Governance Transformation

Governance Transformation


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VOL. 68, NO. 7, 2016


ISSN 0735-1097/$36.00



Governance Transformation On the Path Toward a More Nimble, Strategic College Richard A. Chazal, MD, FACC, President, American College of Cardiology Athena Poppas, Chair, ACC Governance Committee


ver the last 2 decades, the American Col-

This is a difficult task and one that has occurred

lege of Cardiology (ACC) has seen signifi-

not in a vacuum but rather after 2 years of intense

cant growth and change in membership,

discussion and input, and it will continue to evolve

size, mission, and scope of the College itself. During

over the next 2 years. The ultimate goal: to make the

this period, the ACC’s Heart House headquarters


was moved from Bethesda, Maryland, to Washington,

reflective of the diversity and breadth of our car-

DC, and the core mission expanded from a principal

diovascular community. Those at the table are

focus on education to include quality and advocacy.

leaders who have in-depth understanding of the

Nonphysician members of the cardiovascular team

College and its mission and are committed to

became integral to the ACC, and an integration of

focusing on the bigger picture while paying attention

the international community occurred. Dramatic

to details. Expert outside assistance from those

expansion of the College has been accompanied by

conversant with best governance practices is playing

an increased focus on the responsibility of the College

a major role. Ongoing discussion (and listening) with

and its members to improve the cardiovascular health

other engaged leaders and stakeholders has been

of the United States—and of the world community. All







of this has occurred with the backdrop of economic

At a broad level, the changes agreed upon by the

and political forces in the United States, resulting in

ACC’s Board of Trustees (BOT) are on the basis of key

anticipated marked changes in the health care deliv-

principles for optimal governance that call for a

ery system.

smaller and more strategic board, with tactical decihas

sion making occurring at the committee level. Specific

prompted College leaders to implement changes to

changes include a reduction in Board size from an

long-standing governance structures and processes to

initial 31 to 13 members by 2018; the reconfiguration

position the College for success going forward. It

of 6 Board standing committees, including a new

became clear that governance designed for the ACC of

membership committee; and a reduction in BOT






1996 simply does not fit the current organization. It

officers to president, president-elect, secretary, and

was also clear that needed changes would best be

treasurer (1).

accomplished at a time when we were enjoying

These shifts will ultimately allow the smaller BOT

strength and growth, and not in a time of crisis. It is

to be more engaged in strategic consideration of ACC

better to make changes when things are going well

core and noncore priorities and capabilities. They will

than when such change is an emergency and forced

also lead to increased efficiency and will provide op-

by internal problems.

portunities to maximize the value of the College to its members. Another goal of the governance changes is to provide more opportunities for leadership in the

From the American College of Cardiology, Washington, DC.

ACC to members who wish to become more engaged.


Chazal and Poppas

JACC VOL. 68, NO. 7, 2016 AUGUST 16, 2016:763–5

Leadership Page

Although the Board size will be smaller, there will be

ability to be nimble, as identified by those in their mid

a larger role for College committees, placing more

to late careers.

members in positions to guide policy and activity

Member feedback is a critical element of our efforts

(in a way that was previously available to only a

to bring greater clarity to the revised structure and

limited number of Trustees). Additionally, there will

process over the next couple of years. President John

be greater clarity around programs and processes,

F. Kennedy is often quoted as saying, “Leadership

as well as increased accountability for achieving

and learning are indispensable to each other” (2). We



are committed to listening, learning, and course-

from the Board of Governors and from the ACC’s

correcting as needed. In fact, the ACC has already

growing Member Sections, including those repre-

course-corrected on the basis of member feedback by

senting early career, fellows in training, cardiovas-

adding 2 additional positions to the BOT: the Board of

cular care team, and international members, is also a

Governors chair-elect and the Membership Commit-

critical outcome.

tee chair. This change will bring the total number of





BOT members to 13 when the transformation is

although the evolution is underway, there are still

completed in 2018, a change from the original pro-

supporting details that need to be worked out.

posal of 11 Board seats.





Although many changes will start taking place this

ACC leaders are also grappling with the complex

year, there are several key elements that will be phased

issues surrounding the potential conflict of interest

in between now and 2018. We want to get this right.

raised by participation of leaders in the College who

BOT members and other leaders are engaging mem-

also serve at high levels in other societies. This is

bers and stakeholders across the College as they work

being carefully studied by the Governance Committee

to move from principles to implementation.

to balance the importance of input from key thought

Overall, we are finding ACC members are sup-

leaders with the need to avoid placing them, the ACC,

portive of the new governance structure. A recent

and other organizations in any compromising posi-

survey of more than 400 ACC fellows found that

tion. College leaders have and are meeting with ACC

approximately one-half of cardiologists are very/

members who lead our sister cardiac societies to

extremely favorable toward the new ACC governance

strive for input and improved communication.

structure—only 2% answered that they were not

Over the next several months, the Governance

favorable, and the rest were not sure or undecided

Committee will be working to identify and refine

(ACC CardioSurve Survey, May 11 to 16, 2016; 169 out

leadership competencies, job descriptions, and char-

of 405 respondents [42% response rate; not yet

ters for major standing committees throughout the

published]). Additionally, 2 of 5 surveyed feel that

College. We expect to further refine and update these

the governance transformation will move the ACC in

components on the basis of feedback and lessons

the right direction, with only 1% indicating that the

learned this fall after Board and committee nomina-

ACC is headed down the wrong track. Nearly 2 of 3

tions occur. This will be the first formal nomination

respondents also indicated that the new, smaller,

process under the new governance structure.

strategy-focused, competency-based board will bet-

Synthesis Management Group President and CEO

ter guide the College than a larger representative

Roberta “Bobbie” Goheen authored a blog titled

board. Only 1 of 10 cardiologists felt the new BOT is

“Great Leadership Is Not for the Faint Hearted.” She

too small to adequately hear and represent the voice

notes that “the illusion of great leadership is it looks

of ACC members.

easy. Yet behind the scenes leaders grapple with

Of the cardiologists who expressed uncertainty

difficult scenarios, unclear situations, undefined

about the benefits of the new structure, 48%

possibilities, and regular risks. . They have a honed

preferred the small board size, regardless, compared

skilled to not focus on who is ‘right or wrong’ but to

to 16% who preferred a larger board. Early-career

focus on what is the path forward that creates new

cardiologists tended to be more unclear or uncertain

flow for all involved” (3). We, and our BOT and

about the changes than mid- to late-career cardiolo-

Governance Committee colleagues, feel strongly that

gists. This uncertainty is likely because they are

we are on the right path forward and that this path will

waiting to see in what ways committees will play

become clearer as the processes and structures are

larger roles in programs, products, and initiatives.

developed and implemented between now and 2018.

The early-career professionals surveyed listed the

We cannot emphasize enough that we are listening to

increased role of committees as the most important

understand all perspectives and situations in order to

aspect of the governance changes, compared with the

define the clearest and most effective way forward.

Chazal and Poppas

JACC VOL. 68, NO. 7, 2016 AUGUST 16, 2016:763–5

Leadership Page

This must be an iterative process, focused on doing the right things for the right reasons. Devotion to


purpose while maintaining flexibility and ongoing

MD, FACC, American College of Cardiology, 2400 N

learning are of paramount importance. Keep your

Street NW, Washington, DC 20037. E-mail: richard.

feedback and thoughts coming!

[email protected]

REFERENCES 1. Williams KA Sr. ACC approves transformational changes to its governance structure. ACC in Touch

2. John F. Kennedy quotes. Available at:

3. Goheen R. Leadership is not for the faint hearted. Synthesis Management Group Blog. Available at:

Blog. Available at: Accessed June 20, 2016.

results.html?q¼Leadershipþandþlearningþareþ indispensable. Accessed June 20, 2016. Accessed June 20, 2016.