Exceptional Care, Exceptional Performance: The Continuing Medical Education Program's Impact on Quality and Performance Improvement

By Nikki Hatfield, MBA, CMA

It’s fair to say most healthcare organizations are committed to quality and patient safety. But what exactly does that commitment mean? Patient safety, according to the World Health Organization (WHO), isthe absence of preventable harm to a patient during the process of healthcare and reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum”.[1] Healthcare quality may be defined as “the extent to which the care received improves the probability of desired clinical outcomes and reduces the probability of poor clinical outcomes; given current knowledge.” Hmm. “Given current knowledge.” We’ll come back to that. 

Poor quality and patient outcomes can have many implications for an organization. One study shows diagnostic errors occur in approximately 1 in 20 adults seeking outpatient care in the United States each year. The same study indicates up to 26% of medication errors are preventable. Data suggests 115 of every 1,000 hospitalizations encounters a preventable safety event, costing payers $8,000 per admission on average. These errors have a tremendous financial impact on healthcare payers; accounting for up to 1% of overall healthcare dollars.[2]  

Certainly, medical and patient safety errors have a devastating impact on the patient’s welfare.  The results of which may equate to more than just dissatisfaction. Major events can lead to lawsuits, legal fees, settlements and fines for the health system, which can be disastrous.   Maintaining a healthy revenue cycle in today’s healthcare environment is an arduous task for most health systems requiring extreme efficiency. Suffering from refunded or retracted payments due to patient safety errors creates unnecessary obstacles to an already complex and challenging process. Improving physician competencies through continuing medical education is one way of mitigating the negative effects on revenue from adverse events. 

Medicine is a quickly evolving field with new technology and innovative techniques being developed constantly. In order to keep patients safe, it is essential for physicians to be up to date on this material. There is no doubt that provider education and patient quality and safety go hand in hand. The education physicians receive in school is not sufficient to sustain them throughout their entire career.[3]

Remember we based the definition of healthcare quality on the patient’s care and clinical outcomes “given current knowledge?” Knowledge gaps are inevitable in medicine. These gaps are likely attributed to rapid advances in medical innovation and technology. The magnitude of medical information for which medical professionals are now responsible is beyond the aptitude of one person. It takes approximately 14–17 years for new information in medical innovation and technology to be broadly realized.  In order to make progress toward evidence-based care, it is essential for providers and organizations to decrease this period of time, necessitating a team of physicians and healthcare professionals who are well-educated and constantly updated.[4] This is essentially a capital investment in a health system’s employees through continuing education and will ultimately render a return for the business.

Hospital officials may not have previously considered the learning gap amongst physicians having an impact on patient quality and safety gaps. Physician education structured to address specifically identified gaps through continuing medical education offerings could positively impact overall patient satisfaction scores, decreasing or eliminating payment penalties. Data relative to gaps in patient quality and safety are well-documented in organizational safety and key performance indicator reports. Analysis of these reports will reveal trends and opportunities for quality improvement initiatives.   

Currently, physicians have broad sovereignty regarding the topics on which they learn and the types of learning experiences. Modern CME programs are beginning to incorporate a standardized set of curricula addressing updates to core competencies focused on improving clinical outcomes. While CME credits are a requirement for physicians, health systems may want to view programs as an opportunity to improve the competence and performance of physicians providing care within the organization.            

The development and continued growth of a physician’s knowledge and abilities directly impacts the care delivered to patients. Improving upon skills and knowledge is not enough — ongoing education also must provide physicians with content that directly correlates to clinical practice. Studies have shown continuing education programs that are most impactful focused on identified gaps in knowledge or practice (and need to change) and addressed barriers to change in the practice environment.[5]

Health systems invest a lot of time, money and energy tracking patient quality and safety data. Using data to identify gaps in care, as well as patient quality and safety, health systems can then structure an educational program focused on closing those disparities and deliver teachings that are applicable to the physician’s clinical practice.

Continuing medical education guides physicians to appreciate their connection to the healthcare delivery system. By mapping the cause and effect relationship of patient quality and safety to continuing medical education within the organization, it becomes easier to address gaps timely and effectively. Physician buy-in is essential to any continuing medical education program. Continuing education is essentially an investment in human capital — when physicians view CME as an investment in themselves, as human capital, and the returns on said capital are quite significant, accountability and engagement will emerge.   

On Tuesday, March 30, Hatfield will present a rapid-fire session on this topic during the Ignite Showcase. Learn more and find out how you can attend the Alliance Experience Alliance Learning Labs here.  

References

[1] World Health Organization (WHO).  2019.  Retrieved from: https://www.who.int/teams/integrated-health-services/patient-safety

[2] The Financial and Human Cost of Medical Error…and How Massachusetts Can Lead the Way on Patient Safety.  (2019, June).  Betsy Lehman Center of Patient Safety.  Retrieved from https://betsylehmancenterma.gov/assets/uploads/Cost-of-Medical-Error-Report-2019.pdf

[3] Hampton, T.  (2008).  Experts debate need to improve quality and oversight of continuing education.  Jama, 299(9), 1003-1004. doi:10.1001/jama.299.9.1003

[4] Committee, Planning a Continuing Health Professional Education Institute, Services, Board on Health Care, Medicine, I. o., Board on Health Care Services, ProQuest Ebooks, Institute of Medicine (U.S.).  Committee on Planning a Continuing Health Care Professional Education Institute, . . . Institute of Medicine.  (2010;2009;).  Redesigning continuing education in the health professions.  Washington, D.C:  National Academies Press. doi:10.17226/12704

[5]Elkin, P. L., & Gorman, P. N.  (2002). Continuing medical education and patient safety: an agenda for lifelong learning.  Journal of the American Medical Informatics Association: JAMIA, 9(6 Suppl), S128–S132. https://doi.org/10.1197/jamia.m1244

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