Prepared for: ACGME Executive Committee

Transcription

1 March 2007 Governance Reorganization Prepared for: ACGME Executive David J. Nygren, PhD

2 ACGME Current Governance Structure Board of Medical Hospital Medical of Medical Colleges Medical Specialty Societies ACGME Board of Directors Membership Four directors from each member organization Two resident physician directors Three public directors One appointed federal observer One Review Chairs Review Chairs Review (RRC) Review Residents Executive Finance Board Nominating (Ad hoc) Institutional Review (IRC) on Strategic Initiatives on Program Requirements Monitoring on Learning Environment Bylaws and Policies Awards Data Sharing International Accreditation

3 ACGME Current Governance Structure Review Note Each RC is charged with developing program requirements for their discipline and reviewing all programs in their discipline - ACGME reviews all programs except those conducted by the osteopathic community ACGME approves all program requirements The accreditation actions made by the RC are subject to ACGME action only if appealed At least every five years, ACGME's Monitoring reviews each RC and ensures that they are in compliance with policies and procedures All data collection is done via ACGME Review Chairs Review 1. Allergy and Immunology 2. Anaesthesiology 3. Colon and Rectal Surgery 4. Dermatology 5. Emergency Medicine 6. Family Medicine 7. Internal Medicine 8. Medical Genetics 9. Neurological Surgery 10. Neurology 11. Nuclear Medicine 12. Obstetrics and Gynecology 13. Ophthalmology 14. Orthopaedic Surgery Review Residents Review RRC Membership The RRCs are composed of individuals identified and nominated by the following: AMA Relevant specialty certifying board Relevant specialty society 15. Otolaryngology 16. Pathology - Anatomical and Clinical 17. Pediatrics 18. Physical Medicine and Rehabilitation 19. Plastic Surgery 20. Preventive Medicine 21. Psychiatry 22. Radiology - Diagnostic 23. Radiation Oncology 24. Surgery 25. Thoracic Surgery 26. Urology 27. Transitional Year

4 Conceptual Model A Board of Directors Advisory Councils Governing Review/Monitoring Operating/Management Mercer Delta Consulting 4

5 Conceptual Model A: Pros/Cons Characteristics of Model A Independent governing Board that is self-perpetuating; no ties to the original nominating organizations or Members Fiduciary responsibility is to the ACGME Board with reserved rights to the Board Pros Board of Directors has full oversight of all aspects of the organization: strategic, political, financial, operational, review, etc. Simplifies structure of governance Allows independence of ACGME without conflicts of interest among sponsors Cons Multiple committees would still be under the Board of Directors purview; could be unwieldy and complex Does not fully leverage the capabilities of the member organizations Mercer Delta Consulting 5

6 Conceptual Model B Board of Directors Board of Overseers Medical Specialty Societies of Medical Colleges Medical Board of Medical Level 1 Level 2 Level 3 Advisory Councils Governing Review/Monitoring Hospital Operating/Management Mercer Delta Consulting 6

7 Conceptual Model B: Pros/Cons Characteristics of Model B Independent governing Board that is self-perpetuating; no ties to the original nominating organizations Fiduciary responsibility is to the ACGME Board of Directors Board of Overseers/Trustees has no voting rights; constituted by member organizations and the public; act as an advisory body to the Board of Directors Pros Creates various levels of engagement at the Board level, allowing individuals to contribute according to their level of expertise and desired degree of involvement (Level 1, 2, or 3) Enables core support functions of the organization via Operational Cons Multiple committees would still be under the Board of Directors purview; however, is managed by distinguishing level of authority/power, roles/responsibilities, duties, etc. Staffing of Overseers will be required Potential conflict with Overseers and Board of Directors but authority and responsibility can be made very clear Mercer Delta Consulting 7

8 Conceptual Model C Board of Directors Medical Specialty Societies of Medical Colleges Medical Board of Medical Level 1 Level 2 Level 3 Advisory Councils Governing Review/Monitoring Hospital Operating/Management Mercer Delta Consulting 8

9 Conceptual Model C: Pros/Cons Characteristics of Model C Independent governing Board that is self-perpetuating; no ties to the original nominating organizations Fiduciary responsibility is to the ACGME Board of Directors with delegated authority to management Pros Creates various levels of engagement at the Board level, allowing individuals to contribute according to their level of expertise and desired degree of involvement (Level 1, 2, or 3) Enables core support functions of the organization via Operational Leverages the capabilities of the five member organizations via Advisory Councils; have some voting rights Cons Could be difficult to manage how the Advisory Councils will be established and constituted to ensure adequate representation, equal voting rights, etc. Requires strong management and staffing of Advisory functions Mercer Delta Consulting 9

10 Conceptual Model D Nominating & Governance Audit Board of Directors Review Chairs Review Residents Compensation Review (RRC) Member Organizations Board of Medical of Medical Colleges Hospital Medical Medical Specialty Societies Policy and Strategy Approval Advisory and Reserve Powers Mercer Delta Consulting 10

11 Conceptual Model D: Pros/Cons Characteristics of Model D Independent governing Board that is self-perpetuating; no ties to the original nominating organizations Fiduciary responsibility is to the ACGME -driven governance model Pros Key committees are responsible for policy-setting and strategic oversight Leverages the capabilities of the five member organizations via Review ; has advisory and reserve powers Strong sponsor engagement with potential to add more Cons May be difficult for the Board of Directors to manage the 27 plus review committees Mercer Delta Consulting 11