Volume 31, Supplement 1, Fall 2011

http://www.jcehp.com/

Editorial: Collaboration, best-practice CME, public health focus, and the alliance for CME competencies: A formula for the new CME?

Donald E. Moore

Factors contributing to successful interorganizational collaboration: The case of CS2day

Curtis A. Olson, Jann T. Balmer, George C. Mejicano

Continuing medical education's transition from an emphasis on dissemination to changing clinical practice has made it increasingly necessary for CME providers to develop effective interorganizational collaborations. Although interorganizational collaboration has become commonplace in most sectors of government, business, and academia, our review of the literature and experience as practitioners and researchers suggest that the practice is less widespread in the CME field. The absence of a rich scholarly literature on establishing and maintaining interorganizational collaborations to provide continuing education to health professionals means there is little information about how guidelines and principles for effective collaboration developed in other fields might apply to continuing professional development in health care and few models of successful collaboration. The purpose of this article is to address this gap by describing a successful interorganizational CME collaboration-Cease Smoking Today (CS2day)-and summarizing what was learned from the experience, extending our knowledge by exploring and illustrating points of connection between our experience and the existing literature on successful interorganizational collaboration. In this article, we describe the collaboration and the clinical need it was organized to address, and review the evidence that led us to conclude the collaboration was successful. We then discuss, in the context of the literature on effective interorganizational collaboration, several factors we believe were major contributors to success. The CS2day collaboration provides an example of how guidelines for collaboration developed in various contexts apply to continuing medical education and a case example providing insight into the pathways that lead to a collaboration's success.

Developing and Implementing an Effective Framework for Collaboration: The Experience of the CS2day Collaborative

Mary W. Ales, Shelly B. Rodrigues, Robyn Snyder, Mary Conklin

Continuing medical education's transition from an emphasis on dissemination to changing clinical practice has made it increasingly necessary for CME providers to develop effective interorganizational collaborations. Although interorganizational collaboration has become commonplace in most sectors of government, business, and academia, our review of the literature and experience as practitioners and researchers suggest that the practice is less widespread in the CME field. The absence of a rich scholarly literature on establishing and maintaining interorganizational collaborations to provide continuing education to health professionals means there is little information about how guidelines and principles for effective collaboration developed in other fields might apply to continuing professional development in health care and few models of successful collaboration. The purpose of this article is to address this gap by describing a successful interorganizational CME collaboration-Cease Smoking Today (CS2day)-and summarizing what was learned from the experience, extending our knowledge by exploring and illustrating points of connection between our experience and the existing literature on successful interorganizational collaboration. In this article, we describe the collaboration and the clinical need it was organized to address, and review the evidence that led us to conclude the collaboration was successful. We then discuss, in the context of the literature on effective interorganizational collaboration, several factors we believe were major contributors to success. The CS2day collaboration provides an example of how guidelines for collaboration developed in various contexts apply to continuing medical education and a case example providing insight into the pathways that lead to a collaboration's success.

Developing clinical competencies to assess learning needs and outcomes: The experience of the CS2day initiative

Tom McKeithen, Sheila Robertson, Mike Speight

Continuing medical education's transition from an emphasis on dissemination to changing clinical practice has made it increasingly necessary for CME providers to develop effective interorganizational collaborations. Although interorganizational collaboration has become commonplace in most sectors of government, business, and academia, our review of the literature and experience as practitioners and researchers suggest that the practice is less widespread in the CME field. The absence of a rich scholarly literature on establishing and maintaining interorganizational collaborations to provide continuing education to health professionals means there is little information about how guidelines and principles for effective collaboration developed in other fields might apply to continuing professional development in health care and few models of successful collaboration. The purpose of this article is to address this gap by describing a successful interorganizational CME collaboration-Cease Smoking Today (CS2day)-and summarizing what was learned from the experience, extending our knowledge by exploring and illustrating points of connection between our experience and the existing literature on successful interorganizational collaboration. In this article, we describe the collaboration and the clinical need it was organized to address, and review the evidence that led us to conclude the collaboration was successful. We then discuss, in the context of the literature on effective interorganizational collaboration, several factors we believe were major contributors to success. The CS2day collaboration provides an example of how guidelines for collaboration developed in various contexts apply to continuing medical education and a case example providing insight into the pathways that lead to a collaboration's success.

Evaluation of a collaborative program on smoking cessation: Translating outcomes framework into practice

Marianna B. Shershneva, Christopher Larrison, Sheila Robertson, Mike Speight

Introduction: Although evaluating at multiple outcome levels has been proposed for continuing education activities and programs, it is a complex undertaking and is not done routinely, especially in collaborative, multicomponent programs. This article reports on strategies used and results obtained in an evaluation project that examinedmultiple outcomes of a US-based collaborative, multicomponent smoking cessation educational program for clinicians. 
Methods: Evaluation was organized conceptually around the 6 levels of an outcomes-based evaluation model and was conducted using registration data, postactivity evaluations, clinical vignettes with questions assessing knowledge and competence in participants and in a comparison group, a commitment to change approach, data from patient charts to assess clinician compliance on 8 performance measures, and tobacco cessation rates. Additional methods included a success case method study of 9 practices participating in performance improvement (PI) activities and assessment of partner collaboration using a written survey and interviews. 
Results: The program reached more than 43,000 clinicians who participated in a variety of activities. Participants indicated a high level of satisfaction with the program's educational activities and demonstrated higher scores than a comparison group on 6 of 7 competencies. The majority of participants who responded to commitment to change questions reported intended and implemented practice changes consistent with desired outcomes. Performance outcomes of 3 PI activities varied, with greater improvements observed in 1 activity (9.0% to 36.2% improvement across 8 measures). Lower performance outcomes, but a smoking quit rate of 46.8%, was observed in 2 other PI activities. 
Discussion: The program had an overall positive impact on the measured variables for clinicians and their patients. Use of 1 outcomes assessment framework acceptable to all members of the collaborative, common measures and evaluation techniques, and centralized data repositories contributed to the success of the program evaluation reported here and is recommended to others who are considering a collaborative program evaluation.

Sharing collaborative designs of tobacco cessation performance improvement CME projects

Elizabeth A. Mullikin, Mary W. Ales, Jane Cho, Teena M. Nelson, Shelly B. Rodrigues, Mike Speight

Introduction: Performance Improvement Continuing Medical Education (PI CME) provides an important opportunity for CME providers to combine educational and quality health care improvement methodologies. Very few CME providers take on the challenges of planning this type of intervention because it is still a new practice and there are limited examples from which to model. This article offers case examples of educational design, results, and lessons learned from 4 tobacco cessation PI CME activities. 
Purpose: To share with the CME community different cases of PI CME educational design and results so that CME providers may have examples to draw from and develop more PI CME activities. 
Methods: This is a case report. 
Results: Four of 9 partners of the Cease Smoking Today (CS2day) initiative developed the 4 tobacco cessation PI CME activities. Each project was designed and implemented using a common planning framework and clinical performance measures but with varying operational and educational design components depending on the strengths and resources of the leading partner. Three projects that are completed show improvements in aggregated practitioner performance and smoking quit rates. One project is currently under way. 
Discussion: These cases highlight the value of collaboration, identify influences of operational and educational designs on variation in compliance with performance measures, and lead to a discussion of similarities in barriers, successes, and lessons for future practice.

Peering inside the clock: Using success case method to determine how and why practice-based educational interventions succeed

Curtis A. Olson, Marianna B. Shershneva, Michelle Horowitz Brownstein

Introduction: No educational method or combination of methods will facilitate implementation of clinical practice guidelines in all clinical contexts. To develop an empirical basis for aligning methods to contexts, we need to move beyond "Does it work?" to also ask "What works for whom and under what conditions?" This study employed Success Case Method to understand how 3 performance improvement CME activities contributed to implementation of tobacco cessation practice guidelines in 9 outpatient practices. 
Methods: Success criteria were applied to clinical data from 93 practices, generating a pool of 14 success cases; 9 were recruited into the study. We conducted semistructured telephone interviews with 1 to 4 informants in each practice. Individual case reports were developed summarizing changes made, what was done to effect the changes, relevant contextual factors, and contributions of the educational interventions to change. A cross-case analysis followed. 
Results: Twenty informants were interviewed. Practice changes varied in number and degree. Implementation mechanisms included acquisition of new knowledge and skills, making improving cessation practice an active goal, engaging the clinical team, adopting a more proactive approach with smokers, and making smokers and clinical practice performance more visible. Contextual factors influencing the implementation process were also identified. 
Discussion: The study shows that (1) the appropriate target of an educational intervention may be a team rather than an individual, (2) implementing even relatively simple practice guidelines can be a complex process, and (3) change requires scientific and practical knowledge. A richer understanding of implementation mechanisms and contextual factors is needed to guide educational planning.

Advancing public health through continuing education of health care professionals

Karen Suchanek Hudmon, Robert L. Addleton, Frank M. Vitale, Bruce A. Christiansen, George C. Mejicano

This article describes how the CS2day (Cease Smoking Today) initiative positioned continuing education (CE) in the intersection between medicine and public health. The authors suggest that most CE activities address the medical challenges that clinicians confront, often to the neglect of the public health issues that are key risk factors for the onset and exacerbation of diseases. The authors further suggest that the educational activities of the CS2day initiative functioned as Type III translational science in that it facilitated the use of research-derived practice guidelines in clinical practice and in the community. The article concludes by stating that the successful results of the CS2day initiative illustrate what can happen when continuing education efforts develop from a public health problem rather than just a practice gap identified in a clinical practice setting.

The relevance of the alliance for CME competencies for planning, organizing, and sustaining an interorganizational educational collaborative

Jann T. Balmer, Bruce J. Bellande, Robert L. Addleton, Carol S. Havens

The heightened demand for accountability, access, and quality performance from health care professionals has resulted in linkages between continuing education (CE), performance improvement (PI), and outcomes. CE health professionals must also expand their skills and abilities to design, implement, and measure CE activities consistent with these new expectations. In addition to administrative and meeting-planning activities, new competencies associated with educational consultation and performance coaching are needed. This article utilizes the Alliance competencies as the framework for discussion of the competencies of CE professionals and applies it to the unique setting of a collaborative. The CS2day initiative serves as an example of the application of these competencies in this environment. The framework of the Alliance competencies can serve as a guide and a tool for self-assessment, work design, and professional development at individual, organization, and systems levels. Continual reassessment of the Alliance competencies for CE in the health professions will be critical to the continued effectiveness of CE that is linked to performance improvement and outcomes for the CE professional and the health care professionals we serve. A collaborative can provide one option for meeting these new expectations for professional development for CE professionals and the creation of effective educational initiatives.

The Cease Smoking Today (CS2day) initiative: A guide to pursue the 2010 IOM report vision for CPD

Ronald M. Cervero, Donald E. Moore, Jr.

This article reviews the articles in this supplement that describe a smoking cessation project, Cease Smoking Today (CS2day) that demonstrated successful outcomes: physician adoption of a smoking cessation guideline and an increase in smoking quit rates. The authors examine how the activities of the CS2day project compared to the principles and characteristics of the vision for a future system of continuing professional development that was described in the 2010 Institute of Medicine (IOM) report, Redesigning Continuing Education in the Health Professions. While it did not meet all the characteristics of the IOM's vision, the CS2day Initiative met enough of them for the authors to suggest that the momentum that the IOM report generated has been sustained. The authors point out two strengths and two weaknesses that further strategic and organizational efforts should consider. The two strengths were the collaborative nature of the project and an approach to continuous outcomes assessment that was based on competencies derived from a practice guideline. The authors also suggested that future similar efforts should place more emphasis on instructional design and developing a program theory to guide program operations and educational development. The authors encouraged members of the CME profession to consider the accomplishments of the CS2day project as they are planning to move their CME programs toward the vision described in the IOM Report.