Working with Consultants for UME Accreditation and Beyond
Lois Margaret Nora, MD, JD, MBA
As someone who transitioned to consulting after years of working with consultants in my leadership roles, I am occasionally asked about when consultants are needed and how best to work with them. The increasing complexity of medical education reaccreditation work has revived some of these questions.
It's not unusual for individuals and institutions to seek outside perspectives on their work. Consider how many of us engage coaches to support personal growth or turn to focus groups to assess reaction to a planned initiative. In academic medicine, institutions have a long tradition of working with external experts to advance strategic planning, optimize reimbursement strategy, increase philanthropy, create new graduate medical education (GME) programs, and reevaluate research indirects, among other initiatives.
Professionals who work in undergraduate medical education (UME) have been less likely to engage external consultants for several reasons. The substantial expertise within our medical education community and our historically tight budgets have contributed to a more informal consulting culture, wherein colleagues reach out to one another for expertise and acknowledge contributions with gratitude and sometimes a small honorarium. In addition, it can be more difficult to appreciate the return on investment in consulting within the UME mission than it is in the research or clinical mission areas, where funding and reimbursement rates serve as clear barometers for success.
This said, medical education programs have, in recent years, started to engage consultants as the complexity of academic healthcare increases. Examples of where I have seen teams benefit include:
Efforts to evaluate and improve the learning environment.
Support for reaccreditation processes.
New school or campus development.
Curriculum revitalization initiatives.
In the most effective of these engagements, consultants provide critical clarity, objectivity, and knowledge that enable the internal team to address challenges and embrace opportunities. Here are some examples of how they can do so.
Bring Specialized Content Expertise
Few institutions have all the expertise they need at their fingertips. Take curricular transformation, for example. Educators are surely well aware of curricular change models being explored across the medical education community, and they likely have thoughts about what would work best at their institution. Consultants can often augment discussions on a topic like this with further content expertise.
However, I have found that consultants' expertise in assessing organizational readiness and their experience with change management are even more important to such an endeavor. They can suggest and facilitate retreats, propose process maps, and assist with project management, enabling internal experts to make the most of their own expertise and more effectively deliver on goals.
Help Forge Alignment Among Diverse Stakeholders
Many challenges faced by leaders in the UME office (or any office, for that matter) require input and support from myriad stakeholders, all with their own ideas about the nature of problems and how to solve them. Issues in the clinical learning environment are a common example. The clinical learning environment is affected by the policies, practices, and philosophies pertaining to the work of UME, GME, human resources, faculty affairs, the chief medical officer, the chief nursing officer, and the dean, as well as the individuals in the learning environment. The more distributed a clinical training enterprise, the more perspectives there will be within each of these areas.
While issues like fostering a positive learning and patient care environment are important to professionals across the relevant offices, time constraints and political boundaries often interfere with internal teams’ ability to navigate such complexity. External consultants can bring a more objective view, and they can leverage focus groups, interviews, retreats, and other means to engage diverse stakeholders, clarify the perspectives that underlie different policies and practices, help bridge gaps to address issues more effectively, and propose solutions. This approach can provide valuable support with other complex initiatives, as well.
Review and Advise on Key Processes
At institutions of all types, processes may not get much attention after being put in place. They can evolve quietly over time, in some cases resulting in internal inconsistencies across policies and practices, or they may remain static in a changing environment, leading to missed opportunities. In either scenario, attention to processes can make a difference.
Reaccreditation is one place we see this routinely. As schools shift from a periodic focus on accreditation to a more longitudinal emphasis rooted in continuous quality improvement (CQI) principles, they typically benefit from evolving their processes. For example, implementing a midcycle gap analysis and creating a process for regularly updating the school's LCME Data Collection Instrument (DCI) can enable schools to spot and potentially address issues before they affect reaccreditation status.
Consultants with exposure to many schools with many different ways of doing things can bring fresh eyes and ideas that may help medical education leaders see things differently—and address issues more effectively as a result.
Assist with Managing Complex Projects
Medical schools often have myriad complex projects underway. While the competencies mentioned above are key to success, they must be paired with effective project management in order to succeed. Some schools have internal project management capabilities, but the most complex projects (think curricular revitalization and new campus development) involve daunting numbers of organizations, people, and project dependencies.
This is another area where consultants can help. Those who are steeped in project management can head off problems and close blind spots, while their handling of project management leaves internal teams with more bandwidth to focus on executing the initiative.
Strengthen Your Permanent Team
As an organizational leader, I always believed that the most effective consultants positioned my team and me to team to thrive long after the end of an engagement. We appreciated consultants who took work off our plates, and we found engagements even more beneficial when we gained knowledge of new content or processes ourselves, expanding our skills and strengthening our work well beyond the engagement. It's a perspective I try to infuse throughout my consulting work today.
Getting Set Up for Success
A thoughtful decision to engage a consultant is only the first step toward a meaningful engagement. If you decide to move forward, you'll want to lay the foundation for achieving your goals. Here are some considerations that may help.
Finding the Right Fit
Seek external recommendations: Talk with colleagues who have experienced similar issues to those your team is facing. How did they decide to pursue a consulting engagement, and who did they work with? What went well and what didn't? Learn from their experience.
Seek internal recommendations: Other departments may have established consulting relationships. Working with an organization that already understands your institution can help you get to work more quickly and confidently. And you may very well be spared some headaches associated with contracting and vendor onboarding.
Interview several consultants: Some questions to consider asking include:
Who will I be working with most closely if we contract with your organization?
What experience do you have with issues like ours, and with whom have you worked?
What does a successful engagement look like? What problems do we need to watch for?
Consider joint hires: For issues that require collaboration across distinct areas of the organization, a single consulting group that works across silos can create a helpful sense of impartiality. Consider a challenging issue that involves UME and clinical affairs offices. A consultant hired by the UME office may be seen as taking sides when working with clinical leadership, and vice versa, while a joint hire can create a stronger sense of collaboration and mutual benefit. As an added bonus, a joint hire is likely more economical than separate consulting engagements.
Enabling Effective Collaboration
Set clear goals and timelines: Aligning expectations is critical for a successful engagement. Take the time to have a thoughtful discussion of goals, and work with your team and your consultant to agree to a reasonable timeline that works for all parties.
Create interim progress measures: In addition to clarifying end goals and project time frame, it’s important to map how the work will unfold. Be sure to align around milestones for the project, and plan regular touch points for updates on progress.
Set expectations for communication: It’s a good idea to clarify upfront how often the consulting team will be in touch with you and your team. And it’s reasonable to expect that a consultant will have regular contact with senior leaders at your school, rather than solely with the team working directly on the problem.
Be realistic: Schools want problems solved quickly, an understandable position. However, an unrealistic timeline helps no one. A rushed engagement is prone to poor results, failure to hit the timeline, or both. Similarly, it’s important to be realistic about the internal resources that will be involved. The best consultants work extraordinarily hard on behalf of schools, but there will still be internal work required, and they cannot sweep problems off leaders' plates. Rather, they are there to provide insight, support, and solutions the school can execute.
Thoughtfully consider recommendations: Consultants must sometimes share bad news or deliver unpalatable recommendations to the school that has hired them. No leader is obliged to follow a consultant’s recommendations, but it’s always worth giving thoughtful consideration to their perspective. Recognize that your consulting team is on your side, and they want your school to succeed.
Final Thoughts
For teams that have not previously done so, engaging an external consultant may feel daunting. Yet with thoughtful preparation, the experience can not only enable schools to achieve great results—it can also be deeply rewarding.
