Final Report of the 2000 - 2001 Governance Task Force to the Board of Governors and Council of Regents

David W. Benfer, FACHE, Chairman, and Dadie Perlov, Founder and Principal, Consensus Management Group

Table of Contents

• Governance Task Force Overview
• Process to Date
• Some Overarching Observations
• Key Areas of Structure and Governance for Board Attention:
  • HEGs and WHENs
  • Council of Regents
  • Board of Governors
  • National Nominating Committee
  • Committees
  • Special Interest Groups
• Suggested Next Steps
• Conclusion

Overview:

Although the American College of Healthcare Executives (ACHE) can trace its roots to 1933, it existed at various times in its history as a venue for executives to network and socialize and as a force intended to maintain the integrity and raise the standards of excellence of the profession. It has enjoyed considerable growth and expansion of its outreach, its affiliate base and the programs and services needed to support all of that. Now representing nearly 30,000 affiliates, ACHE is the major forum for the exchange of ideas among many parts of the healthcare community, for continuing executive education, and for credentialing.

As with all basically healthy organizations, periodic assessments are prudent investments in the future. For ACHE, the rapidly changing external environment which healthcare executives must navigate encouraged the leadership to suggest a pause...to take stock of the ACHE infrastructure, to be certain that the College is structured and governed appropriately for a future which will be less and less like the past.

In 1999, Chairman Mark J. Howard, FACHE, and the Board of Governors decided to initiate an informed, independent audit of ACHE’s structure and governance, to be certain that the College would be best positioned to deal effectively and efficiently with both present concerns and the many new issues that will certainly surface. The Consensus Management Group (CMG) was retained to conduct the study. This Report outlines the process used for the study, CMG’s findings to date and most importantly, recommendations for change in certain areas.

It is important to acknowledge the extraordinary efforts of David W. Benfer, FACHE, as Chairman of the Governance Task Force, and the outstanding members who served with him. Chairman Michael C. Waters, FACHE, the Officers, the Board of Governors and the Council of Regents generously offered their time, their experience, their wisdom and their candid opinions to help shape the substance of this Report. Most appreciated was their support of our efforts and encouragement of our independence at every step along the way. Without Thomas C. Dolan, Ph.D., FACHE, Karen Hackett, FACHE, and Lisa Freund, CHE, none of this would be possible.

They answered endless requests for information, guided us to people and documents we could not have found without them, and always managed to be available to us, despite their enormously busy schedules.

Perhaps most of all, though, we want to thank the affiliates, the leaders of HEGs and WHENs, of special interest groups and committees, and of course, the rest of the ACHE staff, all whom contributed immeasurably to this report. Their examples and many of their thoughts and quotes form much of the foundation upon which this report was built.

CMG heard and processed the thoughts and suggestions of everyone with whom we spoke. Consideration was given to the source, e.g. would one expect a particular view from a particular source, or is the source for that view surprising? CMG also noted the frequency with which an idea or concern was expressed, and focused hard on the redundancies.

1. Two CMG principals completed a desk audit of ACHE documents and materials, including bylaws, directories, minutes of Board and Council meetings, publications, the Annual Report, fiscal audits, budgets, the February 2000 Fact Sheet, ACHE Organizational chart, 1999 Affiliate Needs Survey, 1999 HEG and WHEN Rebate Report and Membership Composition Report, Election Candidate Statistics, current strategic plan, internal communication instruments and more. This review was independently conducted at the CMG offices in Virginia and New York City, to provide an internal check and balance on what was read and how it was interpreted.
   
   
2. CMG observed a Board of Governors meeting and a Council of Regents Meeting.
   
   
3. In small groups, both the Governors and the Regents had an opportunity to discuss some of the issues identified by CMG as critical to the study, and to offer their thoughts. All of those sessions provided invaluable data.
   
   
4. Three staff focus groups were conducted at headquarters, involving staff at every level of the organization and from every department. A special meeting with senior staff (other than the President) provided CMG an opportunity to see the ACHE headquarters in action.
   
   
5. A telephone interview with the ACHE president helped clarify some open issues that merited CMG attention.
   
   
6. A meeting was held with the Governance Task Force, at which many of the issues listed below were extensively discussed, and many new issues surfaced.
   
   
7. CMG met again with the Board on June 26^th, as part of an interim review of the direction of this study.
   
   
8. Conference call focus groups were completed with:
   
   
   • Presidents of HEGs with over 100 members, and with at least 50% of their members also holding membership in the College
     
     
   • Presidents of HEGS with over 150 members but with less than 30% of the membership holding both local and ACHE memberships
     
     
   • Presidents of HEGs with less than 100 members, and with at least 50% of their members also holding membership in the College
     
     
   • Presidents of HEGS with less than 150 members and with less than 30% of the membership holding both local and ACHE memberships
     
     
   • Presidents of WHENs
     
     
   • Committee leaders/members
     
     
   • RACs
     
     
   • Newest affiliates, because these affiliates generally provide information that is not available elsewhere, i.e., they tend to know exactly why they joined and what they expect
     
     
   • Lapsed affiliates, another key group, because they know why they left the College
     
     
   • Prospective affiliates in a variety of healthcare settings, so that we can learn what they know and think about the College, and why they are not affiliates
     
     
9. Staff facilitated discussions with:
   
   
   • Regents at each of the fall district meetings, providing an opportunity to test interest in a new role for Regents and to provide feedback from the field
     
     
   • Special interest group committees during their fall 2000 meetings. Participants included leaders of post-acute/chronic care executives; nurse executives; systems healthcare executives; managed care executives; group practice executives, physician executives and CEOs.
     
     
10. Focus groups and telephone interviews were conducted by members of the Governance Task Force, reaching about a dozen HEGs and WHENs. (Note: For this report, the sample covered through interviews and focus groups exceeded the statistically valid percentages needed for studies of this nature. In all, more than 250 individuals were formally interviewed, and many more were informally polled and/or observed.)
    
    
11. Much of this report was informed by the assumptions about the future developed by the Governance Task Force, and the implications of those assumptions for the future of the College. Some of the key assumptions were:
    
    
    • Continued fragmentation of the healthcare community will require the College to create more special interest groups
      
      
    • All healthcare systems will continue to be stressed
      
      
    • Gene therapy and new drugs will control mortality, leading to excess capacity in hospitals in some regions of the United States and need for increased long-term care capacity
    • There will be a sharp increase in female leadership in the industry
      
      
    • There will be a less hospital-centric base, with more and more services outsourced to niche facilities
      
      
    • Healthcare professionals will need expanded skills in order to appropriately serve an increasingly diverse US population
      
      
    • Technology will provide a leap in delivery mechanisms, requiring new skills for executives
      
      
    • Aging population will push for more coverage, adding more pressure on executives for bottom line results
      
      
    • With consolidation of services among all branches of the uniformed services, and with the probability that healthcare will become a smaller part of the overall uniformed services budget, there will be less personnel and therefore less affiliates
      
      
    • Increased value of discretionary time will severely impact volunteerism within the College
      
      
    • Growing gap between the haves and have-nots, and sharp contrasts in insurance coverage and ability to pay, will cause increasing schisms between the public and private sectors
      
      
    • Shift in where US population resides, i.e., more people in the sunbelt, will impact delivery systems
      
      
    • Government will be pressured to increase coverage for healthcare, but possible future recession will again cause a redesign of government programs
      
      
    • Consumerism will continue to grow, with demand for options and choices about healthcare impacting how healthcare executives determine which of the many healthcare organizations to join

1. ACHE is a very successful organization, highly regarded both internally and externally. Therefore, all future decisions about structure and governance should seek to protect the credibility of the College, and its reputation, even as it repositions itself for the future. This important criterion must be considered before any change is approved.
   
   
2. The College is blessed with an extremely dedicated, committed and able leadership. In most situations, this facilitates needed change. However, strong commitment to the past and to tradition can also inhibit change.
   
   
3. Staff is overwhelmingly committed and loyal to the College as well, with senior people evidencing a much lower turnover rate than is evident in similar organizations in the Chicago area.
   
   
4. A commitment to making the College more accessible and representative of the changing demographics of the industry and the profession is already evident. The representation of the uniformed services, the addition of Governors-at-Large and Regents-at-Large, and the ability of Diplomates to hold Regent positions are all positive indicators. In addition, the extension to all Members of the right to vote for Regents, regardless of tenure, and the staggering of terms for Governors all point to an increased understanding of the need for change. Reduced eligibility requirements for Members also demonstrates the interest of the College in further outreach.
   
   
5. Governance costs utilize 7.7% of the ACHE expense budget, and 26.6% of its 1999 dues revenues. An average cost for governance today should be approximately 6% of the operating budget of a 501(c) 3 organization with budgets between $3 and $8 million, a percentage that should decline as the budget increases. This statistic is gathered from the American Society of Association Executives Operating Ratio Report and CMG’s association database. Given the breadth and depth of ACHE’s current governance structure (Board of Governors, Council of Regents, committees), more than $1 million is allocated to governance costs. This should continue to be monitored so as to provide maximum value to affiliates.
   
   
6. A persistent question that has been addressed in ACHE’s strategic planning processes is, "What business should ACHE be in, and for whom?" If it is in business to promote and manage levels of certification for those eligible and qualified, it would more easily dictate one type of governance and membership model. However, now that the College is reaching further down the executive spectrum, and does not in fact require a Member to ever sit for the Diplomate exam, implications for governance structure and operations could be dramatically affected. Judicious considerations about bold new directions are required.

1. HEGs and WHENs:
   
   Perhaps the biggest question that ACHE will face in the near future is the desired status for local affiliated groups. Clearly, that has huge implications for how ACHE is structured and governed. With every indication that most healthcare professionals, especially as they make their way up the career ladder, start their affiliation at the local level, this is a level that deserves serious attention. Given that fact, the College must develop programs, products, and services at the local level to recruit, retain, and advance affiliates.
   
   Now, the HEGs and the WHENs are totally independent of the College, without any formal or informal terms of agreement about any mutually determined rights, role or responsibilities. Those local affiliated groups with more than 50% in overlapping memberships and those groups with less than 10% of overlapping memberships, receive virtually the same support. In fact, one HEG that enjoys an 85% overlap receives little more attention than a HEG with a 5% overlap.
   
   Some local affiliated groups already consider themselves chapters. Others are far removed from the College, in thought and in action. A small number of HEGs and WHENs are consistently effective, offering strong programs and services, networking opportunities and some Category II education. They have a history of good leadership, and seem to manage their organizations with little outside help. Some rely heavily on their Regent.
   
   There are considerably more that have uneven leadership and difficulty in maintaining member interest or numbers. Once the downward spiral starts, it is only interrupted when an ambitious, capable leader surfaces, or an exceptionally involved Regent steps in to provide support and guidance.
   
   CMG Recommendations:
   

1. Develop a process that will enable and encourage autonomous HEGs and WHENs to choose to formally affiliate with ACHE. The steps that might be taken include:
   
   
   • Setting a benchmark for the minimum number of ACHE affiliates needed to qualify for chapter status. CMG suggests that this number could initially be pegged at 51%, which would make 32 existing affiliated groups eligible for chapter status. The ultimate goals should be total co-extensive membership.
     
     
   • Convene the current leaders of these affiliated groups to meet for a planning conference to determine: their interest in moving ahead; minimum standards; and most important, the roster of expectations that the chapters would have of the College, and the College would have of the chapters.
     
     
   • Convene a smaller planning group of these affiliated group leaders and College leaders (Regents and Governors) and staff to prepare "Guidelines for Chapter Status". These guidelines might require minimal structure requirements (the fewer the better); suggested level of programs and services; and an established number of new Members, Diplomates and Fellows sent forward each year. The Guidelines should also clarify what support, services and incentives ACHE would provide.
     
     These might include: list maintenance; mailing services; providing a newsletter template; printing and mailing newsletter (with additional copy from local leaders and contributors); leadership and board training opportunities; registrations for education and meetings at reduced rates; a job bank; a hot link on ACHE website; etc.
     
     
   • Require a minimum total number of members for chapter status.
     
     
   • Conduct pilot programs with a number of small and large groups in both urban and rural areas that wish to convert to chapter status.
     
     
   • Do a cost/benefit analysis re staff and service expenses vis a vis potential revenues from increased number of credentialing candidates for Diplomate and Fellow status, Members, and attendees at seminars and conferences, etc.
     
     
   • Based on the results of the pilot programs, develop financials to support expanded implementation of chapter conversion.
     
     
   • Approval of bylaw changes needed to implement a chapter program.
     
     
2. Reconfigure or add staff to assure the needed level of staff support.
   
   
3. Phase in the formal arrangements on a voluntary basis, with approximately ten chapters/year for each of the first two years, allowing ACHE and chapters to refine the approach as real experience dictates. Provide real incentives for chapters and for affiliates, e.g. a co-extensive dues rate that is less expensive than two individual memberships.
   
   
4. Explore expansion opportunities in underserved markets where no HEG or WHEN exists, if there is a substantial presence of healthcare facilities and consider ways to address markets that are served by multiple affiliated groups.
   
   
5. Convene WHEN leaders to discuss potential options for the future.
   
   
6. Establish a dual chapter structure for members of the uniformed services whereby individuals in a particular branch of the uniformed services (Air Force, Army, Navy) would comprise a chapter. In addition, uniformed services personnel could also be affiliated with their local geographic chapter.
   
   
7. Prepare Regents for revised roles at the local level. (See recommendations re Council of Regents.)
   
   
8. When appropriate, establish a "Council of Presidents" structure in Regent jurisdictions with multiple chapters to foster coordination and communication among the Regent and chapter presidents. Until that time, it is important that chapter presidents serve on the Regent’s Advisory Council.
   
   
9. Provide national leadership and recognition opportunities for chapter leaders.
   
   
10. Once chapter status is available to all affiliated groups, discontinue all but basic services to affiliated groups that do not meet or do not attempt to meet requirements, and who choose not to work towards chapter status.

2. Council of Regents:
   
   After reviewing Council statistics and performance, reading and observing proceedings, speaking extensively with Regents, and hearing others speak about Regents, certain realities became apparent.
   
   Individual Regents are by and large accomplished, highly esteemed leaders of the profession. Most are "cheerleaders" for the College, serve as mentors to others coming up the leadership ladder, and advisors for local HEGs and WHENs, even those that have few ACHE affiliates on their rosters. Their local roles are generally more important overall than are their roles in governance. Through no fault of its own, the Council is a weak governing body. Meeting only once a year does not enable it to be fast, a necessity for any governing body today. It generally "rubber stamps" decisions carefully and elaborately discussed and already approved by the Board of Governors.
   
   In 1988, when the need for more service at the local level became apparent, the number of Regents was changed from 57 to over 100, and the size of each region reduced accordingly. This was done at a time when there were already strong indicators that people all across the country would have less discretionary time to offer to their professional associations. The Council's ability to debate and consider issues was severely impacted.
   
   Nevertheless, Regents by and large reported that they enjoy holding the title and value the prestige that comes with it. Most Regents carryout at least some of their assigned tasks. They do not consider themselves a true part of governance, seeing their roles as primarily ceremonial or as many said, "window-dressing". This is not something that any contemporary organization should want to perpetuate.
   
   What is perhaps most troubling, is that fewer and fewer Regents run on a dual slate. In many cases, staff is required to try to identify anyone willing to run. Because of the mobility of the profession, many each year resign their Regent positions because of changes in their job status or location. At any one time, it is possible for there to be a considerable number of interim appointments.
   
   Currently, the performance-based evaluations of Regents are largely contingent on the number of new Members they recruit, the number of students they place onto the regular membership rolls, the number of newsletters they produce and distribute, and the level of activity of their Regent's Advisory Councils (RACs). The performance of Regents vis a vis their service to the field is reported as extremely uneven. Some local groups say they were "saved" by an excellent, hard-working Regent. A disturbingly large number of local leaders say they have never met or heard from their Regent in the past three years.
   
   The demands on time, mentioned by almost everyone interviewed during this process, was paramount for Regents, who are expected to do a lot of work locally. Some reported that as many as six to ten hours per week, plus travel and evening work, are required to really fulfill commitments to the College. An increasing number of institutions are putting specific restrictions on the amount of time executives can offer for volunteer work that takes them out of the office, and are offering less reimbursable expenses for organizational activities, for taking education seminars or for teaching them.
   
   Culling through the raw notes provided by 101 Regents themselves, some of the key, and most revealing themes pertaining to governance surfaced:
   
   
   • Geographic representation is a good idea for Regents
   
   
   
   • Increasing diversity is positive
   
   
   
   • It is sometimes difficult to defend Board actions to affiliates
   
   
   
   • Need better performance reviews at every level
   
   
   
   • Lack of clarity as to principal role of Regents, i.e. field service representative or part of a real governing body
   
   
   
   • Too little opportunity for input into decision-making process because of size of body and tightness of agenda
   
   
   
   • Increased demands at work and from family leave less time for ACHE activity
   
   CMG Recommendations:

1. Maintain a Council of Regents, with decreased numbers and revision of Regents' roles both on Council and in the field.
   
   
2. Reconfigure the Council of Regents to include one Regent for each state, branch of the uniformed services, the District of Columbia, Puerto Rico and Canada with an additional Regent added for each additional 500 Members, Diplomates and Fellows above a 500 affiliate census (i.e., up to 999 Members, Diplomates and Fellows in a jurisdiction would qualify for one Regent; 1,000 to 1,499 Members, Diplomates and Fellows in a jurisdiction would qualify for two Regents; 1,500 to 1,999 Members, Diplomates, and Fellows in a jurisdiction would qualify for three Regents, etc.). Based on the current census, this would result in 62 Regents, including two Regents in the states of California, Illinois, New York, and Pennsylvania and three Regents in the state of Texas. In light of the growing diversity among ACHE’s elected leaders and among HEG leaders, it is no longer necessary to have Regents-at-Large on the Council of Regents. The reduction in both geographic Regents and Regents-at-Large would be accomplished through attrition in the existing class of Regents and Regents-at-Large.
   
   
3. Consider one three-year term for Regents, with one-third rotating off each year. This is in response to many comments about the difficulty of making a four-year commitment in this employment environment.
   
   
4. The overall purpose of the Regent is to provide advice and counsel to the Board of Governors, to elect the Board and Nominating Committee members, and to serve affiliates at the local level.
   
   The role of Regents at the annual meeting of the Council would be to:
   
   
   • Bring a true grassroots perspective to the table, with a formal process for identifying and discussing common trends and issues, and the implications for ACHE and for the profession.
     
     
   • Serve as part of a think tank, working in small groups to consider how ACHE must position itself for the future.
     
     
   • Advise the Board of Governors on all of these issues, trends and concerns.
     
     
   • Become familiar with the organization’s financial resources so that a thorough knowledge of ACHE priorities and how they are resourced can be communicated to the field.
     
     
   • Vote for each class of Nominating Committee members, Governors and Chairman-Elect.
     
     
   • Approve new and revised ethical, professional, and public policy statements.
     
     
   • Receive intensive training and orientation for the Regents' roles in the field.
     
     
   • Maintain the high prestige of the Council, through maintenance of some of the pomp and circumstance surrounding investiture, and through recognition of the essential roles played by Regents at both the national and local levels.
     
     
   Within the jurisdiction, a Regent would be expected to:
   
   
   • Work with assigned staff to service and/or start chapters. ACHE field staff would partner with Regents to support their field roles.
     
     
   • Convene a Council of Presidents of chapters and chapters in formation, for guidance, identification of local needs, training for their roles, and the sharing of best and worst practices.
     
     
   • Maintain grassroots perspective by assisting with career counseling and serving as contact for local affiliates expressing ideas or raising issues about ACHE programs or services.
     
     
   • Encourage the presence of senior leaders at local meetings, to help meet the networking needs of younger affiliates looking to advance their careers in health care.
     
     
   • Serve as an ambassador to local health administration programs, visiting the students or arranging for visits by senior leaders to provide insight about the field and the benefits of ACHE affiliation and credentialing.
     
     
   • Encourage sitting for the Diplomate exam and advancement to Fellow.
     
     
   • Assure a strong pool of possible successors.
     
     
   • Help in meeting the recruitment and retention goals for the jurisdiction.
     
     
   • Identify individuals for future national leadership and attention by the National Nominating Committee.
   
   
   
   • Serve as liaison to state hospital association.
     

5. Continue to provide performance-based annual evaluations of all Regents, to assure accountability, reward excellence and fill service gaps if any surface.



6. In light of the proposed changes to the Regent’s role, consider the role of the Regent’s Advisory Council. The RACs will be critical in the transition process. The long-term goal should be greater reliance on the chapters to provide affiliate support.



7. Election of each Regent should be a jurisdiction responsibility, with a clearly established process outlined in ACHE’s Bylaws. This should provide for:
   
   
   • The continuation of a self-nominating process for establishing an election slate. The Regent would be expected to seek and encourage potential candidates to become part of this process. Every effort should be made to have at least two candidates on the slate.
     
     
   • An election process, within each jurisdiction, managed by headquarters staff.

3. Board of Governors:
   
   By all accounts, and from all those who are aware of this governing body, there is a strong consensus that this body has led the College well, and responsibly. The commitment of time and talent is well known and widely appreciated, as is their accessibility to affiliates. Nevertheless, there is a strong residual belief that the Board of Governors is still primarily an "all white body of hospital executives" and an "old boy network".
   
   There is also recognition that they are in fact the governing body of the College, since the Council of Regents is acknowledged to be a "rubber stamp" assembly for all the reasons already outlined.
   
   With eight elected from the eight districts established for election purposes, three elected "at-large" in an effort to assure diversity, one elected from the uniformed services, and three Chairman Officers, this fifteen member body is at optimum size for effective decision making. However, geographically elected boards were a 19^th century necessity that unfortunately got carried into the 20^th century. Today, more and more organizations are moving into the 21^st century, by opting for a much more effective method of board selection.
   
   When geography was a valid way of choosing leaders, both transportation and communications were difficult. Although the need to continue geographic selection disappeared by the middle of last century, it took many organizations another fifty years to alter the process.
   
   When geographically elected, it is almost impossible to assure that a board will have the full range of skill sets needed for an effective board, or the diversity needed to truly reflect current and targeted member categories, profiles and type of employing organization. When slated in total by a Nominating Committee, efforts to assure the balance of needed skills and experience have a higher likelihood of achievement.
   
   CMG Recommendations:
   

1. No change in the size of the Board is recommended.
   
   
2. In effect, twelve Governors would be elected at-large with at least one elected from the uniformed services to serve three-year terms.
   
   
3. It is suggested that the election of Governors remain within the purview of the Council of Regents, from a slate presented by a National Nominating Committee. Since the Council is a constituent based body and is elected by the grassroots, it is in a strong position to elect those candidates best able to serve with distinction.
   

4. National Nominating Committee:
   
   The candidates would be slated by a National Nominating Committee. This would be a blue-ribbon committee, expected to sit year round, working as a search committee, to seek and identify outstanding people for board service.
   
   The National Nominating Committee would be charged to assure a board that is diverse in every respect. It would be sensitive to but not driven by geography. In other words, it would assure that the Board is not primarily east coast or west coast, urban or rural. It would make certain that all constituencies would be considered. Above all, it would assure a well-balanced group of strategic thinkers, best able to lead ACHE into what, in every respect, will be a vastly different healthcare landscape.
   
   To enable the committee to identify potential leaders from every part of the country, the National Nominating Committee would continue to have some geographic representation. It is recommended that the Committee be composed of eleven members, placed according to the following formula
   
   
   • 8 members elected geographically, one from each of the 8 election districts
   
   
   
   • 1 member elected by and from the uniformed services
   
   
   
   • The 2 most immediate Past Chairmen (the current Immediate Past- Chairman and the Immediate Past-Chairman once removed).
   
   
   
   • It is also recommended that the Nominating Committee be open to service by Diplomates as well as Fellows.
   
   
   
   • The Committee would be chaired by the Immediate Past-Chairman once removed. No one on this committee would be eligible for slating. To assure continuity on this critical committee, yet enable a continuum of new people to serve, it is suggested that there be two-year staggered terms, with roughly one-half of the committee (i.e. 4 elected by the districts) rotating off each year. The uniformed services member would serve a two-year term and then be replaced by another uniformed services person for a new two-year term.
   
   This process maintains the grassroots character of the Nominating Committee while enabling it to develop a board that has the potential to be stronger than the sum of its individual members.
   
   
5. Committees:
   
   Committee members reported that by and large their service on committees was not satisfying, with many indicating that committee meetings were boring, and that in too many instances they were asked to approve what staff had already created. The notable exceptions were comments from committees that have exciting agendas and real work to accomplish, and were being asked to make real decisions or offer recommendations. In all organizations, standing committees often tend to get stale over time, especially when their charges remain fundamentally the same.
   
   There is a high degree of satisfaction and excitement among those who are asked to serve on special, or ad hoc committees. When expectations are unclear, when members serve for many years on the same committees, and when more time is spent on process than on product, there is little pleasure or pride in service.
   
   CMG Recommendations:

1. Only three standing committees appear to be needed by ACHE: Nominating, Exams/Certification, and Ethics. These are the hearthstones upon which the College is built.



2. In the next year, ACHE should evaluate its committee structure, giving consideration to reducing the number of its remaining (approximately 40) committees. For tasks or assignments that need to be accomplished, it may be far more effective to convene a group of those most able to complete the task, and to make the assignments as time and task specific as possible, and to convene them only when needed, not on a "stand-by" basis. People with tight demands on their time appreciate this. The College would benefit from this. There would be no "busy work".
   
   For example, in other associations these ad hoc task forces have been established for many different reasons, and take many different forms, enabling the involvement of large numbers of people, but over shorter periods of time, e.g.:
   
   
   • An advisory panel, when a white paper is produced by staff but could benefit from review by other eyes and minds. Such a group is convened, expectations are clarified, and the group meets once or perhaps only by telephone or internet, or not at all.
   
   
   
   • A think tank can be convened when a tough issue deserves review. Such think tanks might be asked to identify target membership markets, or plan a new education offering, or consider the need for revisions to an existing program. The possibilities are endless. Using talent this way is not only effective in achieving results, it is sensitive to the realities of the amount of discretionary time available to most affiliates. The results are generally in inverse proportion to the small amount of effort required to establish and service them.
   
   
   
   • A reaction panel could be established to review a draft brochure or other product produced by staff, to see how it reads in the field. Here again, Regents can be asked to serve, or an entire chapter or an appropriate special interest group can be asked to offer comments.
   
   
   
   • The internet can be used to put in place some advisory panels made up of affiliates with a common interest, who may be called upon to comment on a white paper, all via the internet.

6. Special Interest Groups (SIGs):
   
   These are by and large extremely successful. Groups of post-acute/chronic care executives; nurse executives; systems healthcare executives; managed care executives; groups practice executives; and physician executives; and CEOs enjoy the networking opportunities that their meetings provide, and expect little else. Most, if not all of them, are also active in their specialty organizations, and look to the College to deal only with their roles as executives in healthcare facilities.
   
   Because there is great clarity of what ACHE can and cannot offer them, and ACHE delivers what is expected of them, the SIGs are functioning well and pleased with their status.
   
   CMG Recommendations:

1. No change in structure or role is suggested. In fact, any other recommendations for more structure should be assiduously rejected. A SIG is most effective when it has little structure, is rather freewheeling, and considers networking its most important role.



2. As the environment dictates, the College may well want to add SIGs. There should be no reluctance to do so.



3. Current WHENs may well want to consider banding together to become a SIG within the College, even if they choose to maintain their local WHEN operations and identity.



4. The College should utilize SIGs to help develop specialized education programs for parts of the profession that are not now well represented or adequately served within ACHE. They may be asked to produce a white paper, and be encouraged to make recommendations to the Board on issues that they identify as important for the College.



5. Listservs or other WEB site interactive opportunities should be provided for each SIG.

If some or all of these recommendations are accepted in concept, the next steps might well be to:

• Conduct focus groups with Presidents of HEGs that have more than 50% of their membership also belonging to ACHE, to determine readiness to move towards chapter status.
  
  
• Conduct focus groups, in person or via conference call, with Regents who have candidates for chapter status within their regions.
  
  
• Conduct focus groups with Regents re the proposed new roles for Regents.
  
  
• Determine, through analysis by staff, the fiscal implications of all CMG recommendations that are of interest to ACHE leadership.
  
  
• Present proposals to Board and Regents in March 2001.
  
  
• If approved, develop a transition plan and timeline to move from current structure and governance model to proposed new model.
  
  
• Revise the bylaws as needed to support changes, and begin transition process.

In reviewing all the raw data collected during the last three months, some recurring comments are worth noting. When asked about the barriers for change within ACHE, the almost universal answers were: the culture and history of the College; elitist attitudes; and the self-interests of those in leadership now or aspiring to leadership. These perceptions remain troubling to leadership.

It is anticipated that this report will be read with a willingness to look at what might be rather than at what is. The College has an illustrious past, is vibrant at present, and has the promise of a dynamic future. To assure this will require some adjustment in "how we do things around here", something that all successful organizations and institutions regularly consider.

The words of Theodore Hesburgh, C.S.C., the former president of the University of Notre Dame, bear repeating: "My basic principle is that you don’t make decisions because they are easy; you don’t make them because they are cheap; you don’t make them because they are popular; you make them because they are right." We wish nothing more or less for the leaders of ACHE, who ultimately must decide what is right for the College.