NOW THAT YOU'VE experienced little victories in moving your CME organization to its desired vision, it's time to develop momentum toward achieving your organizational, strategic goals. Harvard business professor John Kotter suggests three steps that can help to sustain the wins and bring about more of the desired change:

1. Use the credibility

   It is important to share the small victories you've already had with the staff and other stakeholders. It is not enough to create wins if no one knows about them. Each small step can be used to increase the credibility of the entire change process. With this increased credibility, the leader can begin to undertake a review of the current Policy and Procedure manual to see if modifications are needed to sustain the change. Other systems, such as a monthly review of the overall change process with stakeholders (including adding an agenda item to the routine CME Advisory Board meeting) could be put in place.

2. Hire, promote, and develop

   This is the pivotal step in the entire change process. It is not that you will fail without new people, but rather, bringing on new employees with new skill sets, being able to promote others inside the organization to new positions, or providing targeted development activities for current staff is the fuel that drives the change engine. These very visible actions announce that change is happening (and others should get on board or miss the train!). If part of your vision is focused on bringing new business to the organization, creating a new position of “business development specialist” is a clear statement of organizational priorities. Actually hiring someone with an MBA to tackle this task is an additional statement. Then, having this “new-business person” start to provide weekly training sessions for others on staff in this vital area completes the picture.

3. Reinvigorate the process

   Change does not come easily to organizations. For every step you may take in a positive direction, you may find yourself having to take one or two steps backward or sideways. There is always someone or something that is threatened by or has not heard about this new direction, which is why you have to constantly infuse new ideas, new procedures, and new slogans into the overall process — all aimed at helping reach the agreed-upon vision. Perhaps a new advertising campaign is needed to get the attention of the various funding sources for your CME program. If foundations or pharmaceutical companies do not know you have hired a business development specialist to increase outside funding, the desired goals will not be reached.

This step focuses on taking small victories in the journey toward the CME vision and institutionalizing them, building momentum, enhancing the human potential to carry out the new vision, and periodically infusing new energy into the transformational efforts.

Joseph S. Green, PhD, is associate clinical professor, Department of Community and Family Medicine; associate dean of CME, Duke Office of CME, Duke University Medical School; and founder/president, Professional Resource Network Inc., Durham, N.C. Robert E. Kristofco, MSW, is associate professor and director, Division of CME, University of Alabama School of Medicine, Birmingham, Ala. 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.

To Sustain the Wins:

1. Use the credibility gained in the small victories.

2. Hire, promote and develop people who can implement the change.

3. Reinvigorate the process.