Becoming an Entrepreneurial Continuing Medical Education (CME) Enterprise – EthosCE



I you the today's discussion entitled becoming an entrepreneurial CME enterprise and just by way of housekeeping we do have a full house today so the phone lines will be muted so please do submit your questions in the tabs box in the lower right-hand corner of your gotomeeting console we will get to as many questions as we can during the Q&A session at the end please do complete the brief survey at the end of the webinar your feedback is greatly appreciated and finally we will notify you next week when the on-demand version of this webinar is available at wwd LC solutions com so welcome again i am your host Jeremy lundberg and I am the CEO of ethos EE learning management system ethos ee is an enterprise level learning management system that has been specifically designed to streamline and automate the delivery of CM e by medical association's health systems and academic centers so getting over to our presentation over the past few years the CM e community has been faced with significant economic legal and regulatory challenges that have changed the landscape of our field some organizations have you had to shut their doors while others have managed to survive and in some cases flourish today I'm pleased to welcome my friend dr. church's subramani to discuss how she and her colleagues are transforming their office of cme into an entrepreneurial enterprise Chitra is the assistant director for the center of educational excellence and the assistant dean and director of the office of containing medical education at the Duke Clinical Research Institute Chitra welcome and thank you for joining us today thanks Jeremy so good afternoon everyone and thanks for I'm excited to be here so and thanks for taking the time to participate in the webinar so hopefully at the end of it you have you learned you learn something from our experience and we're happy to share and of course if you have any questions or want to continue the dialogue feel free to contact me and be happy to to talk to you so I actually was looking at the title and I was thinking you know maybe I just said becoming an entrepreneurial siiii enterprise because that we have the sort of moved from CM e to do other things within within continuing education or CPD so just a note there for myself but so one in quickly share with you and Jeremy asked me to do this I thought what should I say so I should have put together a presentation that talks about the reasons why we had to change the way we thought about our little unit here in the grand scheme as you can and then some of the things that we thought about and things that we are doing right now that might be helpful for you to think about as it within your own settings so so just some information about me I have been at Duke for now almost three and a half four years seems a long time but before then and before this ever said a medical specialty society and before then tipped as an educator in several different areas have been in k through 12 four-year colleges have been corporate federal government pretty much doing human performance improvement training and education and I have a PhD in instructional technology and then a graduate degree in biomedical informatics so have special interest in design and development of education education technology and outcomes based education of course so when I came to Duke read where the office of cma and if you can look at this life here of our see any mission is in there we used to be with the school of medicine and physically in in the school of medicine building in one of the traditional DME offices but now we have moved into what we're calling the Duke Clinical Research Institute under the center for educational excellence and CME or siiii is the backbone of the center so if you look at what we are trying to do today and what we used to do before was just the CM e mission but now we have a different mission of which see me as a part CA me or see e is the part of what we do so to really take we have a bigger scope to translate into some innate complex research or medical information that might be useful to physician scientists and health care workers to the best where we are today but how do we get there that's I'm hoping to share with you some of that it so just as the background we are accredited with combination we have joined accreditation assume we do quality improvement team based education there we offer several different types of credits we do see used a sec acte which healthcare executives Social Work are lots of different things because our client base has diversified and we're going out and seeking more different types of businesses so so neccessity that we do this we are applying for the emoji portfolio program so we can accommodate that as well so just a summary of data just what we do if you look at the 2013 data we have closed about 11,000 hours of instruction and over joined a thousand credits awarded to our program so that's the scope of our program and this is just a certification when the credits that we award so so what necessitated a change we were affected by everything else that all of us in the community are attracted with and just to give you an idea I have I used to have when we were at the School of Medicine about nine people in my group we did the traditional Grand Rounds we have directly sponsored activities which are about today they're about 140 annual scientific meetings we do have a joint and correspond to group and we actively seek funding for many of our activities and so that's typically what our portfolio used to look like and those tme programs supported all the nine staff and I used to receive from the school's medicine a hundred thousand dollars in support which I lost three years ago as soon as I came on board a year later this prevents and decided that they're not going to pay for anything so today I'm a self-sustaining entity within Duke and all of the revenues that we generate supports all of my staff everything that we do and and and that definitely is a motivation to think differently but besides that the sort of the environment and within healthcare with all the changes that are brought in also made us think differently especially if you think of the regulatory needs the painful performance the quality standards and metrics traditional CM e was not going to work anymore and the biggest question that I kept repeatedly hearing from people and even if any of you are in academic medical centers the biggest question is what is the value that the Sammy office brings and pretty much even in specialty society sometimes we get asked that question so the so we couldn't we didn't have an answer and yeah we we do traditional and CME but like where does that fit with changes of course we had technology issues we definitely had to look at how do we expand that skills for ahran competencies for our staff was we needed to rethink that in order to meet the new demands and then we also had issues in terms of the motivation overload the reporters already a lot of work being done by the staff as well as within the system you know in order for people to participate or be a part of the piq I programs and we would propose low motivation and stress was an issue and then there was the whole reality right i mean in my role as is the assistant dean i do work with you ma gme and i have jukka head which is the academy for health educators were a part of the advisory executive group but but before it was low fever low on the totem pole and that wasn't something we wanted to be and we realized that we couldn't really do what we needed to do we wrote it that way and then if you look at an organization like UK everybody works in silos so was it was really an awareness that we had that well how do we connect or how do we become the bridge that connects a lot of these entities that could benefit from what we're doing so that's the question we've been asking and of course finances were vulnerable to cut huge budget cuts Lester and the year before and like I said I lost all of the support that I got and continue to not have support to this day so and now they see us as a revenue generating officers to of course we're on our own said the biggest question was imminent all the question was in all of those were just the right of cme in the landscape and we couldn't really enter it so we said well this is not working for us and now we're required to generate revenues and we have to have to really pay for ourselves and and then the cme landscape is changing do you get an organization and the continued education that we provide should really have value and we should be a leader in the community just as we are in other different things so so we decided that either we change or private down the road I'm not going to be able to sustain this and really not have a department anymore so so I said okay we have to make the change and one of the things that you know is my favorite quote from Michelangelo which is on the screen is the greatest danger for most of us is that we join in too high and we get we miss it but it's too low and we reach it so he's so fun with very great cme enterprise we have accreditation with commendation we're all that but so what now what right and and the Todd was ok let's aim high let's see how we can get to where we need to be and see if we can achieve it so so here's how we thought about things this might be totally different from how you would approach it but this is our story I'm really here to tell you our story and hopefully you will get them some pearls from it that you can apply in your own own areas so when we already thought about okay what is it that's going on and really trying to figure out where do we fit in because because when you're an entrepreneurial enterprising in your thinking like a business it's the message it's the way the message is conveyed and it's the way you carry your message and implemented and the way you share successes of what you do as a part of your message as well so in order for us to create that message and really think about what our goals should be and what we needed to do we needed to think about really the system around us and if you really look at it learning the lessons learned with and the CME enterprise horas de Enterprise we we talked about the translation of knowledge into practice but we never talked about it in terms of what's really important to health care providers today it within the ecosystem so if you think of the health care is a business and then there are three different aspects of the business one is the K consumption the core verge of the patients the taking was important Jesus healthcare delivery which includes all of your providers you have get teens your caregivers all of those guys as well as the purveyors who actually support the delivery of healthcare and then there's of course a big bucket of finances where your peers are involved and and the significant impact is that finances can have so the problem that really existed is exist even today is is that there is misalignment of all these building blocks within the ecosystem sentence state oci chais and tension on the line many times one does know what the other is doing there's not enough cohesive comprehensive sort of a look into what all of this is and we're missing the connection between all of these because this is reformed the health care ecosystem so then the question we asked is okay where do we fit into all of this and and how do we really approach this so so I have been in human performance improvement for several years they've done a lot of work on organizational development learning and when you taking organization and if you consider health care is a business organization if the important thing is to clearly identify what the business needs are because your business means is what drives your job means your performance me so if you take a physician or a healthcare provider and really think about what they need to do in the context of care consumption care delivery and the the financial implications then you identify what the needs of the business are and in order for a physician or provider to survive within that business there are specific performance rules and those performance means aboard drive your learning mean so so if you really look at what we have to do and what what kind of things that need to be involved and it's both a top-down approach starting from the organization and then bought them up because once you finish your activities and collect data it informs your business as well but notice on this crew mean that the business means really if you go across the screen it helps you identify your impact objectives so what are the consequences it is what is the ROI what is the LOI Richard you know the learning impact or impact of learning in tightening iol and and then what is the other why with my return on investment and and how can i define that return and recognize your value and differentiate myself as a provider and then if you take the applications the performance means performances of at a level of applications that you do your application objective so when somebody learn something what do they what what should they do with this on their job and then what is the consequence of implementing something on their job and making a difference and then of course when you address the learning objectives and the learning needs of learning and confidence that so this is a vicious cycle that everybody goes through so that the key to remember here is you don't you're not an entity by yourself who who can continue to do education activities and and figure out you know that your valuable you have to be aligned with the business you have to be aligned with what's going on in the market and you have to be aligned with with what the moons are in that moment and this goes with any any business so let's take a healthcare environment and this is all of our sort of research and understanding of everything you wanted to document and put on paper so of course this patient centered we talk about personalized care it's not about just one peas or the other but it's about the process it's about diagnosis treatment management and them self management now and wellness tritanus there's so many different aspects and it's the whole process the patient goes through and and then in trans the patient's you're not only looking at the demographics and looking at the behavioral cognitive social factors that affect the patient but you know the physical mental and social well-being of the patient becomes core and important now it's an integrated system it's all about the experience is about the process it's about the workflow it's about the business processes it's about process improvement so rather than just thinking of it as a clinical outcome or something that's purely clinical and scientific there is process improvement and while their business process reengineering Awards could be a resource allocation issue it could be a process improvement issue so it's a system that that if you take a hospital and there is a snow you know like a waterfall the fact when not to the other then you also need to move on micro and macro level issues with and we'll talk about micro macro level in a bit and then and standardization accountability health outcomes on your regulatory reporting and all the incentives now that are going on and we also talked about sustainability can we continue these costs how can we cost-effectively do things and then on top of it you are required now nez need is to motivate patients to work with them and then also to turn your learner's into a lifelong learner so that so the concept of teaching and learning are the signs of teaching and learning has now a significant impact on how we design or education which i think when i started in family would we want given any ancestors at all so we said okay fine we we now know the different dimensions within the environment where we could create an impact so so what does that really look like and what is that be translate to in terms of our responsibilities and roles that we can be a part of so we said well if you look at this thing this slide over here the core of what we do is really patient centered patient safety it's evidence of you know we need to always think about what is the value of C and family and what is the evidence that we can provide about and we want to be focused on the patient and one of my roles is to not only chance disseminate core knowledge but also to say there's new knowledge we want to do research synthesis and applies to practice and so that's the knowledge piece but then around it is the whole regulatory maintenance of certification and licensure and all the other things that are important in reporting now and then there is the quality improvement lifelong learning but if you look at the context in which all of this happens and we definitely knew that okay in order to address all of these things we need to look at patients and population outcomes integration into research in health care delivery we want to address the system needs and talk about continuous care and things like that so so these are things that we have to sort of put together to even create a plan on where we are going what we're doing where we could have some significant impact and how do we address you know some of this so if you've done any kind of you know business process reengineering or if you really lift at creating business plans and coming up with a strategy perhaps the past the issue is defining the problem and the defining where your value is what is that differentiator how do you differentiate yourself among the people what is the value that you bring and where the areas in which you can bring value and what you focus on so that's an important question to ask before you launch into any kind of transformation then we looked at okay we know the system level but now let's look at the learner because the learner has an environment and the learner is probably the closest one to you know coaches one to us as a see provider and how could we affect them and what are the different dimensions of learning and competencies and skill sets and attitudes that we can impact well liner so so this is a great slide actually picked it up for one of the journals but it clearly indicates what I was um we were trying to say so you have the learning needs and then you have the learners environment but remember that learning happens within a context and in order for it to retain you know the context has to continue and there has to be some continuity in the way we address those so we looked at the look at the context around the learner and and the environment and and here are all the different things that influence influence the learner so so we figured well if these things influenced the learner and has affect the way they learn and what they do with their behavior then we need to be influencing some of these things and we need to talk about these and see how we could play a role in any of these dimensions and then of course it's influenced by one's own learning abilities and interest in learning and then the clinical establishments which is the teaching hospital or you know the medical schools and others play a big role in contributing to this to this is another aspect of not the business that the learner that we looked at and so so if you if you look at the scope of what you know I oh and I always tell people that there is so much value in what we do i do I don't think we'd have clearly articulated that so far and hopefully we'll we'll be able to do that really well someday but I think we also you know when we started to transformation in reinventing ourselves we really have to articulate and teach other people and I continue to do this within Duke everyday really helping educate people as to why we are an integral part of what they do so all of these visual did you see is my attempts to educate people but I think it captures a lot of where each of us depending on our strengths can find areas to reinvent ourselves and just sort of be a part of the whole continuum and all of the that that's going on in education so many of you might i'm not sure what the participants demographic is but you might not be in an academic institution like I am so even if you leave out my little green box where I'm talking about um EG må and CM e and the two boxes on either side are pretty important the system needs and then the health care delivery and then the bottom considers rectangles it talks about the context which is the disparities episodic comes to the moves of cows get treatment from being episodic to now a lifelong treatment your relationship with the patients that you have to go the relationship with caregivers extended families patient expectations and demands and and all of that look at the number of areas in which you could make an impact and I think even if we picked one or two and we were successful and I can tell you that I'm not agree or not in any every area here where we've just started and I can share with you some of the stuff we're doing now but there is significant impact that we can make if we did it well so so thinking about the learner centered experience but within the context of this big universe and identifying specific areas or points at which we can create impact is significant for you too before you start thinking about a direction orienting yourself taking a position and starting off so it with all of those I think the other issue was that there had to be a whole paradigm shift because traditional see me doesn't work now we're at the then we said okay if we have to do all of this so we've identified all these different areas that opportunity and and we've said the health care environment or the ecosystem offers us several opportunities to go beyond what we want what we're doing right now then what are the core areas that we really have to focus on and this is what we came up with said the the core is really patient care but then the dimensions around in their research quality care and education and if you look at the intersections of the you know of the circles of the men diagram you can see how the combinations of each give you an outcome so research and education I love you to disseminate reinforce and evaluate what's already existing and what new things we can do research and quality care where your health services research or other areas are they provide evidence for what needs to be done and a love for the nobility of all your processes and methods and data and then if you look at education and you know from quality improvement and then we're able to share best practices implement solutions and and really affect change so we go through the cycle of inform assess implement and evaluate which we thought was a message to send out and also help ourselves understand that we're going to a paradigm shift so the other area of every files that there are opportunities was okay fine and we're going beyond traditional CMA and with the entire whole system now to worry about then what are the areas that we can really look into and this is what we came up with so this are opportunities and challenges and helps us think differently about about what we really need to do and and where are the opportunities for maybe collection of data maybe for collaboration maybe for bringing in other people to participate with different expertise thinking beyond the scope of what we do and maybe adding in dimensions to our our services that we offer if you look at that if you consider the concentric circles as the healthcare system and then the court is the patient and you have the provider and then and you go out to the healthcare team the family caregivers and then the entire community is now involved because both the size and the scope of now you're you're looking at populations community and health system there are opportunities or these different types of researchers and evaluations and studies that we could also be a part of that actually inform what we need to be doing that actually inform continuing education and actually inform gaps and needs that we might have in order to develop education so so we just me realize that oh wow does you know we could do patient reported outcomes we can look at public health we can do needs assessment you know there's data coming from some of the outcomes work that people have done there's public health and community research that's also there so so the reason why I'm sharing with you all of it is because it helped us this exercise helps us build our own awareness of wow we we thought we are this my little group that didn't have much impact and we're doing this education but look at all the areas in which we can be a part of and and it opened our minds to thinking big picture and looking at board of different ways in which we can create impact and like I said even if we said even if we could create some difference in one or two areas it would be great right we're going to do it so so standing from all of this discussion became the you know the whole patient side of things patient-reported outcomes and then you know talking about the whole technology influence on patient behaviors that said me also started thinking about now in order for all of this to happen the question I might come pop into your mind is oh yeah this is all fine and dandy but how do I really do this in time to want to implement that and and what why red white begin so where we begin is to do this exercise of identifying you know where are the areas we could make a difference what does it really mean and how do I give an elevator speech to somebody when they ask me okay well what are you doing and you're she enterprise and then what is the value add that I can communicate with my faculty my department and to the business lead parent you that always say okay what's the differentiator why do you why you guys and not others so you have to constantly answer this question and have a speech prepared so and this exercise is identifying the various areas where we could influence the community was so important for us and this is also important to to send us a message to educate our staff to educate others so it serves a lot of purposes in terms of identifying the need and not showing what you so as you can imagine seven we said Oh fine okay we have all these opportunities we're going to do this we're going to try we're going to you know not be complacent about it and and of course the biggest motivator was I needed to generate revenues and and have our costs covered and also make a margin but it didn't go without any problem if there's a it's a paradigm shift what is the biggest challenges than I have even today is culture change and the perception and that I have to change and then the biggest time-consuming work for me is the process changes because you you have to function differently as a business your turn around time your response time your efficiency and quality of work you do within the within the short period of time is so critical for when you look at it as a business enterprise so so we have to take differently in terms of our processes we definitely had to integrate ourselves with the rest of the organization we had issues no funding no funding from the school of medicine and overall general decrease in funding from Pharma and others one of the biggest challenges and if the cma staff competency is to be so our with that right now we have said most of our work we are doing either contracting part-time or we do work for hire most of the time too and and that's sort of thing a part of our process now and so we've managed our budgets and bids that we do to accommodate that and then there's always a struggle between you know you have existing people who perform certain skill sets and then there are others who are new and times you balance that Nanda he moved into systems based projects we need the large scope of the project sometimes is complicated and itself it hurts us so we we have to look at ways to collaborate the partner be more open and share the wealth which which were happy to do so and then we started realizing that if we're going to research there we need to build some skill set and then also nothing is of any value unless I'm able to discriminate outcomes and look at it so the levels of outcomes revealing what became higher and so as we thought about all of these different issues we sort of made ourselves talk more about an organization that's on the pathway of transforming their see enterprising and we call it transformational Cee and we've actually dr. Joe green and who most of you know he worked with me here as a part-time consultant and him and I have done several sessions at the Alliance now talking about the transformation of C and identifying pathways for these transformations and kind of things that we have to do so so as we went through our research and and try to identify where the areas we need to focus on and where we need to improve our processes and think differently and these are the pathways that we came up with so accreditation is key that's the court or business we want to keep that going that have to remain and then we needed to think about strategy you know how many family offices really have a business strategic plan I'm not sure but we have one for sure and we have a strategy and well as we have an implementation plan that that is key and then an assessment and evaluation strategy how do you actually show that you've done what you're supposed to do and and we are working on locating now it divided in doing simple one-off family we're looking an opportunity to do more curricula based education faculty development has become key to our success and the normies about a faculty and comfortable de wariness the better they support us technology is a key part of what we do we've made significant investments and that in trying to use any sort of technology solutions that will make it more effective across the board looking at organizational efficiencies and effectiveness and making sure that we're publishing in contributing to the profession one of the key things to remember is to ensure that as you if you think about these pathways and think about the value you bring it's important to sort of evaluate how close you are to your organizational goals even if you are within the medical specialty society if you are within a matted company or even in a hospital you're within a health system like I am and it's important to align yourself with the goals of the organization and always when you talk to people try to map out the relationship and how there is a cause and effect sort of a relationship and how te contributes to that bad goal overall and those are questions to ask you know really what is the organizational and how do I fit into this so now if we think about okay if we've identified all of that so where do we begin ready to be big in the implementation so for those of you who are familiar with the conscious and knowledge management and for somebody like me who's been in that area it's all about it's all about you know you take education you take learning or learning health system where we're learning from our mistakes we're in this virtual cycle of Christmas quality improvement then what what drives bad quality improvement and what drives that kick you out of the total quality informative Community improvements being in any business organization which only want to call it the key is to have have systems processes and resources and and sort of models and place that promote the sharing and exchange of data information and knowledge that that's the key so today when I go in and and and I'm I want to make sure that that you know that there's the difference between those three terms they're not the same so so if there is continuous exchange of the three and one informs the other and knowledge is generated it's used it's evaluated then you knowledge is formed and it sort of goes in this vicious cycle so so when we really think about that piece and then our learners really become powerful knowledge managers they paid sort of learned by themselves and that's where you want them to be won than to be suffer glazed learners and how do you create that and then our role becomes more of a curator or a coach or a facilitator being a partner in this journey for them and so so when you take this concept then there were three different buckets that we really needed to think about one is the knowledge architecture would is our overall philosophy how do we align ourselves and you know what is our mission who is our learner who's our target audience who are our competitors what differentiates us what is our value adds so those kind of questions you want to ask before you put together a strategy for any change then we have to talk about this whole synthesis piece which is how do you have you synthesize how do you translate and how you integrate the the content in the knowledge that you create in two different things that you do which is rare a lot of our curriculum instruction designing all of those aspects come into play but it's so it's taking data information and knowledge and in all of the learning from it and really synthesizing information and being able to disseminate it and then we needed to think about the infrastructure right so technology tools to support an integrated elimination and knowledge because without technology you cannot really achieve all of this and the question you may ask is you know did you start all over did you know reasons start all over B has some processes in place already based on some of the traditional cme's we were doing and then I added on some of these concepts and from the time we started the transformation we said we have to follow best practices we have standards of practice we have to do XYZ things we have to have some you know data integrity and all of that and we said we're going to lay down processes and we're going to follow them with this whole philosophy in mind so first of four from this slide for you to sort of think about you know which piece of this are your strengths you might already have some of this we might want to build some of it or you might say some of it I can do right now and I'm not going to be worried about it but at least to start the right way which is what our philosophy was if we're going to change let's change for the good let's change the right way let's look at what is the most optimal approach would you you know you're approaching strategy might be totally different from mine and that's absolutely fine because it works for you so so we said he's let's start there let's think big picture first and let's draw down let's look at priorities and see what we can cannot do but it's a great concept for you to start thinking about the knowledge system and in reading and learning healthcare system the core things that are critically critically important is data information and knowledge the data is raw data if I give you my phone number that's raw data information is if I say that 401 1205 is Chitra desk phone number at Duke that's information but when you use the number and you call me and you put it into practice that's knowledge so there's the interaction between those three dimensions that make up your knowledge system in your learning enterprise so so then we said okay if if we're going that route we really need to differentiate what we're going to do you know so there's been doing things in the past and we're doing certain things in the present now but really ready we need to go and what do we need to do so so if you look at the present it's what it is we do some systems based education we do Qi so we do interprofessional education we've expanded our services beyond you they have a lot of partners but in the future we do want to have you know solutions-oriented strategy so i'll show you the message we currently use down in terms of solutions and we're reaching out to a lot of stakeholders we actually had we've created a consortium for research and education have invited people to participate in it we're building a work tool center for ze studies where we would like to do our dissemination and outcomes through research work and then focus on quality and efficiency now you might ask me this you know you have lots of these things who's doing all the work we don't have people doing working all of these different areas we have the big picture that's where we want to go and one of the consensus and the agreements we have in the leadership team is no matter what we do we're going to work to a sequel period so if it doesn't fit within this philosophy where we're going then we're not doing so which has been great for us and and also to communicate this over and over again as many times as possible so the leadership understands and they begin to see the Bears you can create an in fact and then also in the future we're hoping that there's you know social accountability responsibility SP provider we felt that semi have a responsibility in a social obligation to to do this and to do it the right way and this was important because of the culture change issue the more I'm passionate about it as a leader the more my peers are and we talk about this as something Anthony has to do and in something that is that institutional like Duke has to take on and do the more people realize it's something we're passionate about and it's good for my staff here at every time and so we brought in the 1200 social responsibility in our business strategy and then also as you build the enterprise then there is the whole learning aspect remember we talked about the learner centered approach in the contact around the learner but where is the learner now if you folded educational research and learning theories like I have we are now in the age of connectivism and learning happens outside of most of the classrooms and continues to happen outside and we all learn from our experiences so we had to change your approach to learning and it types of education and we both now you can ask is all of your education gone this route know but we're slowly transitioning we are we have a few products that are this way we have traditional family we have and we have activities that are in between and and so we have we have them in transitioning they have them in different phases and this is so in order for a liner to sort of survive today and you know really looking at the future how people are going to learn and what they're really going to do and sort of shows where we are thinking about in terms of where we can bring in new competencies new skill sets and and create new programs that we've never gone into before so for example we now have a program in leadership that we never offered before that that we have partnered with expand external we sought out partnerships we for people who are already doing things that way already and reached out to them and said hey we would love to do this would you want to partner and share the wealth so so we're going into more of the revenue share models with a lot of people certain areas were really good at we are building our own custom learning solutions but scenarios rejecting sticking out health and the gist of this slide is to really help the learner you know be more conscious about information literacy and helping them understand their new competencies and and being consciously looking for information making the right connection validating that information in creating their own knowledge so we within that knowledge infrastructure that you have seen several of the learning experiences and tools and technology that were using is more to bring out some of these competencies and people so that they can one better we also used a different model now for our Qi activities and actually looked at this the prison model and specifically it's related to a you know therapeutic diagnostic or treatment method or a specific when I say product it's not a commercial product is the product or service within the healthcare system and then it's relevant is interprofessional we always think about your trunks and multiple sites involves and it's and meiotic that mean it's been it's mutually beneficial to everybody and mutually beneficial is pretty important because most of our qi activities now are either do you so Qi gaps or some of our national partners that we work with the align ourselves with those that so that I don't have to sell it it's it's mutually beneficial for people to participate and help us with the program so um so we identified our our gasp identified areas where we could make an impact we always identify the strengths and weaknesses we talked about building on new processes in a new way of approach and philosophy and then we said okay so now what how do you take it to market and how do you create the awareness and market yourself this way so people understand that you're different you're a different organization and and you're thinking ahead and they value what you bring to the table so I just wanted to share this I got it from a book called road to success and I can send your me the name the book but it talks about how do you really think about a market strategy and how do you take your products or any of the CM e stuff you do or see yourself for education that you provide what are the things that you want to look at you definitely want to look at your market domain at the macro level at the higher level revisit extensive analysis of who's out there in the market who are our competitors more to be too fast how much money are we making every year we did a market analysis and then within your domain of education or are your competitors so who are you click folks who who probably compete with what we do and then going down to the micro level of what are your target segments what are the areas were good at who ready we have the maximum return retention in our learners you know who's coming back to us all the time really we have so looking at your specific target audiences and seeing where the potential is there and then also our growth risks and sustainability where can we sustain as the infrastructure already supports and processes and new programs that we would be able to sustain are they revenue generator programs and they can live on for the law so we really change our folks our approach to also being can be build educational custom lighting solutions and products that now can live by themselves because we sell and we market them and we're sort of a one-stop shop or education where we can start from basic sciences and go all the way to translation into practice and do a lot of different types of education and and sell them and have in this product that the business of thing in addition to family that we provide but critical to your success is this little circle here in the center which actually is a part of your team in your staff and we're constantly evaluating our ability to execute and deliver which I could tell you the most challenging piece and then always the need to remain connected whether its internal or external you want to remain connected and up and down the value chain so you're constantly asking yourself what is the value I add what do I differentiate myself by what is the elevator speech and how do I tell somebody in the markets avoid is the value library and how does this connect with what you already doing and what our external partners are already doing this from a community is doing or the community needs are or the goals are show so when you are coming up with a business plan or trying to transform your strong reinvent yourself whatever that might be or even just to say okay if i were to think about the next three years what am I going to do these the questions to ask and get the responses to and that might lead you to your goals for the next three years 25 year or so so we did it on a more sheer is known to become transformed into this more entrepreneurial stuff and so from all of this we just have to figure out okay this will be struggle is this and then do this we needed to create the message this is our cars message this is what we tell everybody who we are we are you know within the center for educational excellence and we develop informed solutions that impact patient care so the word informed solutions can be it is pretty heavy intense and solutions is a learning solution it could be a process improvement solution could be a faculty development solutions could be any solution that helps you improve care period and the reason we say it's informed is because we are now in two different types of research gathering data working with different partners who can give us the data working with the health system to give us the data that informs the solution that we provide and hopefully all of our solutions in fact patient care so that our tagline or our little slogan or message that we carry with us we didn't have to identify areas of focus or what we do we do certification we just basic UI implementation suppose you care we do custom learning solutions and media strategic advising witches are we started this new unit of consulting with in Duke where me and Joe and I reach out to organizations that are that want to transform that that are looking and ways to do this and go out and help them we do a lot of faculty development we hope with curriculum development lots of different agency there and then the question is which our areas are we going to focus on so we have identified for this year five different therapeutic areas which will be our areas of focus we're only doing projects in those areas and building our portfolio in those areas and also every time we get a project we can value eight if that fits with our overall mission our goal is does it fit within these therapeutic areas are we going to do them or not and and we had to come up with a way in which we wanted to present ourselves and across the continuum and think about think about how we're going to to deliver this and talk to people about so sorry about the visual but this is my little info graphic if I can call that on on what we actually do because the question that always comes up is if can you just show me visually what you're doing so so here is so here it is the most important thing is so for us there is a phase one and phase do for every project the phase one is this whole area of research and collecting the data and really thinking about learning and behavior change and consumption and delivery and gathering all the information that we need to make an informed decision and then the best piece right here which is where the educational eyes and it has performance and quality improvement all of the different credits we offer now outlining these two are of course the Duke the Duke omission that you helped systems of Medicine mention of you know the clinical care education research and quality and then we have the continuum of learning here with undergraduate graduate medical education but that's this defective us but but this is where your opportunity lies you know in terms of all these areas that you can impact and what you can do so this is now our standard visual so to speak that we use with all of our partners and tell them where everyone do constantly looking at water resources we need to accomplish our goals here I don't know if we are you know we be able to achieve all of the resources we need but we're always looking at it and when are we going to do is we say the time is now we just have to start and and what have we done to really get there we need to create a business development strategy we have revenue targets we talk about resource allocation staff development training and accountability which is key so so it's ask the question who Lord when we're rich and how to to really create the message and spread it so it is not show now we have we have increased our revenues over the past year since we started extra revenues about 1.2 million dollars we have expanded our scope of services to bring in corporate clients we are the certification provider all the DoD I have about ten twelve thousand learners going to our learning management system every year we provide our learning management system now for people to use across the health system and and we've expanded our service is beyond of what we would normally do and we also have some educational products better that we are building in order and they would be out in the market its products that would trust the same stuff so so we just learned from I think where we were and some of the situations that forced us to think differently I if you ask me have you done everything and no we haven't but I know for sure that we're on the right path we have a lot of work to do but we we are seeing small successes so it's very motivating and and also to share the message that we are different is a great thing that's what I got Jeremy okay well no that was wonderful teacher thank you so much for everything that you covered here I I particularly like your emphasis on having consistent marketing and education messaging about the value of CM e whether it's to internal stakeholders or your external partners and really baking that mantra into your organizational DNA so I know where that we are up on the hour so one question you did speak about but we're you know this this emphasis of becoming instead of being a cost Center and you're now being required to be a revenue and profit center and we're hearing that obviously you know across the entire field can you talk about you mentioned revenue sharing you talk about some other models that you have found successful because we get asked a lot particularly about subscription cma you talk a little bit about that yeah sure so we have a revenue share we have a subscription model and actually we're working with the Duke health system to create a mobile platform for delivery of education so called the Duke education gauge way and through the Gateway one of the strategies is to create a subscription model where for years with the subscription they would have access to the library of resources and education that we would provide to the Gateway and we do have a couple of programs already within our cme portfolio where there is a description p and you get access to it this one is in radiology they have about four hundred and seven years two case studies that are available and you subscribe it's a 1200 olive fief and you get access to the entire library as long as you are an active subscriber and that's a very successful program we have people from outside the country a lot of international people also participating because it's totally online and there are 30 minutes minutes of cases and followed by expert discussions that says so there we just did it very cheaply there and done and recorded the physician reports their own desktop as they're looking through MRIs and then then there is an audio recording of their discussion it's not in high end but it's a very popular program and and that's a subscription model we have a couple of others and then hopefully the Duke education gauge we would work and then we also offer services you know like our LMS there's a service we offer instructional design content development so this is we work with a group of faculty who are content generator so we have revenues coming from there we help departments and do some of the logistics and meaning planning and all of that so services we've increased the services we offer and in revenue great and then two quick questions one was how is the size of your a full-time staff changed during this process yes so I had used to have nine people now we are 14 we have hired a director of operations so I'm not involved in operations and I do business development I have a business development counterpart and we've hired for our systems education so right now 14 but because of the revenues that we've generated I have five more jobs that are listed to be fun great and then one last question and it may be a little bit longer to answer and explain but someone wanted to learn the audience members asking to explain a little bit more detail how you collaborate with associations to provide siiii it's so specialty societies yes sure so I think specialty societies have a special place in the community because as a your membership base and you focus in a specific area so the waveney partner mostly with specialty societies is if if we have a proposal and they're interested in doing it most of the times you've become the site for implementation and then we have access to of tronic health records and things like that that you don't have access to the most efficient with the partnership there to help take the outcomes that you provide to a different level we also work with societies in building content feels like I said we have several groups of faculty who work in different therapeutic areas or our content generators so sometimes we work with specialty groups too and our faculty work with them to create the content that that might be required and then I to our strategic advising we do a lot of work with society's to help with their measurement and evaluation plan overall program evaluation and then we'll see

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