Strategic Planning (Concurrent Session)-Strategic Planning

Strategic Planning

Video Transcription

OK, good morning, and welcome to concurrent session number four on strategic planning. My name is Matthew Gertzog. I'm deputy executive director at the American Society  of Hematology. Today I have the honor of moderating a session which will feature two presentations on a topic that some of us hate to love, some of us love to hate,  strategic planning. Now this year, CMSS received a number of proposals from our members about strategic planning. And that's really hardly a surprise,  given that most of our societies engage in some sort of strategic planning. We may use different descriptors, such as visioning, scenario planning,  establishing strategic pillars or priorities. We may use different time frames. Some of us look in the shorter term. Some of us may be establishing longer-term, long-time horizons.  And we may be tapping a mosaic of different resources and stakeholders, both internal to our organization and externally as well.  Today you'll have an opportunity to hear two perspectives on strategic planning. The first presentation is called A Self-Managed Approach  to Strategic Plan Development and Implementation. And our two presenters will be from the American Society of Anesthesiologists, Paul Pomerantz and Brian Riley.  Their presentation will focus on the concept of self-developed strategic plans. And in just a moment, I'll invite Paul and Brian to explain more about that concept.  Second presentation is called Member Engagement in Strategic Transformation. The co-presenters will be Tracy Siraco, Associate Executive  Director at the American Academy of Physical Medicine and Rehabilitation, and Megan Bruner at the same organization. Their presentations will focus on ways  to use market research and member engagement as a tool to inform a society's strategic planning process. We'll also offer an overview of tools that help members share and feel more  invested in the outcome of the strategic planning process. I'd like to take a moment now just to introduce our four panelists.  Paul Pomerantz, FACHE and FASAE, is the Chief Executive Officer at the American Society of Anesthesiologists. In this role, Paul is responsible for executing  the many programs of the ASA as directed by its board. Prior to this role, he served as CEO of the Drug Information Association. The American Society of Plastic Surgeons,  Society of Interventional Radiology, and Clinical Laboratory Management Association. Paul is a frequent speaker and writer on various topics, including association and health care  leadership, governance, and strategy. He holds a master's of MBA specializing in health administration from Temple University,  and as I mentioned, is a fellow of both the ACHE and the ASAE. He's also the outgoing treasurer of CMSS. Ryan Riley, CAE, is the Chief Operating Officer  at the American Society of Anesthesiologists. And in that role, he oversees the day-to-day executive management of ASA's operations division, which  includes the society's education, meetings, component, and inter-society relations, governance, and publications department. He is also Paul's successor and will  be the new CEO of the ASA. Prior to joining ASA, Ryan was Chief Digital Officer at Crane Communications in Detroit. He received his BA in English from the University  of Notre Dame in Indiana, and holds an MBA in Finance and Organizational Behavior from Northwestern University in Evanston, Illinois.  Tracy, at the far end, is Associate Executive Director, Specialty Engagement and Market Development at the American Academy of Physical Medicine  and Rehabilitation, and has a passion, as you'll hear, for guiding transformation and innovation in a mission-driven organization amidst dynamic health care challenges.  She leads multidisciplinary teams that deliver results with emphasis on understanding member needs and driving member value.  Her 20-plus year career extends across strategic planning, governance, facilitation, market and brand strategy, membership, and Tracy has an MBA  from the Kellogg School of Management at Northwestern, where she also received her BA in Political Science and International Studies. And as we heard earlier this morning,  Tracy will be joining the 2023-2024 Board of Directors for CMSS. Last, but certainly not least, Megan Bruner, MBA, is Director of Engagement, also at the AAPMR,  and leads its membership and strategic engagement efforts. Megan completed her Bachelor of Science degree at the University of Illinois Geist School of Business,  and her Master's from North Park University, focused on nonprofit management and operations management. What we'll do now is we'll have a presentation  from Paul and Brian, and then we'll shift to our colleagues at the end of the table. And at the conclusion of both of these presentations,  we'll have an opportunity for engagement questions and further insights. So with that, I'll hand things over to you.  Paul. Do I need to hit this? Yeah. Okay, thanks everybody for being here. It's a great audience, well, half the audience, but still great. And the reason we're doing this is,  for us, strategic planning is still a work in process. It's still, we're learning how to do it, we're learning how to do it right. But I think we've gotten to a good point,  and I wanted to share, Brian and I wanted to share what we've learned so far and where we're heading on our journey to strategic planning.  The challenge is that a lot of strategic planning techniques are difficult to apply in associations. You really have to adopt to the culture, and you have to adopt to the way,  really the politics of an association. And when I came in to ASA about 10 years ago, we had a strategic plan that was totally meaningless.  It was not followed, it really had no relevance. And so over time, we've really developed something that I think works, but we know is a foundation for the next step.  So we're going to share this journey that we're on. And while I'm still CEO, I'll do some talking, but Brian, as COO, will advance slides. Yes.  That's how we divide the work at ASA. That's why we're so effective. But at any rate, no real disclosures. I will be a consultant, effective January 1, and I do have business cards.  Next slide.  So today we're going to talk about a number of things. We're going to learn the pros and cons of doing it on your own, and try to answer the question  whether a medical society can do it on their own without consultant help. We're going to talk about challenges and some of the solutions to the strategic planning process  that we've discovered, and how we've done it, and how we can develop it and implement it through very tight member and staff collaboration.  But before we get started with the discussion, let's get the group centered on a few questions. First of all, does your organization, show of hands, like Horschak there,  and the last question is going to be, and don't answer now, who knows where this GIF is from? But the first question is, does your organization do strategic planning?  So show of hands.  All right. Everybody, it looks like. Very good. How many of you do it internally with no consultative help?  About a third, maybe, here in the room. Great. How many use consultants to help the process?  Great. And then, no matter how you do it, how many of you are satisfied with the process or the results?  Good.  Very good. Not everybody, but many. And then finally, does anybody know where this GIF is from? All right. That's very good, very good. It's a good group. Yep.  So a little bit about ASA. We're 120 some years old, roughly my age, and we have 57,000 members. We're really the preeminent organization globally,  and certainly in the US, as it relates to anesthesiology. We've organized, here you see our, basically the framework for our plan, and you'll see how that was developed in a bit,  but really focuses, you know, the mission, vision, sometimes are a little broad, but what we're really focused on is our strategic pillars,  which we didn't have when we first started this process, and those pillars establish the domains in which we do our planning around. So those are advocacy, educational resources,  member engagement, leadership, patient safety, quality and practice advancement, research and scientific discovery, and stewardship of the society and the specialty,  which really deals with the interrelationships, as well as the financial management and organizational management of the organization.  Next slide.  As organizations, we do strategic planning for a variety of reasons. It provides focus and direction to the organization, aligns key stakeholders,  both inside and outside the organization, helps the organization adapt to the broader environment, to changes,  and it really, it helps us establish our annual work plan, the budget. You know, we use it, everything cascades from the strategic plan to the budget,  and even organizational and individual goals. But, you know, one thing that I love about a good strategic plan, it's also a way of saying no. When properly done, it becomes a filter  for all the great ideas that come up, and really, it's a way to kind of say, well, that's great, let's think about that as we move forward with the next plan.  One challenge, of course, we always have is the urgent that creeps in during the current year, and you'll have to assess, is the urgent, you know, whether it's a legislative issue  or just an unforeseen black swan event, whether that, how that gets dealt with in the context of the strategic plan. I do wanna tell you a little bit about our governance structure.  Usually, when I talk about it, people recoil in horror. I'm gonna do the best I can. So, we have a four-layered governing structure,  and one of the reasons I do share this with people, it puts them at comfort about their own governing structures.  We have a House of Delegates, and we have a, which has 300,  350 delegates and alternates, so that's 700 people. We hold our House of Delegates meetings in the Los Angeles Coliseum. Just kidding. But, you know, it's a big group.  And our Board of Directors is also a representative body, which consists of one director for each state, plus alternates, plus other components, so roughly about 70 people,  and their alternates. So, it's a big group. So, you say, how do you manage through all this? So, maybe we could go to the next slide.  Right there. So, really, the primary bodies that we're concerned with for this are what we call our Administrative Council, and that's 12 people. That's our elected officers.  They cover a variety of roles, but for the most part, they function like a board. They really direct the work of the society. And we look at the Board of Directors,  which does have many responsibilities, but really serves more and more as an advisory group.  It's a pool of thought to inform our strategic plan, to guide us, to react to things. And they, in turn, get a lot of input from their states and from the House of Delegates.  But the real work is done by the Administrative Council. And so, what I like to think, that even though we look weird, as in this slide, we're really not all that much weird  because our work is being done by essentially a 12-body group working with staff. And then using these larger bodies as really advisory groups to the process.  Now, before 2017, we used external consultants.  Some years, we brought in groups to help us with scenario planning and very deep research, expert consultation. And no matter what we did,  the strategic plan looked the same from year to year. We spent a lot of money, but when we brought the leaders together to really get into the planning process,  the urgent took over. And so, not what was important, not what was in the future, not even a balanced perspective towards our programs and initiatives.  It really was a result of solving the problems that were most immediately on the members' minds. So, it was expensive. We saw really the same result from cycle to cycle.  Had little meaning to it. The dissatisfaction couldn't translate it in a way that was meaningful for our component societies, our other stakeholders, and our staff.  So, the plan was delivered and really the urgent then took over. So, in 2017, we decided to do it differently. We said, no to consultants.  There was an easy savings there of $100,000. And we tried to figure out how we could do this ourselves. So, we developed, and Brian does have a passion for these old TV shows.  I'm a little bit more modern than he is. But anyway, we developed a three-year cycle. And the way the three-year cycle works is that the initial year is a rewrite.  That's the year we take a deep dive and do kind of that SWOT analysis, environmental scan. Brian will describe the process in more detail. And then, in the subsequent years,  we kind of go in and see what are the elements that need to be refreshed. And we do look at changes in the environment. We look at the impact of member surveys, member research.  We look at the input coming from our committees and house. And we actually use our board quite a bit to help generate what are the key issues that we need to confront.  So, next slide. So, this really describes the two pathways, the rewrite, which is really a comprehensive dive with a landscape analysis and development  of strategic initiatives of tactics. And then, the refresh. One of the core factors of our strategic plan is the pillar teams. So, you heard before the six or seven pillars  that I described, advocacy, education, member engagement. So, for each of those, a team of member officers and staff  get together, work on those pillars, look at the, again, kind of do their landscape analysis, look at what the current strategies are,  look at what's happening in the marketplace, and adopt and develop those. And then, those updated pillar strategies and tactics  are presented to our administrative council and further developed from there. So, I'm gonna turn it to Brian to really describe the process in more detail. Sure, thanks, Paul.  So, in the original, because we made some tweaks to it that we'll talk about in a little bit, the original timeline for this process had staff beginning in January  to lead the research and the landscape analysis, the development of a SWOT and other resources, the member surveys and that sort of thing, assembling all that data and providing it  then over the course of March, April, and May to the pillar teams. And those pillar teams, which included, as Paul said, members and staff, would develop the strategic pillars,  the initiatives, the tactical statements, and the tactics.  And so, it was a lot of work. This was done primarily by phone calls, by Zooms, a lot of emails back and forth. And then, we would get to our summer AC meeting,  and the AC would then approve the strategic plan. Sometimes, because of the volume of work involved, that work bled into July a little bit. We always needed to get it done by August  because we wanted to present the plan to the board of directors at its August meeting. And then, in refresh years, we would just not do that first step, but really catch up in March  with the reform of the pillar teams and do sort of an informal sense check on what's happening in the market, what needs to be adjusted,  and then make those adjustments across the board in the strategic plan. Again, same cycle for approval. AC approves it in June, hopefully,  and then the board accepts the strategic plan in August. So, the way we structure the document is that there's a strategic pillar, and you see on the right here  an example of our advocacy strategic pillar from our 2022 strategic plan, which was still done under the old methodology.  A strategic pillar. Each strategic pillar has one or multiple strategic initiatives. Those strategic initiatives are supported by tactical statements and tactics.  And so, very detailed, a lot of stuff to talk about, and a lot of work to be done to get this sort of a document fleshed out in a few months.  So, the process that we developed, even though it was an improvement from what came before, was still not ideal. It was still very much in the weeds.  Members were spending a lot of time at the tactical level. And our members like to solve problems, right? They like to take a deep dive into the tactics.  They're less comfortable at the high strategic level. So, as a result, it was hard to get strategy from them. We would just focus on a lot of priorities and be,  still, we had the pillars, but we still had long lists of things. So, the other thing is with these, the plan, the way it was framed with all these tactics  meant that when we shared it, all stakeholders, including competitors, would have a fair amount of detail about our plans. So, it wasn't focused and it wasn't confidential.  So, we made some adjustments. Yep, in 2023, in 2022, for the 2023 plan, we decided to split the document into two and come up with a strategic plan and an operational plan.  And it seems like common sense, but we had been putting everything into one document because we felt, initially, that we wanted to account for everything in the strategic plan.  We realized that was sort of a tactical and procedural mistake.  We asked the AC members to focus only on the strategic level. So, the strategic pillars and the strategic initiatives.  So, those tactical statements and those tactics themselves were not really on the table for the AC to consider.  We asked the staff to take the lead on developing the tactics for what we now call the operational plan.  So the result was a single-page strategic plan down from about four or five pages. It was very easy to consume.  We felt comfortable sharing it because it didn't dive deep into the details of our confidential tactics.  It also provided us with the operational plan that, as Paul mentioned earlier, we use for our annual work planning, our budgeting, and goal-setting, and I'll show you an example  of the operational plan in a bit. We still had more work to do, so this year for the 2024 plan, we continued to make changes  to the process, and what we wanted to do was involve the board more in the process. They are a resource. They are in every state.  They're seeing the issues in front of the specialty, but we hadn't been tapping their expertise in the previous process, so we developed a way to do that.  Our president, Dr. Champeau, impaneled an ad hoc committee on board strategy sessions to help us focus board discussions on the key issues of the day, and that really has  done wonders for us because now our board spends a lot of time during its March meeting  focusing on very important strategic issues, and they've been really enthusiastic in embracing this change in process.  Our previous March board meetings have been relatively unidirectional where we would provide them with information, and there wasn't a lot of chance for interaction.  Now there are huge opportunities for them to interact with each other, interact with staff, and really have a say in the very important strategic issues facing the specialty.  So from a procedural standpoint, this is how we adjusted it. So this is comparing the top row is the original rewrite cycle that we discussed before, so  I'll direct your attention to the bottom row. We have now, starting in December, so next month during the December AC meeting, in preparation  for our 2025 strategic planning cycle, our administrative council will have what we call a strategic generative discussion.  We're going to ask them a series of questions about what they're seeing in their local marketplace,  in their state, at the federal level, what trends they think we need to be aware of. They're going to also be given a reminder on what our most recent member surveys have  shown, and then we're going to talk about things we learned here and in other association  forums that medical specialty societies writ large are facing, and we'll include that insight into our discussion about how ASA needs to move forward.  So we'll have that discussion, we'll take very careful notes, we'll bring that information to our ad hoc committee on board strategy sessions, and we'll develop a plan for the  March board meeting that will include interactive sessions, so small group discussions or large  interactive sessions using, you know, digital voting technology to enlist their support and their insight into the process.  We'll have those discussions at the March meeting, so usually our March, the whole afternoon of the March board meeting will be spent on strategy sessions.  One thing on strategy sessions I want to make a note on for everybody, you have to be very thoughtful about how you set up the surveys, the questionnaires, and the data capture.  In our first meeting, we had a lot of very high-level, open-ended questions, and each of the groups, we had 10 individual groups of board members talking about all of the  same issues. They broke up into groups, and they had a scribe, and they provided us back with the information from their group. That was extremely difficult for us to collate.  So in our next iteration, we're going to have more closed-ended questions, a single document using shared documents to capture all the data in one place so that we don't have the  sort of the content management issue that we did from the first go-around, but it's a learning process. We took the output from our March board meeting.  We did a very thorough review of it, including some frequency analysis on the types of themes  that were coming up, and so we collated all of that information, and then the ad hoc committee on board strategy sessions, our members are very comfortable in research environments.  They did follow-up surveys with the board. They did Z-score analyses to identify the most important topics, and it was really quite  impressive how they took the data and distilled it into really important strategic issues.  We used that board input for our AC member pillar team discussions to develop the strategic initiatives and also confirm our strategic pillars, and we actually made a change to  our strategic pillars and many changes to our strategic initiatives based on the board input. So we developed the plan. The AC approved the plan, the strategic plan, in June.  The staff, during the month of July, created the tactics for the operational plan. In August, the AC approved the operational plan, and the board accepted.  They don't really approve it. They accept the strategic plan. So a much better process in many ways. There are some cons to it. Here is what is now our strategic plan in our format.  So it's a single page. It includes just very high-level strategic statements that are associated with each strategic pillar.  And so here is the first page of our strategic and operational plan, which it correlates to the strategic plan.  Those pillars are the same, the strategic initiatives are the same, but the tactics are included here.  And what we do with this is we assign, we actually do a RACI for every single tactic in the plan, and there is a senior team member responsible for the accomplishment, and those  are used to form the basis of their work plans for the year and also their individual goals for the year.  So it's a very useful tool, and there is a lot of accountability built into the process. So coming down the homestretch here, but over the years that we have developed this and  improved on it, clearly we brought order out of chaos, and it does direct and inform the group.  You see the pros on the left-hand side, just an easier-to-consume plan that the members buy into, we're able to use it to really direct the work of the organization.  But the cons are it's a lot of staff and member work, but the biggest con is it's still incremental.  We're still building on our current foundation, and I'm really not looking at the future. So as we go forward, we'll be looking at, we're going to be looking at additional changes  to the process long-term. And best practices in strategic planning really require a look at the destination, where you're going and how you're going to get there.  But I think with the foundation that we built, we're now ready for that next stage. So looking to the future, we're looking to develop a capacity to create a destination-driven  strategic plan that can focus on the future for the specialty and then build towards it. And we still have the foundational plan, which is we'll still continue to direct our  annual operational planning. So why don't I stop there, maybe turn it to the next panel, and then we'll go from there. Thank you. Thank you both for that great presentation.  Megan and I are going to go ahead and talk a little bit about member engagement in strategic planning.  And so a couple of things that we wanted to emphasize in this presentation.  We have no disclosures. But really, some of the objectives that we wanted to focus on are how we used market  research to engage members significantly in the process and how we also focused on transparency in the ongoing strategic planning process.  So we'll take you through one of our processes a number of years ago and then our most recent strategic planning process where we've engaged members in many different ways.  And then we also want to look at the pathways that we've built more community through these types of changes in engagement.  So to set the stage, around 2015-2016, our Board of Governors, and even years prior to that, we're looking at the changes in the evolving healthcare landscape that we've all  been looking at for years and really looking at healthcare transformation. So how are we going to support our members through the transformation from fee-for-service  to value-based care? And a clear need was identified by our board, really, that if the specialty is going to  be well-positioned in the future, that the academy would really need to take a leadership  position to help actively prepare our members. This led to a complete reimagining of the overall strategic planning process.  So in the typical process the academy had used, as was mentioned before, we would use market research. We would do some surveying. We would do some focus group information.  It would take a few months. There would be a retreat with the board very focused on confirming and achieving the vision for the academy and those supportive strategic goals.  We would get input from our committee structure, particularly focused on the strategies that would support the goals, and then the staff would help support with the tactics.  And we would share that with the membership, and that communication would come from our leadership.  In the focus that we had around 2016 and 17, there was an active effort to look at how we could engage members even more in this process.  So there was a significant decision that our board made to really invest in extensive market research efforts beyond the traditional means.  And we'll go into a little bit of those tactics in a later slide, but it was multi-channel  opportunity over the course of seven months, a pretty extensive effort to really focus with the objective, not just being getting their, to get their input, because you can  do that with surveys. You can be statistically significant. You can be relatively certain that you're going to get the information you need about member needs.  But we went above and beyond that with intentionality to really show the members that we were actively  involving them in the process and for it to be them seeing themselves as having a hand in where the organization and where the specialty was headed.  We concluded that with a retreat where we had not just our board, but we had 50 plus stakeholders who we discovered along that journey, some who had been actively involved  in the academy in the past, some who had not been involved at all in the academy, but were  doing innovative and new things for the specialty that were of interest to us as we were looking at the future opportunities.  And they played a role in developing a vision for the specialty. So the key thing here is that the academy was working on developing a vision for the  specialty, and we'll explain that a little bit more, not just a vision for the organization, but a vision for the entire field itself.  In strategic planning with the board, the board then did adopt the vision for the specialty as a vision for the academy, something that the academy would support.  And we've continually updated that process with volunteer leaders and membership throughout over the years, as we'll explain a little bit more.  So I won't go deep into these slides, but to say that the direction was absolutely set by our board of governors and Tom Stotzenbach, our executive director and CEO, hiding in  the back back there. And the initiative was led by us as staff, and it was a cross-functional effort. So it wasn't just one or two staff.  We took a lot of different staff members across the organization to partner with our committee leaders, to partner with our board, and drive this forward.  And we didn't have a playbook on this. We looked at research, we talked to organizations, we asked around.  We found maybe one or two that had done this because it was looking at a vision for the  specialty, not just a vision for the organization, and not just asking the questions on how we can meet your needs now, but how we can anticipate things in the future.  So it took a significant effort. We had help from Paul Meyer at Tecker International to help us think that through and really imagine  what this would look like and sort of pave the way and create the playbook as we went. So the core question that our board set in front of us was, could we create a compelling  vision for the specialty to thrive in the future? And this was a could we. We have a very diverse specialty.  We thought we could, but we needed to really affirm that of where the specialty would be going. We had an affirmative yes. We came up with a vision.  And when we were looking at research questions to ask the membership, I agree with the other  speakers, it is a big challenge because you start off asking these very open-ended questions. We couldn't get to complete closed-ended, but we learned along the way how to ask the  questions in such a way that when you're talking about the future and you're talking to physicians, you're talking about the changes, you start a lot about the first bullet here,  the pain points, the challenges. You could spend hours and hours on that. So we had to figure out ways to shift the conversation to first start off with that  opportunity to kind of talk about those pain points and those current challenges and then really move to where the opportunities are for the specialty to shine, to thrive, to  align with the core values of where healthcare was headed. Fortunately for us in working with PM&R physicians, there were a lot of those opportunities and  we could shift the conversation to brainstorming new ways that the specialty could be practicing  in the future that would help them feel satisfied and really delighted to be working in their specialty that would align with where healthcare was headed.  So we kind of went through the process asking these core questions in a variety of ways. So this slide gives you a sense of some of the different things that we did in the process.  Our membership is around 10,000 members. We had the participation of thousands of physiatrists in the process, which was a big deal for us  and not just from having, you know, 25% of our members answer a survey. It was actively involved in a lot of different ways with thousands more providing input or  reading the materials that we had provided for them. One of the first things we did was virtual town halls. This was back in 2016 and leading into 2017.  At the time, virtual town halls were novel. Now with Zoom, that's not the case anymore. But at the time, that wasn't something that we were regularly doing.  So we were spinning up Zoom calls with five staff in a room, very nervous about handling a Zoom call, trying to figure that out with our members.  And we actively went out to about 16 different member segments. It wasn't, you didn't have to qualify for it, but we did it by our different councils  that we had at the time and communities and actively asked them some of the key questions that we discussed on the prior slide, but also got them engaged in thinking about the  future opportunities for the specialty. We did the standard market research of doing focus groups and surveys.  We also did a roadshow where over the course of a number of months, we went across the country coast to coast.  We identified the largest populations of physiatrists and we did events in those cities.  It was a networking opportunity, which they all appreciated, but it also was active engagement. So there were tasks for them to be doing and giving us input.  We had a board host for each of those sessions to participate in the process. And then before we had the food and drink portion, we had focus groups on site with  physiatrists involved at round table discussions to kind of tell us about their pain points and where they saw those different opportunities.  We visited sites across the country with members taking time out to speak with us one-on-one and capture where they saw the future opportunities.  We did in-depth interviews and a lot of other, I would say, more fun member engagement opportunities  with video and kind of presenting this initiative in a very different way, because as I said in a prior slide, a big part of this, yes, we wanted the member input.  We absolutely did. We didn't have to go to this length, though, to get confidence in the input that we were getting.  What we also wanted them to see was that the academy was doing something different on their behalf to help them thrive in the future of health care.  So I'm going to turn it over to Megan to talk a little bit more about after we did the visioning  process for the specialty, kind of where we took that on to operationalize it a little bit more within our structures, and then how we've been carrying that forward as we've  relooked at our strategic plan and how we want to engage members in that process. Thanks, Tracy. All right, so she mentioned to the left on our visioning PM&R bold, that was getting  to the vision and the board accepting that and adopting it as part of their own vision and mission. The right side here is advancing PM&R bold.  We actually shifted the branding slightly, and we started talking about, okay, the academy is taking this on. What does that mean structurally?  What do we need to do to support this?  How do we communicate? And then the engagement side. So on the advancing PM&R bold, some of our key outcomes, we went through a process of  a vision was about three sentences at the start. So what does that mean in reality for our practice areas, our physiatrists practicing in different ways?  We went into five practice areas and did a process with think tanks of developing an envisioned future.  If this vision happens for the specialty, what does that look like in your practice area? How is your practice different?  What has fundamentally changed if this vision becomes a reality? And that process created a three paragraph envisioned future statements.  And the second half of these think tanks was great. What needs to change to get there, to make that a reality? What needs to change to get there?  And what structures do we need to create to support that? With those envisioned futures and strategic plans, which happened over time, we released  two at first and then support for those, an additional two the year following and a fifth the year after that, I believe.  So it wasn't all, we didn't come out all at once, but we were announcing along the way as those were created.  We created a steering committee specifically for governance in this area. they were charged with advancing those strategic plans, understanding them.  They are very cross-functional plans. They cover regulatory, advocacy, awareness, understanding lots of educational needs, continuing  medical education, graduate medical education, the whole gamut. So ensuring that they're working with the board and our strategic coordinating committees  that have their additional priorities as well to ensure alignment throughout.  And then we're launching the engagement opportunities with members around this healthcare transformation to provide value to them, to bring them along this journey.  For us, that looked like practice symposia at first at our annual meeting, learning collaboratives  to bring people together and kind of have some case studies and mini reports of what this looks like in their practice, finding ways to share those stories, creating areas  for forum discussions to happen, manuscripts to honestly back up a little bit and build the case for why this is needed also for those that don't quite understand where we're headed  with this or are trying to understand it in different ways. And then looking at how we can feature members that are really practicing now in these future forward ways.  So even right now, we're rolling out new podcasts, new award structures to really be able to highlight those innovations across the specialty.  And then we were continuing to survey focus groups, obviously, throughout to ensure that continued alignment, and we were pleased to see that there is still that alignment six  years later. So as we move to what we just recently did, as mentioned, we revalidated this just in the last year.  We did go through a more traditional market research process this time, but we did redesign the questioning to focus on their needs, but also gauge their support for specific  outcomes from the last strategic planning session. The changes we've made, the new barriers that we're addressing, do they support our time  and energy focused on these forward looking efforts? Just to ensure that that is something that they're going to continue to support.  And so that market research effort did validate that support for those efforts. And so throughout their 2023 strategic planning, we decided to put a very intentional focus  on increasing transparency of that process. So we created a dedicated social media strategy throughout, which was new.  There's a lot here, but our focus was to increase trust in this process, something that I think we can all struggle with to some extent.  Peer leadership, showcasing that peer leadership. These are your peers that are in the room. You know the names of some of these people.  You are working with them, kind of understanding who's making these decisions. And the transparency there was important, as well as making the direct connect from  you provided this input. You just saw the request for this market research, participated in it potentially.  It's directly being used in these conversations and making sure that that was reinforced throughout. So as far as the social media side, we did this with five types of posts.  We had pre-event posts. This is happening.  This is coming up. Very public discussion of what they would be discussing, that when they were meeting,  how that was going to go, and thinking ahead of time for the input that was received. And just centering that from the get-go.  On Twitter, LinkedIn, and Facebook, sorry, ex-LinkedIn and Facebook, we were doing start and end of day posts.  So more summaries, more welcomes, but we were not going into the nitty gritty on those platforms.  We kept that for Instagram stories for this round to test it, to see what the reaction would be and the conversation that we could generate.  And we did a mix of pre-planned, highlighting commitments, similar to what we learned in the roadshow and the focus groups and the discussions.  We had to address some of their top concerns and barriers or to allow them to be invested in the discussions about the opportunities.  So ensuring that we were commenting on regulatory commitments that we had or physician burden commitments that we had. We put those up front. These are happening.  These discussions are happening and discussing those. And we knew we'd want to do that ahead of time.  We found just the right time to work them in when we were sharing from the meeting. And then we supplemented those with micro interviews, one to two minutes with our leadership  that was gathered to share those real-time insights. Those questions were focused primarily on what was their experience there? What were they hearing?  What surprised them in the discussions of strategic planning? What excited them and what themes they were hearing, to be able to share those directly from their words in real-time.  And then the wrap-up stories and next steps to make that transparent as well. So those are all part of the process there and shared still as a highlight in our reel.  So they're still all accessible. But it was a great way to share that transparency. These key learnings really cover both sets of processes. The variety of engagement opportunities.  There's an individual out there that I'm sure would have seen themselves in a virtual town hall. We would have been in their city. We would have visited their institution.  We would have asked them questions at our annual meeting. They could have engaged with us 15 times, but one stuck out to them. It was the right time for them.  It was the right opportunity for them. So having those multiple ways of engagement was very critical throughout.  We've spoken to this, but repeatedly addressing the boulders that the members felt were in the way of the vision or just their day-to-day practice, letting them get that out first  and making sure we're always addressing that first, kind of brought down their guard to want to engage in this more.  And building the case or building understanding along the way about value-based care for those  that are not in the day-to-day changes or not considering that, not feeling it in their practice necessarily yet. Additionally, members really enjoyed the peek behind the curtain.  The reactions there were good. And really a great outcome for the academy was we have identified many new volunteers that are future-focused and that are now into this day engaged.  Some are ones that we met at a community gathering in Philadelphia that are now sitting on that steering committee today and are leading part of this plan.  So that evolution from non-engaged to a very committed leader at a high level has been really gratifying to see.  Thank you to our panelists. We now have about 10, 15 minutes for questions or queries on any of the items that were discussed.  I'm not sure if anyone wants to share anything that may be relevant to their own experiences in the context of our discussions today.  Yes. Good morning. Thank you. What a great couple of presentations, really informative, extremely helpful as we continue  to do our own strategic planning, self-approached strategic planning. I have just two questions if I could ask the panelists.  One is the initials, I'm thinking more Paul and Brian, but this actually applies for the whole panel.  When you look back historically, like those large strategic pillars, sometimes they don't really change significantly because healthcare is giving us some of the same challenges.  But when you rewrite, refine, refresh, how do you measure that you're moving the needle?  Are you able to identify year-over-year, three-year cycle process that you're actually moving the needle meaningfully?  Any thoughts in terms of how you set those metrics that tells you how you make that progress? I could start and maybe share, but some areas really lend themselves to more objective  measurement. Membership would be a key example or education, number of programs, number of people engaged. Are we having an impact? Other areas are really much more difficult.  Advocacy, it seems like the same issues are there, but the number of issues are growing. But a couple areas have really evolved over time. One would be the leadership one.  It started off as a focus on developing health system leaders. A key part of our thinking was we were observing many of our members moving into key positions  of influence, and that was our initial focus. And we saw that we were successful, but what we felt was we needed to start, and this was  the feedback, we needed to start earlier and make it a career-long effort. So we're able to look objectively because we're able to gather data on people who are  engaged in leadership development programs. We looked at where the programs are working and not working, but we took more of a career lifecycle approach.  So that changed from health systems leadership to leadership and professional development. Another one was on the, it used to be called like financial and operational excellence.  That was the last one, and Brian described that. And we realized, you know, that was really kind of operational. We're doing okay in that area.  But really where we're failing is in leading all the stakeholders in the organization. We're a very fragmented specialty and many kind of spinning off in their direction.  So that evolved as well, and while it's not, it's more qualitative type things we're looking at, but the amount of unity between our foundations and our subspecialty organizations.  So what would you? Yeah, I would add that only that our plan now, as Paul mentioned, is kind of incremental. It doesn't have that destination.  And so as we refine the process, and we made some changes for 2023, we're making more changes for 2024.  I think as we get into 2025, one of the things we may want to do is not just have that checklist of tactics that at the end of the year, do we check them all off?  Measuring the activity. We want to measure the outcomes. And so up front, we have to figure out what should these bundle of activities amount to? And we haven't done that.  So that's something we need to add to the process. Yeah, really helpful because, you know, as you talk about allocating resources, you want  to know what's working and what's not working, so you reallocate. So that was really helpful. If I could ask one other question. The other question is actually for AAPMNR.  I just want to congratulate you on what a great way to engage your members in this process. I saw from 2016 to 2019, a lot of time, a lot of resources, and then we had the pandemic.  And so you talked about how it still aligned when you kind of checked in and you were doing more services, but those are really disruptive two years.  And so after you put a lot of engagement in with your members and inputs, did you find significant impact and readjustments that you had to make without having to go back  and reinvest in that similar kind of process? Did the surveys really help you feel like you validated you were still on the right track? That's a great question.  Our board and Tom have talked about this a lot because during the pandemic, we checked in with our board members, and we're very grateful that we did it before the pandemic  because we really think it helped set us on a good course where we didn't have to make as many larger strategic changes because we were anticipating things about the future.  I think the other thing that it helped us to do is because we were creating a new pathway and sort of making something that didn't have a playbook, it allowed us to have a little  bit more nimbleness within the organizational culture to address some different and new opportunities and bring that through the organization, through the steering committee that  Megan had mentioned. We had a new steering committee that was helping to drive where the vision for the specialty was going.  It gave us an opportunity to bring that in, assess it quickly by our board, by the steering committee, and move forward faster as we went along. I think you mentioned the research.  We had no idea when we went back to our members if they would validate the direction that things were headed for the specialty, so that was assuring.  But it is still a constant challenge to sort of see that translate over into increased  membership, all those different kinds of things because this plan was really focused on the specialty, but we're also focused on the individual member.  That's what all of us have in terms of our organizations, but we hope that will continue to translate over to membership stability, increases, those kinds of things.  But that is an ongoing quest for the organization. Thank you. Thank you. Other questions? I have one I'd like to pose for the panel.  During the GLEAM discussion, there was a focus on the challenges associated with polarization,  polarization of our country, of our memberships, and concurrent with that, members wanting to see values reflected in the directions of their societies.  How have you been able, and at the same time, both of your groups talked about the importance  of engaging stakeholders, the desire to have more members involved, the desire to be more transparent.  Can you comment on how your groups are reconciling this, I believe, unfortunate trend of polarization with the goal of having a consensus-focused strategy or strategic pillars?  Well, I think, Matt, that the good news that we all face is that on many of, if not most, and close to all of the core issues facing the specialty for anesthesiologists, there's  widespread agreement. So it's on the edges where there is the opportunity to have those sorts of polarizing issues.  So up until now, our strategic plan has focused on those things that impact the specialty and the society with a focus on anesthesiology.  Now, it's absolutely true in anesthesiology, as it is probably for all of our memberships, that there's a growing desire to have more members involved.  There's a growing desire to embrace causes that are outside the core of the specialty. And we're wrestling with that. I think everybody is.  I don't think we've solved that problem yet. I would echo. I mean, the strategic plan was very focused on the specialty. And we have a very diverse specialty.  So we often have to focus on different views. But it's different views. And while sometimes they don't agree, it's not polarizing in the way of social issues  and those kinds of things. So I think that is a different process. And I think when you talk about social issues and those kinds of things, that's many other  sessions and other discussions that we've had here that I don't think we have time for.  Okay. Time for another question or so. If not, I'm going to have one more. Okay. I want to just ask one last question on the social media that Tracy and Megan referenced.  Social media is obviously a very strong communications tool. It can get information out. But sometimes it's being criticized as reaching certain markets.  How do you balance that in your communication strategy? That's a great question. For this process, for strategic planning, it was less about gathering voices that we  would be amplifying and more about sharing the outward communication versus collecting inward and amplifying. So we were able to do that. We were able to do that.  So we were able to control from that perspective and ensure that what we were sharing was across  both our board and our future leaders that were present and ensuring the diversity there of voices and opinions. Instagram stories was purposeful because the reactions are private.  They can send a reaction to you. But it's more difficult to share externally. And so that's why we piloted it there originally was to be able to control that a little bit.  If we had that discussion on X, for example, the replies could be much more public. And it could have taken a different course. So that was a risk assessment that we did.  And that's why we started the way that we did. Any other questions? Just another thought on the polarization issue.  I think that some of the issues facing the specialty, our specialties combined, are so daunting. That they really supersede political divisions.  And I'll use workforce as an example. And I think one of the things we're learning is that by reframing, you know, getting away  from the political division, but framing the issues from the context of the specialty, I think that makes a big difference.  And so in that context of workforce, you can address a lot of issues around diversity and equity and inclusion. And I think that's a big difference. I think that's a big difference.  But in the context of workforce, you can address a lot of issues around diversity and equity and inclusion in the specialty. Another one is around the environment.  That's another polarizing issue. But in the context of the specialty and the difference, A, not only the difference we  can make, but the changing regulatory framework, it's another issue we can address. Thanks, Paul. Yes, Sue. Hi.  You know, we often think about when we make changes like this, what changed. But then we also want to kind of reassure people what hasn't changed.  Is there anything about your messaging that you felt like you needed to sort of say this hasn't changed in the way you've delivered your plan to your members?  Well, I would say in our case, you know, it's our preeminent focus on as an organization  and standing up for our members and in advocacy. And putting that at the forefront, you see it's the very first thing. It starts with the letter A, which is why it's number one.  But really featuring that as a primary pillar is really reassuring to our members. Yeah. And I think that, as Mary identified, the pillars are slow to change.  And so there's a lot of stability within the plan because the challenges we face aren't going away. So we add things. We subtract things.  But the pillars have largely remained pretty stable over the last four or five years. I think one of the lessons that we learned in the process, we were focused very much  on the specialty. And we had an academy strategic plan as well. But in getting this out for the specialty, what we've been doing more in recent years  is really, you know, continuing to convey that message. But it is an individual member society. So saying, you know, this is what we're doing for the specialty, which is for you.  But also here are the things that we are regularly doing for you as an individual. And I would echo that advocacy focus. This is what we're fighting for.  This is what we're fighting against. You know, these are the things that we're doing for you as an individual while we also work on behalf of the specialty. Okay.  We're at the end of our session. I want to thank Paul and Brian and Megan and Tracy for sharing their wisdom and the stimulating discussions that ensued from your presentations.  And enjoy your break. That's the next part of our meeting. Great job moderating.

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