>>SINGER: Hello, I’m Steve Singer I’m the Director of Education and Outreach at the Accreditation Council for Continuing Medical Education.
>>AKINS: Hello, I’m Gayle Akins, National CME Program Manager for Kaiser Permanente.
>>SINGER: So, Gayle, welcome. Glad to have you here.
>>AKINS: Thank you.
>>SINGER: Tell me, you work with Kaiser
>>SINGER: And Kaiser’s a large organization, so, I think, as a context for what we’re going to talk about today, we’ll talk about sort of two different things, one being sort of what you’re currently working on and where you’re trying to take it
>>SINGER: And the other will be sort of looking at the, the, what you’ve done in the past, some successes that you’ve had.
>>AKINS: All right.
>>SINGER: So, just to frame our conversation can you tell me about the way in which sort of what’s your role, and, and your role in CME at Kaiser and then let’s sort of pick up to the 30,000 foot level and talk about sort of the structure of, of the way in which you interact or could interact with physicians and other stakeholders at Kaiser.
>>AKINS: OK. Well, currently I’m the National CME Program Manager for Kaiser Permanente out of the Permanente Federation and what I do is I work with the eight regions in Kaiser and we plan national programs. So, for each of our programs we have to have at least three representatives on the planning committee for each conference and we just meet and we come up with, you know, good needs assessment, get gaps in practice, and we produce national programs. Produce about 20 to 25 each year. And what we are trying to do now is sort of align those programs with stakeholders within our organization and national stakeholders, regional stakeholders, and also, down to the health plan and the medical facility stakeholder.
>>SINGER: So, you’re taking a real sort of a top down strategic approach to saying how does a national program of CME, right because that’s what you’re working on?
>>SINGER: How can it really plug in and be integrated across the organization in a number of different ways.
>>SINGER: So, the direction for that, is this, is this, is this all your idea? Is this an idea that’s coming from above?
>>SINGER: Well, where did this come from?
>>AKINS: No. It’s not all my idea it actually came from our national CME committee. David Price is our medical director. So, with David, Carol Havens, KM Tam and some other people on the committee we’ve all sort of started talking about that. And how to really integrate what we’re doing across Kaiser. And what we found is that, there’s a lot of education going on, of course, but there isn’t a lot of, they’re not talking to each other. You know, the regions are not sharing best practices, you know, across the regions. And so, we just want to sort of have an umbrella group kind of at the national level to kind of look at what’s going on. And how we can take CME to a higher level on the national realm, but also, bring in you know, the regions, and the facilities, and, you know, the local folks. You know, to even know what we’re doing. Because a lot of them don’t know what the national programs are all about. And we felt like, you know, this is a way for us to kind of stand out; kind of show them what we’re doing and we can help them. Because that’s really what the national CME committee is for and our group is for, to help the regions and the, you know, the health plan and the facilities with their CME.
>>SINGER: So, you’re describing a very strategic view of integration from the national perspective all the way down to the local
>>SINGER: hospital, local practitioners. Do you have an idea of the enormity of the task from the perceptions of that local, those local stakeholders? What, what, are they unaware? Do they have certain opinions about what value you might or might not be able to bring to them?
>>AKINS: Well, at this point, since we are just starting, we’ve been really talking to the regions about it. You know, we’re at that level at this point. And, you know, we’re not getting pushback, but there is a little bit concern about, you know, Are we trying to take over their role? And we’re not trying to do that we’re just trying to, you know, sort of bring everybody together. And make sure that we all know what each other is doing, you know, we’re talking about eight regions nationally, you know, across the United States. And a lot of them don’t know what the other region’s doing. And there’s some regions that have really good practices that could be shared with other regions. Doesn’t mean that the other region is going to do as well, but there are some best practices out there that we feel need to be looked into and maybe need to be adopted or could be adopted in other regions. So, that’s sort of where we’re coming from we want to see what’s out there, what works and sort of how we can sort of fit into that and maybe even sort of disseminate what’s going on in the other regions. And so they can kind of communicate among each other. And I don’t know sometimes it seems like there’s a little competition among the regions, you know. And, so, we’re just sort of trying to be there as not sort of overseeing them, but just kind of like almost a resource I guess you could say.
>>SINGER: What you’re describing is fairly common from a corporate, national corporate perspective, where you are using communication, integration, collaboration, as a way to share best practices across a sort of a large network. It’s interesting to hear it used in a healthcare
>>SINGER: environment, because as you said that, for, for educational leadership, for clinical leadership, who are down in the trenches sort of the local level it may be difficult for them or it may be hard for them to hear what you’re asking me to manage and control my own group here
>>SINGER: and now you’re giving me things that you’re learning sort of across the country.
>>SINGER: So, the, the approach to integrate is that something that you and your staff are responsible for solely or is there, how is your leadership at Kaiser helping you to bring about that team building?
>>AKINS: Well, what we’ve done and we’re just in the planning phases of this is, we’ve come up with something called, the Education Steering Council. And what we’re trying to do is use that as a way to talk to leadership in the regions. And to help them to understand, that you know, we’re trying to help. We’re not trying to dictate what they should be doing; we’re not trying to lead them where they should go. We’re just trying to offer our services and what we see. And another way that we feel that we can sort of push this forward is to align our conferences with the chief’s groups. And the chief’s groups come from the regions. And if they’re on board and if they sort of know what’s going on in the other regions and we can sort of disseminate information to them; then we feel like that will filter down. You know, region, facility, you know, local level, and so we need those kinds of people on board. You know, in the chief’s group, they’re MDs and you know, they’re chiefs so they’re in leadership positions and so, they’ll be listened to, you know. And so, I think, in that way we won’t seem, you know, sort of like we’re overbearing and we’re, you know, trying to tell the regions what to do, because actually the regions are doing a good job, you know. But, we just want to be able to bring it all together under sort of one umbrella and sort of be a resource for them, as I said, to help them with their CME help them along, you know. You know, we want to be able to track outcomes. I know when I was at the San Francisco Medical Center we were very good about tracking outcomes and that’s because Kaiser has a lot of resources, we have a lot of data. There’s a lot of things that we track. And so, you know, that one thing we can do, you know, at a national level is track data and look at the data across regions. So, that’s another way, I feel, you know, we can help them with their CME. Just to really see what the outcomes are; and see what difference they’re making.
>>SINGER: It’ll be exciting to see how this develops as you keep working on it and I think something that is dynamic about the way that you’ve approached it is to see that you didn’t have to create a new structure. You didn’t have to create a new process and what you’re doing is you’re looking at the way in which these clinical leaders and these clinical teams across the country are already working, are already communicating within the Kaiser system
>>SINGER: and you’re finding a way to bring value and have CME as a strategic asset within that. And I hope that that’ll be effective for you. So, let’s switch gears and talk about um, you mentioned that when you were in San Francisco there was a project that you did it was interesting so tell us a little bit more about it.
>>AKINS: Well, in San Francisco, we want to work more with the what are called community physicians, safety net physicians. And my medical director at that time, Dr J S Chandra and I we’re trying to figure out a way to do that. And so, about the same time, we were thinking about that, Lisa Pratt, an MD, a community physician, in San Francisco contacted our regional physician education folks and said they wanted to collaborate somehow. They wanted you know, to get their physicians to some of our CME meetings in San Francisco. And so, we met with Lisa, and we talked about, you know, some challenges. One of the big challenges is that community physicians are not like at a medical center, you know. They’re not like sort of a captive audience, you know, sort of be there at 12 o’clock, noon, have their lunches listen to CME. So, in that way there was a challenge to sort of get them or get us somewhere where we could get like a large audience of community physicians. So, what we decided to do is to let Lisa know, you know, the conferences that we were having, so that she could disseminate that information. And then we decided to work with community groups that wanted to do things like the San Francisco Hep B Free Campaign. And that campaign was brought about by Mayor Gavin Newsome of San Francisco and some of the supervisors. What they wanted to do was make San Francisco the first hepatitis B free city in the nation. And 34% of San Francisco population is Asian Pacific Islanders and they also found that of that group about 80% of people that have hepatitis B develop liver cancer. And so, through their research and needs assessment there was a problem with the diagnosis, treatment, and vaccination. So, they came to us with this proposal to collaborate on producing CME conferences. And so, we produced about six in 2008, six conferences. We invited safety net physicians, our local physicians, of course. We did it at, you know, our local campus. We advertised, you know, television, on their Web site, and we got a really, really good response from that. And we felt like, you know, we were really getting good CME out to the safety net physicians.
>>SINGER: It was about something real.
>>AKINS: It was about something real and something they were, you know, have to deal with, you know. Another project that we worked on was this San Francisco asthma network. And asthma network is composed of clinicians that work with asthma patients, organizations in San Francisco that work with asthma patients. And what they wanted to do was, they found that there was a gap in the treatment, diagnosis, self-assessment of asthma, and that there were, also, some problems with religious and cultural beliefs of the patients. And so, they came to us and said, you know, Can we sponsor some conferences? Can we accredit some conferences to help the people, the physicians and clinicians in the network? And so, we did. We made that an annual conference starting in 2006, and started out, you know, kind of small maybe about, you know, 50, you know, participants. And then it, you know, over the three years, it just ballooned to about 300. And very successful, of that 300 I’d say 75% were safety net community clinicians and because we did those two safety net community physician-type conferences we started to get requests from other community groups.
>>SINGER: As these, I’m going to call them community based programs
>>SINGER: because the gaps and the needs have come out of the community
>>SINGER: You collaborated with different groups in order to capture community based physicians and bring them into the educational opportunities
>>SINGER: what have you found, what was the outcome now that it’s couple years later?
>>AKINS: For the Hepatitis B Free Campaign the vaccination, diagnosis, and treatment particularly the vaccination rate went up at least 90% is what we’ve been told. And that was in 2008. And I’m not at the San Francisco Medical Center anymore so I’m not sure what else is going on, but I know that the campaign is still going, and so, I mean it can only get better.
>>SINGER: Yeah. And it’s important that we tell providers, we tell providers: you can take responsibility for the problem
>>SINGER: you know, it’s not your fault
>>AKINS: it’s not our fault
>>SINGER: you can take this responsibility for trying to solve, help solve the problem and you can take some responsibility for some of the success.
>>AKINS: Carol Havens’ rule is that
>>SINGER: Carol Havens, she can have it
>>SINGER: It’s not just me
>>AKINS: no it’s not just you
>>SINGER: So, thanks very much for being here.
>>AKINS: Thank you.
This is a transcript of Engaging with the CME Environment Both Nationally and Locally.
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