Author + information
- Richard A. Chazal, MD, FACC, President, American College of Cardiology∗ ( and )
- Athena Poppas, Chair, ACC Governance Committee
- ↵∗Address correspondence to:
Richard A. Chazal, MD, FACC, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
Over the last 2 decades, the American College of Cardiology (ACC) has seen significant growth and change in membership, size, mission, and scope of the College itself. During this period, the ACC's Heart House headquarters was moved from Bethesda, Maryland, to Washington, DC, and the core mission expanded from a principal focus on education to include quality and advocacy. Nonphysician members of the cardiovascular team became integral to the ACC, and an integration of the international community occurred. Dramatic expansion of the College has been accompanied by an increased focus on the responsibility of the College and its members to improve the cardiovascular health of the United States—and of the world community. All of this has occurred with the backdrop of economic and political forces in the United States, resulting in anticipated marked changes in the health care delivery system.
This evolution (or possibly, revolution) has prompted College leaders to implement changes to long-standing governance structures and processes to position the College for success going forward. It became clear that governance designed for the ACC of 1996 simply does not fit the current organization. It was also clear that needed changes would best be accomplished at a time when we were enjoying strength and growth, and not in a time of crisis. It is better to make changes when things are going well than when such change is an emergency and forced by internal problems.
This is a difficult task and one that has occurred not in a vacuum but rather after 2 years of intense discussion and input, and it will continue to evolve over the next 2 years. The ultimate goal: to make the ACC more nimble, strategic, accountable, and reflective of the diversity and breadth of our cardiovascular community. Those at the table are leaders who have in-depth understanding of the College and its mission and are committed to focusing on the bigger picture while paying attention to details. Expert outside assistance from those conversant with best governance practices is playing a major role. Ongoing discussion (and listening) with other engaged leaders and stakeholders has been crucial.
At a broad level, the changes agreed upon by the ACC’s Board of Trustees (BOT) are on the basis of key principles for optimal governance that call for a smaller and more strategic board, with tactical decision making occurring at the committee level. Specific changes include a reduction in Board size from an initial 31 to 13 members by 2018; the reconfiguration of 6 Board standing committees, including a new membership committee; and a reduction in BOT officers to president, president-elect, secretary, and treasurer (1).
These shifts will ultimately allow the smaller BOT to be more engaged in strategic consideration of ACC core and noncore priorities and capabilities. They will also lead to increased efficiency and will provide opportunities 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 ACC to members who wish to become more engaged. Although the Board size will be smaller, there will be a larger role for College committees, placing more members in positions to guide policy and activity (in a way that was previously available to only a limited number of Trustees). Additionally, there will be greater clarity around programs and processes, as well as increased accountability for achieving expected results. More effective involvement from the Board of Governors and from the ACC’s growing Member Sections, including those representing early career, fellows in training, cardiovascular care team, and international members, is also a critical outcome.
Large-scale transformation takes time, and although the evolution is underway, there are still supporting details that need to be worked out. Although many changes will start taking place this year, there are several key elements that will be phased in between now and 2018. We want to get this right. BOT members and other leaders are engaging members and stakeholders across the College as they work to move from principles to implementation.
Overall, we are finding ACC members are supportive of the new governance structure. A recent survey of more than 400 ACC fellows found that approximately one-half of cardiologists are very/extremely favorable toward the new ACC governance structure—only 2% answered that they were not favorable, and the rest were not sure or undecided (ACC CardioSurve Survey, May 11 to 16, 2016; 169 out of 405 respondents [42% response rate; not yet published]). Additionally, 2 of 5 surveyed feel that the governance transformation will move the ACC in the right direction, with only 1% indicating that the ACC is headed down the wrong track. Nearly 2 of 3 respondents also indicated that the new, smaller, strategy-focused, competency-based board will better guide the College than a larger representative board. Only 1 of 10 cardiologists felt the new BOT is too small to adequately hear and represent the voice of ACC members.
Of the cardiologists who expressed uncertainty about the benefits of the new structure, 48% preferred the small board size, regardless, compared to 16% who preferred a larger board. Early-career cardiologists tended to be more unclear or uncertain about the changes than mid- to late-career cardiologists. This uncertainty is likely because they are waiting to see in what ways committees will play larger roles in programs, products, and initiatives. The early-career professionals surveyed listed the increased role of committees as the most important aspect of the governance changes, compared with the ability to be nimble, as identified by those in their mid to late careers.
Member feedback is a critical element of our efforts to bring greater clarity to the revised structure and process over the next couple of years. President John F. Kennedy is often quoted as saying, “Leadership and learning are indispensable to each other” (2). We are committed to listening, learning, and course-correcting as needed. In fact, the ACC has already course-corrected on the basis of member feedback by adding 2 additional positions to the BOT: the Board of Governors chair-elect and the Membership Committee chair. This change will bring the total number of BOT members to 13 when the transformation is completed in 2018, a change from the original proposal of 11 Board seats.
ACC leaders are also grappling with the complex issues surrounding the potential conflict of interest raised by participation of leaders in the College who also serve at high levels in other societies. This is being carefully studied by the Governance Committee to balance the importance of input from key thought leaders with the need to avoid placing them, the ACC, and other organizations in any compromising position. College leaders have and are meeting with ACC members who lead our sister cardiac societies to strive for input and improved communication.
Over the next several months, the Governance Committee will be working to identify and refine leadership competencies, job descriptions, and charters for major standing committees throughout the College. We expect to further refine and update these components on the basis of feedback and lessons learned this fall after Board and committee nominations occur. This will be the first formal nomination process under the new governance structure.
Synthesis Management Group President and CEO Roberta “Bobbie” Goheen authored a blog titled “Great Leadership Is Not for the Faint Hearted.” She notes that “the illusion of great leadership is it looks easy. Yet behind the scenes leaders grapple with difficult scenarios, unclear situations, undefined possibilities, and regular risks. … They have a honed skilled to not focus on who is ‘right or wrong’ but to focus on what is the path forward that creates new flow for all involved” (3). We, and our BOT and Governance Committee colleagues, feel strongly that we are on the right path forward and that this path will become clearer as the processes and structures are developed and implemented between now and 2018. We cannot emphasize enough that we are listening to understand all perspectives and situations in order to define the clearest and most effective way forward. This must be an iterative process, focused on doing the right things for the right reasons. Devotion to purpose while maintaining flexibility and ongoing learning are of paramount importance. Keep your feedback and thoughts coming!
- American College of Cardiology Foundation
- ↵Williams KA Sr. ACC approves transformational changes to its governance structure. ACC in Touch Blog. Available at: http://blog.acc.org/post/acc-approves-transformational-changes-governance-structure/. Accessed June 20, 2016.
- ↵BrainyQuote.com. John F. Kennedy quotes. Available at: http://www.brainyquote.com/search_results.html?q=Leadership+and+learning+are+indispensable. Accessed June 20, 2016.
- ↵Goheen R. Leadership is not for the faint hearted. Synthesis Management Group Blog. Available at: http://getsynthesis.com/great-leadership-is-not-for-the-faint-hearted/. Accessed June 20, 2016.