   If your CME staff feel left out, unsupported, uninformed, or just plain confused, that becomes a barrier to broad-based action. Do you support your employees? Do you listen to them? If an employee makes a suggestion for improvement in your organization, how do you handle that recommendation? Listening and reinforcement are perhaps the most important traits to cultivate as a leader.

To empower broad-based action in support of organizational change, keep these thoughts in mind from Harvard business professor John Kotter's book, The Heart of Change: “In highly successful change efforts, people find ways to help others see the problems, or solutions, in ways that influence emotions, not just thought. Feelings then alter behavior sufficiently to overcome all the many barriers to sensible large-scale change.”

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.; Joseph S. Green, PhD, is associate clinical professor, Department of Community and Family Medicine and associate dean of CME, Duke Office of CME, Duke University Medical School, Durham, N.C.

To empower broad-based action:

1. Make sure your organizational structure supports what you are doing.

2. Make sure your staff have the right skills and talents to support the vision in practice.

3. The personnel and technology system should facilitate the vision.

4. Listen to staff and support their recommendations.