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  President’s Desk Column

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Pathology without barriers

April 2002
Paul A. Raslavicus, MD

"Make no small plans" is a line attributed to Daniel H. Burnham, whose 1909 "Plan for Chicago" is said to have been our nation’s first comprehensive urban planning document. A famous architect, Burnham apprenticed under William Jenney, who designed some of the first skyscrapers. Jenney’s skyscrapers surely taught Burnham lessons about vision, perspective, and, perhaps most important, attitude.

Vision, perspective, and attitude came up often during the Board of Governors’ review and analysis of the CAP strategic plan. Beginning last November with a facilitated Board retreat on strategy and leadership, the Board has extensively discussed the strategic proposals developed by the Strategic Planning Committee that I chaired as your president-elect. By February the Board came to a collective vision for the College, one both dynamic and anchored in our shared mission.

The College is the leading organization for our specialty. We are also the leader in laboratory medicine standard-setting, performance measurement, laboratory accreditation, and the computer-encoded medical record. We are the most influential advocates for pathologists, patients, and the public on all that is related to pathology and laboratory medicine. Maintaining such preeminence is our vision, and to do so, we must evaluate the effectiveness of our structure and the value we create for our members and customers through our services and programs.

The CAP mission statement calls upon us to represent the interests of patients, pathologists, and the public by fostering excellence in the practice of pathology and laboratory medicine. We have agreed to undertake a number of strategies to that end:

  • We have made a baseline commitment to keep the wants of our customers foremost when we design our programs and develop our initiatives. We must listen to our members and customers, of course, but we must also anticipate their needs and be seen as the best source to fulfill them.
  • We will strengthen and expand our advocacy efforts on behalf of members, patients, and the public. A number of new tactical approaches have been designed and approved for implementation.
  • We plan to grow our membership and make it easier for our members to participate in and contribute to the College and to benefit from their status as Fellows.
  • We intend to become the No. 1 resource for those seeking information and education in the practice and science of pathology and laboratory medicine. We will study proposals to expand our direct educational programs, but we will develop them only if we can fulfill your needs better than others, and in a fashion that delivers exceptional value.
  • We will develop a plan to define a role for the College in helping members become leaders in the use of new diagnostic technologies for patient care.
  • We will ensure the College’s continuing viability through incremental functional and structural changes in governance.
Many pathologists are uneasy about the changes they see taking place in medicine and what they may portend for our specialty. Rather than perceive the environment as hostile, the Board sees it as changeable and will take steps to ensure that, through innovative and directed action, the changes benefit our profession and our patients. Hospital systems will continue to consolidate. Advances in genomics and information-sharing will revolutionize the way medical care is provided, and new skills will be needed. These circumstances create opportunities to expand the scope of pathology practice, and we intend to seize the day.

To do that, the change will start with the Board itself. The Board will metamorphose from a Board that deals with current issues and operations to one that focuses its energies on developing strategy and managing the future. To effectuate this radical departure from the present, the Board will need to delegate responsibility for operational tasks. Starting now, we will enter a transitional period in which the College’s councils and committees will begin to assume direct responsibility for their activities, including budgetary control. While the change will not be abrupt, we will proceed with all deliberate speed to empower our councils to act in accord with their charges and on approved tactical initiatives. The Board is convinced that, with such empowerment, we will make our collective vision a reality.

We have also considered a Strategic Planning Committee proposal to change our approach to representation in the House of Delegates. Pathology may be better served with a House whose delegates are selected using a formula that reflects not only state pathology societies but also pathology subspecialties or special interest organizations. We are also looking at proposals to empower the House in other ways—overseeing and generating new initiatives, grooming new leadership, and encouraging vigorous dialogue within our ranks. Before taking action, and because it believes these proposals are of great significance, the Board has turned to the Steering Committee of the House for its opinion. This time period will also make it possible to accept comments from the full membership.

In summary, our strategic plan provides a new vision of the pathologist and this College in the 21st century. It turns our everyday tool, the microscope, into a telescope for the future. The more we look to the future and plan accordingly, the greater our control will be over what is to come.

Daniel Burnham’s vision reasserted itself last month during a debate about the future of Chicago’s famous lakefront. It seems that the effects of time and environmental forces have eroded the shore of Lake Michigan, and there is a movement to erect concrete barriers on the beach. Opponents have argued that this would amount to destroying the property in order to save it. They cite Burnham’s plans for the lakefront, which stipulated that it should be "forever open, clear, and free."

Burnham’s lakefront landscape is not unlike pathology’s sphere of influence. Although battered by environmental forces, both are fundamentally intact. Both require properly focused protection and nourishment, and neither is likely to benefit from new barriers.

Pathologists, like all physicians, need a practice environment that is open, clear, and free. It’s a matter of urgency, to be pursued with energy and all deliberate speed. As we know, it can be a struggle, but it’s one we will win with a strategy that builds bridges and disables barriers.

Let us borrow a chapter from Burnham’s playbook. Let us make no small plans.