Co-creation with professional societies: Transparency, listening, and trust

The American Board of Internal Medicine (ABIM) has employed a co-creation strategy over the last five years to address concern among professional societies about its Maintenance of Certification (MOC) program. Why does this build trustworthiness? ABIM has rebuilt relationships with and trust from medical specialty societies through active listening, feedback, co-creation and transparency – key to communication and mutual respect

How It Works

ABIM employed a co-creation strategy over the last five years to address significant anger and tension regarding Maintenance of Certification. Professional society trust in ABIM was lost because of concerns about MOC – adversarial relationships resulted.

The co-creation strategy includes:

  • Dedicated staffing: ABIM dedicated a small, senior level team for society relationships. This team leads relationship management and connects society leaders and staff to others within ABIM, including discipline-specific governance.
  • Transparent communication: ABIM committed to regular dialogue. Additionally, we exhibited trust in societies by sharing confidential, embargoed information before public release. This has led to reciprocal sharing of such information– thereby demonstrating their trust in us.
  • Clear communication of ABIM’s role: As a certifying body, ABIM has a defined role in medicine – different from professional societies. By clearly communicating the constraints faced when modifying the program, while simultaneously emphasizing the envelope in which we have latitude, we build trust. We set clear expectations of what is possible.
  • Genuine collaborative opportunities: Co-creation may ring hollow if genuine collaborative opportunities are not identified. ABIM has worked diligently to build potential collaboration into a variety of programmatic initiatives.
  • Active listening: The team employs active listening – listening for shared values, shared goals. This includes reflection of what we heard – while being forthright in letting them know what is possible given the restraints we face because of our role as a certifying body. ABIM also informs professional societies about the ways their feedback helps shape a program or a policy decision.

Skills and Competencies

To manage these relationships effectively, ABIM needed to build staffing capacity focused on professional societies. Due to the nature of the discussions – the strategic collaborations and co-creation proposed – the team needed to be fully aware of ABIM policy, ABIM strategic directions, as well as the requirements and restraints attendant to being a certifying body.

Skills of team members include: effective listening skills, excellent communication skills (verbal and written), and ability to constructively handle conflict.


In 2014, upon implementation of a redesigned Maintenance of Certification program, diplomates of the ABIM voiced significant concern and anger. In turn, professional societies advocated for their members by calling for the suspension of certification activities or immediate revisions to the program. Some went further, fundamentally questioning the necessity of certification beyond initial certification. Relationships between ABIM and its associated professional societies quickly became adversarial. True dialogue was absent: ABIM and its societies were talking past each other.

In an effort to regain trust and restore dialogue, ABIM adopted a going forward strategy focused on co-creation. Committed to transforming the program, ABIM revamped its engagement strategy – focusing on listening and identification of common ground. This strategy became the basis for a variety of trust practices employed by staff and governance bodies.


Though we do not have baseline data from 2015 – when tensions were at their height, ABIM has surveyed professional society staff over the last couple years. Compared to 2019, when asked to characterize the society’s relationship with ABIM, aggregate “favorable” ratings moved from 54.5% (“very favorable” 31.8%, “somewhat favorable” 22.7%) to 76% (“very favorable” 35%, “somewhat favorable” 41%) with the largest gains coming from those that previously characterized the relationship as “neutral.” During that same time period, when asked about their optimism in working with ABIM in the future, aggregate “optimistic” ratings moved from 63% to 66% – but, importantly, the percentage that are “pessimistic” fell from 14% to 3%. Similarly, when asked about the direction the relationship is heading, 36% (2019) to 38% (2020) believe the relationship is “improving”, while those who believe it is worsening decreased from 9% in 2019 to 3% in 2020. These are not scientific studies, but we are pleased with the trend we are seeing.


Scalability is dependent on the ability of an organization to have designated staff focus a bulk of their time to managing relationships of external stakeholders and collaborators. In addition, rebuilding trust with stakeholders is enhanced by having an organizational culture committed to co-creation. That culture includes trust in the designated team from senior management and other management teams. Scalability is also dependent on finding individuals with the requisite communication and relationship-building skills.