Pathology without barriers
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:
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.
- 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
- 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.
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
Let us borrow a chapter from Burnham’s playbook. Let us make no small plans.