Aligning Governance with the New Mission and Vision
My name is Michael Kaufman and I am designing the internal review offsite to be held in June of next year. The result of that offsite will be a set of recommended changes to the ACGME board. This interview will take between 20 and 40 minutes depending on how much feedback you have.
The general focus of this interview is what recommendations you would have for changes and improvements to the ACGME governance structure.
Starters:
- Are you aware of the new mission, vision and values recently developed by ACGME?
- What impact, if any, does their new mission, vision, values have on you and your associates?
- In general, what can the ACGME do to make your life easier? (relative to accreditation and residency programs??)
- What recommendations would you offer to strengthen the governance of ACGME?
Appointing Organizations
- Do you presently know how new members of the board of the ACGME are appointed?
- Do we have the right appointing organizations? (To the board? To the RRCs?) Should others be appointing? Who?
- Who should appoint members to the RRC’s?
Inclusion
- What would make the ACGME board more inclusive?
- What is the optimal size of the board?
- Is their adequate representation on the executive committee?
- Who else should be on the board? Executive committee?
- Should the Board be composed of competencies rather than representation? Council and Governance? What about shifting the board to distinctly different roles/functions?
- If so, what competencies are essential to be an effective trustee of ACGME?
- Should we bring patients into the evaluation process of resident competencies centered around communication?
- Communication between ACGME and members?
Right Relationships
- Is there something you would change in the relationship between ACGME and the RRCs?
- What is the right relationship between ACGME and the residency review committees?
- How should ACGME address consistency issues across residency review committees?
- Should the RRCs collaborate with each other? If so, what would improve collaboration? What should they collaborate on?
- How can we be sure that the RRCs are represented as a voice and individually in the halls of ACGME?
If you were going to send a message to the Board of ACGME about what should be changed in the governance structure, what would that be?
#5 RRC member
Are you aware of the new mission, vision and values recently developed by ACGME?
Yes.
What impact, if any, does their new mission, vision, values have on you and your associates?
I don’t think any more than the last mission and vision. The things I do for the ACGME have to do with program evaluation and don’t think it impacts much.
In general, what can the ACGME do to make your life easier?
I do think we need to keep the paper records, but I do think we need to beef up the information technology abilities. Maybe we could capture information and be able to print things so that we can more effectively use the data we do have.
Are you familiar with the governance structure and the board?
Yes.
What recommendations would you offer to strengthen the governance of ACGME?
I don’t see any problems there. There probably is some room for improvement on the RRC side. ABMS has had parent appointments that have come from 3 parents in emergency appointments. An individual who is a good RRC member still might be not noticed for an appointment. We should open up the nominating process so that there are more individuals who may be appointed to the RRC.
Are the RRC appointees capability-based or representational?
The nomitations are capability-based but it’s also mostly your connections, who you know and how you’ve positioned yourself to get noticed. The RRC gets a lot of capable people, but I think there are more capable people who get overlooked.
Any suggestions for improvement?
A call for nominations that is more open.
What would make the board more inclusive?
There might be a similar issue with the board.
What’s the optimal size for the board?
I’ve usually worked with smaller boards, but this is a larger organization. I imagine it’s adequate but if you changed I would move to cutting about 15-20% to make it smaller.
Is there something you would change in the relationship between ACGME and the RRCs?
I think more interaction would be helpful. I don’t know how you would engender that but maybe it would be helpful to have our meetings the time the board is meeting. There is a feeling that our certification is unique to our specialty, but it might be good to hear their need for consistency and ours for individuality.
How should the ACGME deal with consistency?
I think we need to have some consistency, but there needs to be more discussion.
Should the RRCs do more collaborating between them?
This gets done at the chairman level. A couple of departments have been meeting because they have some disagreements about standards and this really helps to have these conversations. There is a lot of turf battles. But trying to have the 20 committees get together in a room may be informative but hardly practical. The way the hierarchy is set up it’s hard to have lateral collaboration.
How can we make sure that there is adequate representation from the RRCs in the halls of the ACGME?
I presume this is the role of the chairs of the committees. Maybe there could be meetings, or email and bulletin board, so that more of the RRCs could participate in the discussion.
If you were going to send a message to the Board of ACGME about what should be changed in the governance structure, what would that be?
The biggest one is how the RRC members are selected. There needs to be a more inclusive process to recommend candidates. I think candidates should be selected by their peers. Also I would suggest improvement in communication.
#6 RRC member
Are you aware of the new mission, vision and values recently developed by ACGME?
Yes.
What impact, if any, does their new mission, vision, values have on you and your associates?
It probably does very little in the trenches. Ultimately it focuses the ACGME in a direction that will be come back towards us. Increasing the conversation about education is going to be the biggest impact, and then maybe some specific issues that will need pragmatic answers.
In general, what can the ACGME do to make your life easier?
They’re going in the correct direction; creating more electronic abilities. They’re asking for lengthening of the cycle for specific discrete data coming in. They could become more consistent within each individual RRC. ACGME is really a corporate umbrella and it cuts both ways. The heterogeneity comes into play here. The workload of the executive directors is increasing so they’ll need to hire more people. We’re going to need more people with different competencies. They also need to tie financing to the education. How can we move forward with only one accrediting agency for osteopathy and another for allopathic medicine? There are 5 states with active osteopaths, Michigan being one of them. It would be more streamlined if we had just one.
Do you know how the board members are appointed?
Yes.
What would make the board more inclusive? What about competency vs. representational?
I don’t have enough knowledge to really answer that. It seems realistic. I would assume that the board is selecting people who are competent. I think it’s important to have the organizations represented.
How about the RRCs? Should that be changed?
It’s done well because the organization knows pretty well what they need in each specialty. The program directors have their own organization and they should work with the RRCs as well. It’s not a big deal in terms of the overall situation. People view the AMA as a big box that doesn’t represent education and they need to have representation on these committees but getting into the different specialties would improve the process. I think it’s important to include the public as well.
Is there something you would change in the relationship between ACGME and the RRCs?
It’s unclear to me how all the communication goes. I have no strong feelings about this. The bigger issue is how the residents communicate with the ACGME. How do you engage the individuals in the trenches to improve communication?
How should the ACGME deal with consistency?
There should probably be more consistency among the RRCs. There needs to be some internal quality control. There is a monitoring committee but I’m talking about an external decision-making body that looks at each specialty. You can get a pretty good sense about a program across boundaries.
Should the RRCs do more collaborating between them?
I think there is a lot to learn. I do think RRC members should participate in other RRCs. I think the silos are the biggest problem. It would be great to bring an EMT on the opthamology RRC and really cross-pollinate.
Is there anything that can be done to make sure the RRC is represented to the ACGME?
I may be naïve but it feels like it’s going okay.
If you were going to send a message to the Board of ACGME about what should be changed in the governance structure, what would that be?
Cross-fertilization of the RRCs. Make the paperwork easier. Try to change patient safety and quality from the inside out by developing strategies that the ACGME needs and uses to influence safety. Include other member organizations, such as the university professors group.
Just a comment, the strength of the ACGME is customer service.
#7 RRC member
Are you aware of the new mission, vision and values recently developed by ACGME?
Yes.
What impact, if any, does their new mission, vision, values have on you and your associates?
They serve as good guideposts.
In general, what can the ACGME do to make your life easier?
It would be good to more efficient with the volume of paper they generate. I guess so much mass paper and everything they do is heavily-bound and wordy. It would be nice if they could be more pithy. I would also better to be more web-based or CDs. I’m environmentally opposed to it, but it’s also unwieldy. It would be nice if they could keep the agenda time tight. They’ve been better about that, but still could use improvement. The ACGME generates a lot of regulations and they also actively seek to accomplish their mission. It would be great if they could be more efficient at disseminating best practices and helping programs come into compliance.
From the residents perspective, they could communicate better to them especially about programs and how they’re ranked.
Are you familiar with how the board members are selected?
Yes.
Is that the right model to do that?
I think it would be good to continue to garner more younger, progressive voices. The general sense I get is that even though there is a lot of voices of reason, it seems that there is a lot of grey hair. You’re impacting people in their late 20s and early 30s and the last time the board members were in a residency program was decades ago.
Do you have a sense of optimal size?
It’s a big board and then there’s an executive committee. The executive committee is really where the power resides. The board structure seems like a façade. The report you’re generating will likely go before the executive committee.
Is the executive committee the right size and right people?
It seems like that should be more like 8 since they wield so much power.
Should that be representational or competency-based?
There are plusses and minuses in that.
Is there anything that can be done to improve communication between the board and RRCs?
No, there are a lot of emails going around.
Is there something you would change in the relationship between ACGME and the RRCs?
It would behoove the board members to sit in on the RRC meetings more frequently than they are. There are several people on the board who have never sat in on an RRC meeting. This is where a big portion of the work of the ACGME impacts.
How should the ACGME deal with consistency?
I think that’s happening pretty well with the monitoring committee.
Should the RRCs do more collaborating between them?
There should be a mechanism for best practices. The meetings of RRC chairs are somewhat tedious and this could be a place where they disseminate this.
Is there anything that can be done to make sure the RRC is represented to the ACGME?
This would be satisfied by having the board members go to the RRC meetings. The executive directors could sit in on a different group of RRC meetings.
If you were going to send a message to the Board of ACGME about what should be changed in the governance structure, what would that be?
- Get closer to your customers, the residents and their wants and needs. Follow them around, take a call with them.
- Cross-pollinate ideas better.
- Improve transparency within the board structure.
- Have more cross-pollination of the ACGME staff.
- Reduce paper; be more efficient in transmitting information.
- Decrease mind-numbing meetings; increase meetings which disseminate better information.
#8 RRC Resident
Are you aware of the new mission, vision and values recently developed by ACGME?
Yes.
What impact, if any, does their new mission, vision, values have on you and your associates?
I’m currently a fellow, but was resident so yes, I want the medical education to be as best as it can be.
In general, what can the ACGME do to make your life easier?
It would be nice to do less paperwork. There are so many forms and evaluations to fill out. It’s annoying to fill things out, such as a patient log, in two or three different ways and I felt it took away from my education.
Are you aware of the governance structure?
Now that I’m on the RRC, yes. The residents only know about it when there are site visits.
What recommendations would you offer to strengthen the governance of ACGME?
As a resident, it’s good to know that they’re out there to help. Right now, sometimes the program directors look at the ACGME in a negative attitude, because for one they can take away the accreditation of their program. Also because the ACGME dictates how we should learn. There is also a sense of the way they learned, in lectures instead of seeing more patients, is the best way to do it.
Do you know how the board members are appointed?
A very shallow understanding.
What would make the RRCs or appointment process more inclusive? What about competency vs. representational?
I know the members are appointed, but I don’t know what they went through to get there. The variety of the membership is well represented. There’s never that many women and I know that there are more women going into neurology.
Should we bring patients into the evaluation process of resident competencies centered around communication?
I don’t see how logistically that could be done. Also, the patients don’t have training to understand how things are done. I don’t know what they’d be evaluating. That would be hard at the RRC meetings.
Is there something you would change in the relationship between ACGME and the RRCs?
I really don’t know what the other RRCs are doing.
Should the RRCs do more collaborating between them?
I realize that they’re all run very differently. It seems like there are a lot of issues that relate to turf wars and that is not pleasant a lot of times.
Is there anything the ACGME can do about that?
There is some concern when there is conflict when people are on two different RRCs. Sometimes some people think there is a bias. I don’t have a good answer for this one.
Is there anything that can be done to improve the relationship between the RRC and the ACGME?
I didn’t find the orientation as helpful as it could have been. People weren’t sure what they should have done ahead of time. There might be a better way to do this. It all seems like hocus-pocus and not much standardization. It’s hard to compare the reviews of the different citations.
How should the ACGME deal with consistency across the RRCs?
It would be great to know when we should use probation or progress reports. I think orientation could be used to improve that. Maybe having a cheat sheet on how we evaluate these programs would be helpful.
Is there anything that can be done to make sure the RRC is represented to the ACGME?
I’ve been to two of the ACGME meetings and I thought there were lots of opportunities for the RRCs to be heard. I don’t have any suggestions to that.
What would you say is the greatest strength of the ACGME?