SPECIAL SECTIONS
President’s page: ACC takes strategic steps to address members’ needs
George A. Beller, MD, FACC
Reprint requests and correspondence: George A. Beller, MD, FACC, Cardiovascular Division, Department of Internal Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, Virginia 22908-0158
On Saturday, March 11, 2000, as many College members were packing for or en route to Anaheim, California, for the American College of Cardiology 49th Annual Scientific Session (ACC 2000), the College’s Board of Trustees (BOT) was already actively engaged in a day-long meeting to discuss several of the key issues affecting the state of the College—including the recommendations of the four task forces assigned to address the new challenges facing the College and the changing needs of its cardiovascular specialists, both today and in the future.
The issues addressed and recommendations made by these task forces—the Task Force for the 21st Century, the Task Force on Strategic Directions for Continuing Medical Education (CME) at the ACC, the Task Force on Member Relations, and the Task Force on Board Effectiveness—will influence the strategic directions of the College in the areas of advocacy, education, and members’ services for many years to come.
The task forces were appointed as recently as the spring of 1999, following a year of environmental scanning to find out what were the greatest concerns and needs of the membership. Through the ACC Vital Signs surveys, which a number of members completed during ACC ’99 and throughout the year, the ACC learned that members wanted several things—more advocacy, a way to filter the massive amounts of information flowing into their offices, and electronic, or just-in-time (JIT), CME.
The task forces met periodically throughout this past year. They presented preliminary reports to the BOT last December and offered final recommendations for approval at ACC 2000. All recommendations were favorably supported.
The recommendations of each task force, and their implications for the future of the College and the specialty as a whole, demonstrate that a great deal of work must be done but that the foundation of the College is a strong one on which to build.
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Task force for the 21st century
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Several recent developments have created unique challenges for the College in continuing to meet its mission of fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.
The Task Force for the 21st Century, chaired by Dr. Michael J. Wolk, used the College’s mission, as well as the strategic plan, and grouped its recommendations in four key areas—education, advocacy, clinical practice and the ACC–National Cardiovascular Data RegistryTM (ACC–NCDRTM), and member-giving and dues.
The task force recommended that the College significantly enhance its advocacy efforts and become engaged in an increased array of political activities. This is in direct response to a clear message from members asking that the ACC do more to advocate on their behalf. To accomplish these goals, the task force urged the ACC to enhance its legislative and regulatory capabilities, increase advocacy support to chapters, establish a political presence through the formation of a political action committee (PAC), improve communications and public relations, and offer practice management resources.
The ACC will first need to form a separate affiliated organization that is classified as a 501(6)(c) to allow more resources to be devoted to lobbying efforts that are currently limited by the ACC’s tax status as an educational organization. The affiliated organization will also allow the College to endorse candidates for office, form a PAC, and contribute to political campaigns.
The task force also recommended establishing programs to "bring guidelines into practice." One approach is the current "guidelines applied to practice" or GAP project, which is an evaluation study of the effectiveness of educational tools intended to help physicians apply guidelines to actual practice. Quality measures need to be developed to provide a basis for benchmarking practice patterns. To implement the guidelines, certain derivative products will be developed, including patient guides (educational tools to improve patients’ understanding of their illnesses and their responsibilities for their health care) and clinical decision aids, which will comprise a package of tools and resources to assist cardiologists in decision making.
Other recommendations included expanding and transforming many of the ACC educational programs and products and approving the budget plan for the innovative online learning strategies proposed by the CME task force. The task force paid particular attention to enhancing the breadth of programs given in the Learning Center at Heart House, ACC headquarters, recommending the development of more partnerships with industry for cardiologists being trained in the use of new devices and technologies. The Annual Scientific Session, the showcase of the College’s educational offerings, will be characterized by even more collaboration with subspecialty societies for the Sunday spotlight sessions.
The task force also recommended increasing support for the ACC–NCDRTM. One proposal included partnering with other professional organizations, such as the Society of Thoracic Surgeons and Society for Cardiac Angiography and Interventions, to expand the value of catheterization lab products and services.
As an outcome of this task force’s recommendations, the ACC is going to enhance a member-giving program to increase revenue in the form of charitable gifts from ACC members. Members will be given the opportunity to support the ACC’s mission, programs, and activities through 1) annual giving, 2) special/major gifts, and 3) planned giving.
The task force recommended establishing a Unique Investment Fund, to be capitalized with $4.5 million from the ACC reserves and to be available over five years. The fund will be used for new ACC program initiatives and capital projects.
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Task force on strategic directions for CME at the ACC
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Medicine is being transformed by the Internet revolution as physicians and patients gain immediate access to health-related information. One billion people a day now access the Internet, which is a 40% increase over last year.
Several technology-driven trends will permit the electronic delivery of CME in the near future. Some of these technology trends include Internet access "anytime, anywhere" through a combination of wired and wireless technologies and devices. Access to CME will be available at home, in cars, on hospital wards, and in physicians’ offices through various devices and in many media formats.
Recent surveys show that ACC members are seeking tools to direct themselves as well as their patients to credible information. In addition to this "self-directed" mode of learning, many ACC members want immediate access to information—personalized CME that is available anytime, anywhere. This type of learning is often referred to as "just-in-time," or JIT CME.
Because ACC members want reliable information pertaining to these areas accessible to them at all times, anywhere within their professional environment, it is important to use digital data sources effectively via desktops as well as hand-held computers.
With increased bandwidths, users will gain access to new technologies, and costs will decrease. Increased bandwidths will be commercialized through cable modem access and Digital Subscriber Line access to the Internet. Computers and electronic appliances will converge to be more like one another. Already, software is available that can add television to a personal computer. The ultimate convergence, however, will occur when the same broadband Internet access is available to users whether they sit down and watch television or go to their studies and log on to their computers. The ACC needs to take advantage of these new online opportunities for providing high-quality and personalized learning for its members.
This new trend of immediate information can also cause physicians to suffer from information overload, and the cardiologist attempting to keep current in his or her field of expertise must continuously absorb updates from clinical trials data; introduction of new drugs, devices, and treatment options; new research data on various disease states and their molecular mechanisms of actions; and other advances in medicine.
The Task Force on Strategic Directions for CME, chaired by Dr. Rick A. Nishimura, called for immediate action by the College to transform its CME curriculum for efficient use in the Internet age. The task force recommended that the ACC immediately and quickly establish the foundation for direct electronic transmittal of information and education to its members and their patients. To do this, they suggested creating the "ACC Knowledge Database," an indexed database populated with cardiovascular education and information modules.
The task force also recommended a radical restructuring of the knowledge currently offered through ACC CME curricula to create discrete, interrelated "knowledge units" of information composed of one or more media objects stored in the data warehouse of cardiovascular content. The goal of this effort is to create an Internet-accessible system that accommodates "self-directed" learning and JIT CME while maintaining a framework for the efficient development of the ACC’s expert-structured educational products and programs. Knowledge units will be composed of one or more media objects (e.g., educational text segments, audio segments, still images, moving images). Media objects will be indexed with digital tags identifying the nature of the information, origination, cycle for modifications, presentation medium, and other pertinent information searchable by key words or questions posed by the database user. In addition to storing knowledge units, the "ACC Knowledge Access Database" will also serve as a portal, or "gateway," to selected external (i.e., non-ACC-generated) sources of information. Collaborative societies, industry partners, business partners, online medical journals, and other online information brokers could provide such information.
The ACC will develop a prototype for the "ACC Knowledge Access Database" and create and maintain an editorial office to oversee its implementation, including a full-time physician serving as editor. This will allow for editorial filtering that will keep the knowledge units within the "ACC Knowledge Access Database" maintained and up to date.
The task force also recommended that "self-directed" learning be supported by the creation of a portfolio of personal learning services to assist the user in tracking his or her own progress through CME activities, thereby managing his or her personal continuing professional development.
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Task force on member relations
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The Task Force on Member Relations, chaired by Dr. Spencer B. King, III, was charged with finding ways to provide more services to members. This group re-examined membership categories and the roles and responsibilities of the Board of Governors (BOG). They worked on ways for the ACC to communicate more effectively with the chapters on national and local activities, proactively respond to member needs, and guarantee that the College leadership be broadly representative of the ACC membership.
Each state chapter will be encouraged to assess its member needs annually and to channel its findings to the BOG to determine common and unique member needs from the grassroots level. Members can help with this by communicating with their chapters.
The task force stressed that ACC advocacy efforts must be anchored at the grassroots level and experiences should be communicated broadly to the national membership. It was recommended that mechanisms to facilitate grassroots lobbying be expanded. The use of listserves was one approach suggested, as were grassroots e-mail and letter campaigns originating at the annual meeting.
The task force recommended creating an "issue response" advisory group, consisting of representatives of the Government Relations, the Private Sector Relations, and the Economics of Health Care Delivery Committees, to advise the leadership about issues and problems identified at all levels so that the College can respond promptly, cohesively, and effectively to hot issues.
Web site communication is crucial to the success of the College’s enhanced advocacy efforts. The ACC Web site will list ACC Fellows alphabetically and by region. Members will be able to network with their peers and learn how they are handling the challenges facing the profession or their individual practices. Leaders of chapters that have effectively partnered with local subspecialty societies will be asked to write articles or editorials about their experiences. These pieces will be published on the ACC Web site to encourage other chapters to explore similar partnerships. To identify and meet the needs of Fellows-in-Training and other physicians entering the field of cardiology, the College will also create an Affiliates-in-Training section on its Web site.
The task force also recommended exploring increased participation of nonphysician cardiovascular health care workers in the ACC, including potential opportunities for affiliation and nonclinical education.
The task force emphasized the importance of identifying future leaders and maintaining the flow of "new blood" into the ACC. Thus, the task force placed the highest priority on implementing an internal database that will allow tracking of activities, demographic information, interests, areas of specialization, and national/chapter involvement for ACC members and others who participate in ACC activities.
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Task force on board effectiveness
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The work of the Task Force on Board Effectiveness is critically linked to the work of the Task Force for the 21st Century. As the Task Force for the 21st Century worked to develop a plan and processes to align the College’s strategic priorities with its financial resources, the Task Force on Board Effectiveness made sure that the BOT’s role, responsibilities, and decision-making processes would ensure that the College remain strategically focused on and operationally aligned with the future.
As president-elect, I chaired the Task Force on Board Effectiveness. The task force specifically focused first on examining and then on transforming the governance process for the ACC, including the methods for linking agenda development with strategic priorities. The task force embraced a new paradigm for BOT members—being a "strategic thinking partner" and taking an active role in looking for talented ACC members. One particular goal was to attract a broad range of diverse members for its committees, task forces, and working groups. The task force would also like to see the BOT encourage program directors and cardiology division chiefs to support their local ACC chapters through the involvement of their faculty and trainees in chapter activities.
A process for ongoing evaluation, learning, and continuous improvement, as well as the refocusing of meeting agendas to emphasize issues of strategic importance, was also recommended for the BOT.
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A job well done
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The task forces did an incredible amount of work and should be congratulated for taking the initial steps in this ever-changing process; in particular, Drs. King, Nishimura, and Wolk have made immense contributions, putting the College on a new and exciting course as the ACC enters this new millennium in a rapidly changing world. I would also like to thank the many members of the ACC staff who contributed so much time and effort to the process.
A special thanks should be extended to Past President Arthur Garson, Jr., and his predecessor, Dr. King, who were instrumental in providing leadership to the overall activities of the four task forces.
I welcome your thoughts and comments about the task force recommendations. Please feel free to write me at Heart House, 9111 Old Georgetown Road, Bethesda, MD, 20814-1699; fax me at 301-897-9745; or e-mail me at pres@acc.org.
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