Policy Coordination
ABIM seeks input from sectors of the internal medicine community that will be affected by significant policy decisions, using surveys, social media and other means. This is part of ABIM’s larger effort to enable the community to set standards for itself; thousands of physicians have participated and their input has changed ABIM’s thinking about critical issues. Why does this build trustworthiness? This co-creation process builds trust through its transparent communications strategy and its respect for diplomates’ competency.
How It Works
ABIM policy coordination is the community engagement effort connected to all significant policy decisions made by ABIM in recent years. When a policy question arises, ABIM identifies what sectors of the community would be affected by the proposed change and invites them to tell us whether they would support the proposed new policy, to help us anticipate the downstream effects of said change, give them an opportunity to share anything they think ABIM should know about the issue, and to tell us what other individuals or groups may be stakeholders, thus expanding our policy coordination network. We utilize surveys, social media, and formal written communications to reach stakeholders.
The appropriate level(s) of physician-led ABIM governance weighs the community feedback as part of its decision process. Once a decision is made, ABIM shares back with stakeholders what was learned through the engagement efforts, how it influenced the decision-making, what was ultimately decided and why.
Some of the policies ABIM’s community has helped shape include:
• The procedural competencies required for initial ABIM certification, to better reflect today’s medicine
• Giving MOC points to program directors and key faculty in graduate medical education for their intrinsic role in helping to advance education and improve patient care within the profession
• Pursuing co-sponsorship in a new discipline (Neurocritical Care), ABIM’s 21st subspecialty certificate
Physicians can “speak” directly to ABIM about issues that affect them, and ABIM’s decision-making becomes more transparent. This feedback channel has been essential to demonstrating that physician input matters to our organization.
Skills and Competencies
Communicating clearly to all stakeholders – physician, healthcare sector, and public alike – about ABIM policy is critical to the success of our engagement efforts. Planning outreach also requires a carefully iterated development process to ensure that the feedback that is received is a fair representation of the views of the community. Feedback goes through content analysis to identify key themes and is impartially presented to decision-makers.
Origins
Policy coordination comes out of two overlapping chapters in ABIM’s recent history – the evolution of its governance structure, and physician backlash against changes to Maintenance of Certification in 2014-2015. ABIM created discipline-specific (ABIM Specialty Boards) and cross-disciplinary (ABIM Council) governance groups in 2013-2014, responsible for policy-making across the 22 internal medicine sub/specialties ABIM certifies. More importantly, Specialty Boards and the ABIM Council were composed of physicians, patients, public, and interprofessional health care team members representing the community of each discipline, to serve as a conduit between ABIM and the internal medicine community at large.
Physician backlash toward ABIM and its programs made unavoidable the image of ABIM as an out-of-touch, ivory-tower organization. As a result, ABIM made a strategic commitment to transform its relationship with the physicians it certifies through co-creation to become authentically the vehicle by which the communities set standards for their disciplines as opposed to being an organization that set standards for the disciplines. It was a “with them and through them” strategy as opposed to a “to them” paradigm. A fundamental part of that transformation has been incorporating physician input into the varied dimensions of our work.
Effectiveness
Since 2015, ABIM has invited 200,000+ physicians to comment on our policies and changes, and heard from thousands. We have collaborated with dozens of organization to seek the advice of their constituencies. Through MOC credit for program directors, ABIM has awarded millions of points to educators for quality improvement in patient care.
ABIM’s policy coordination has been singled out by the American Board of Medical Specialties as a ‘best practice’ to other certifying boards for how to proceed when vetting the community about sponsorship of a new discipline (Neurocritical Care).
What we hear from the community changes our own thinking. For example, the ABIM Cardiovascular Board was approached by the Society for Cardiovascular Angiography and Interventions (SCAI) requesting the elimination of procedure requirements for maintenance of the Interventional Cardiology certificate. Together with SCAI, we asked general cardiologists and interventional cardiologists to comment. Generally, physicians tend to favor fewer requirements; SCAI and ABIM felt confident we would hear the same. Instead, we learned that two-thirds of responding interventional cardiologists and 87% of responding general cardiologists said the requirement should continue. Those findings changed our minds and were validation that physicians do see a place for ABIM to set standards for physicians.
Scalability
Over the years, there has been a small inter-departmental team coordinating and executing most of the policy coordination efforts. ABIM is the largest certification board nationally, and so it does have technology and person resources that others may not. We believe there are parts of the process that any organization could customize to their needs.