- Email: [email protected]
American Association for Geriatric Psychiatry—Strategic Thinking
ARTICLE IN PRESS Am J of Geriatric Psychiatry &&:&& (2019) &&−&&
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.ajgponline.org
Special Article
American Association for Geriatric Psychiatry—Strategic Thinking Rajesh R. Tampi, M.D., Brent P. Forester, M.D., Christopher N. Wood, B.A., Josepha A. Cheong, M.D., Christopher C. Colenda, M.D., Susan K. Schultz, M.D. ARTICLE INFO
ABSTRACT
Article history: Received November, 5 2019 Accepted November, 5 2019
Never has there been a more pressing time for the American Association for Geriatric Psychiatry (AAGP) to articulate a unified strategy to meet the challenges of our aging world. To this end, this report summarizes an AAGP leadership meeting that reviewed the results from a recent membership survey and launched a strategic planning process on behalf of AAGP members and stakeholders. This meeting was the first step in drafting a blueprint for the future that may serve as our guide in the context of finite resources to meet the infinitely complex and growing need for education, research, public advocacy, and clinical practice support. The following report serves to invite our valued colleagues to provide feedback and actively participate in defining our mission. Among the outcomes of the planning session, the following aspirations were identified by the participants 1) assert the AAGP as the “go to” organization for all things related to geriatric mental health, 2) prioritize activities that enhance the inclusivity/diversity of membership, and 3) collaborate across disciplines focused on geriatric mental health. From this initial framework, the group developed four general themes to guide AAGP’s strategic future: 1) collaboration, 2) advocacy, 3) inclusivity, 4) high purpose. Inclusivity was further defined as encompassing growth, return on investment, and workforce development. Higher purpose was further defined as encompassing engagement, purpose, branding, communication, and expertise. The AAGP affirmed its commitment to serving the needs of its members and widening its scope of impact in view of staggering demands for better access to geriatric mental healthcare. (Am J Geriatr Psychiatry 2019; &&:&&−&&)
Key Words: Strategic thinking
From the Cleveland Clinic (RRT), Akron, OH; Harvard Medical School, McLean Hospital (BPF), Belmont, MA; Degnon Associates Inc. (CNW), McLean, VA; University of Florida (JAC), Gainesville, FL; West Virginia University Health Sciences (CCC), Morgantown, WV; and the University of South Florida (SKS), Tampa, FL. Send correspondence and reprint requests to Christopher N. Wood, Degnon Associates Inc., American Association for Geriatric Psychiatry, 6728 Old McLean Village Dr., McLean, VA 22101. e-mail: [email protected] © 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jagp.2019.11.002
Am J Geriatr Psychiatry &&:&&, && 2019
1
ARTICLE IN PRESS American Association for Geriatric Psychiatry—Strategic Thinking
INTRODUCTION
C
linical practice in geriatric mental health has evolved greatly over the recent decades with ongoing changes in public health policy, models of care, and reimbursement procedures. Further, advances in technology have revolutionized the way we educate the field, conduct research, document patient care, and communicate with patients, colleagues, and health systems. Amidst these myriad changes, the field faces a workforce crisis with a decline in the number of board-certified geriatric psychiatrists. These challenges were elaborated in recent commentary in this journal1 that provides a backdrop for the results of the strategic planning meeting presented here.
BACKGROUND The history of the association formally began in 1978, as interest in mental health and the process of aging grew, and older adults were increasing in number and as a percentage of the US population, a small group of visionaries met to discuss late-life mental health needs and the field of geriatric psychiatry. From this meeting, the American Association for Geriatric Psychiatry (AAGP) was born. What began as the vision of 11 leaders in the field of psychiatry grew to a society of several hundred by the end of its first year. Today, the AAGP is an established membership association of nearly 1,400 geriatric psychiatrists and other healthcare professionals in the United States, Canada, and abroad, dedicated to the mental well-being of older adults. Over the past 6 years, the AAGP has faced and overcame significant organizational challenges. Beginning in 2011, the AAGP recognized financial concerns with the existing organizational process. In 2013, The AAGP Board of Directors, following considerable deliberation, took action to reorganize and achieve financial stability. Most significant among these changes was the transition from a traditional association staff model to an association management company model. This resulted in the move of the AAGP office from Bethesda MD to the McLean, Virginia-based office of Degnon Associates. Since 2014,
2
Degnon Associates employee, Christopher Wood, has served as the AAGP Executive Director managing the day-to-day operations for the association along with the staff team at Degnon Associates. From 2014 to 2016, the association’s primary focus included achieving financial sustainability, planning, and directing a successful Annual Meeting, implementing a newly redesigned AAGP website, and publishing the American Journal of Geriatric Psychiatry. Through concerted efforts of the AAGP Board of Directors, general members and staff, the association made a remarkable recovery. Over the past 6 years, there have been many additional areas of success to highlight including a growing AAGP membership, expansion of the Annual Meeting, and a continued rise in the impact factor of the American Journal of Geriatric Psychiatry. As the future for AAGP is bright with numerous opportunities for further growth and development, the Board of Directors and the executive director determined the need for a 3−5-year strategic plan to assure the future of the AAGP, an organization that has helped to define and support the field of geriatric psychiatry and mental health over the past 40 years. Following an extensive search and review, Leadership Outfitters, LLC, was selected to guide the strategic planning process for the AAGP’s future. Leadership Outfitters, LLC is a leadership coaching program led by Drs. Steve Swafford and Jill McCrory who, combined, have over 60 years of experience working for and with nonprofits, small businesses, volunteer-based organizations, corporations, universities, and public agencies. Leadership Outfitters specialize in various areas of leadership development, strategic planning, communication, group facilitation, and staff training. On September 21−22, 2019, current and former AAGP leadership, volunteers, staff, and Drs. Swafford and McCrory from Leadership Outfitters, convened in Washington, DC, to explore professional issues affecting AAGP and to identify strategic priorities for the next 3−5 years. Specific participants in the process are noted in Table 1. While we are currently refining and prioritizing goals and developing an implementation plan, this article describes high-level goals, potential tactics to achieve those goals, processes, themes, and discussions identified at the strategic planning meeting.
Am J Geriatr Psychiatry &&:&&, && 2019
ARTICLE IN PRESS Tampi et al. TABLE 1. Strategic Planning Meeting Participants Roles Facilitators
Names
Affiliations
Steven W Swafford, EdD, IOM Jill McCrory, PhD
Leadership Outfitters Leadership Outfitters
Howard Aizenstein, MD Josepha A. Cheong, MD
University of Pittsburgh Malcom Randall VAMC/University of Florida Departments of Psychiatry and Neurology Emeritus—West Virginia University Health Sciences and WVU Medicine Degnon Associates, Inc. Oscar G. Johnson VA Medical Center Yale School of Medicine McLean Hospital, Harvard Medical School, Partners HealthCare University of Texas Southwestern Medical Center Mount Sinai Beth Israel/Icahn School of Medicine at Mount Sinai Johns Hopkins University School of Medicine Massachusetts General Hospital & Harvard Medical School University of Rochester James A. Haley Veterans Hospital/ University of South Florida University of California San Diego Duke University Medical Center Palmetto Health—University of South Carolina Medical Group Diamond Healthcare Cleveland Clinic Santa Rosa Community Health Department of Veterans Affairs University of Connecticut Degnon Associates, Inc.
Participants
Christopher C. Colenda, MD, MPH Victoria Cooper Marie DeWitt, MD Ebony Dix, MD Brent P. Forester, MD, MSc Mustafa M. Husain, MD Melinda Lantz, MD Susan Lehmann, MD Olivia I. Okereke, MD, MS Elizabeth J. Santos, MD, MPH Susan K. Schultz, MD Daniel D. Sewell, MD Moria Smoski, PhD Shilpa Srinivasan, MD, DFAPA Deena Tampi, MSN, MBA, HCA Rajesh R. Tampi, MD, MS, DFAPA Alexander Threlfall, MD Ilse Wiechers, MD, MPP, MHS David C. Steffens, MD, MHS Christopher N. Wood
STRATEGIC PLANNING RETREAT METHODS AND RESULTS Preliminary Survey of AAGP Membership and Board of Directors Prior to the strategic planning meeting, a survey was sent out to the board of directors and the AAGP membership addressing key issues that AAGP is or will be facing. An electronic survey was emailed to all current AAGP members and the board of directors. Both groups were asked to complete a seven-question survey with the intent of capturing advance feedback for the Association’s upcoming strategic thinking process. A total of 57 stakeholders and board members responded and completed the survey. While there were 57 responses, some individuals skipped or did not provide comments to certain questions. The answers from this survey were compiled and reviewed in depth at the meeting and can be found below. The results of the surveys were analyzed using a “Word Cloud” qualitative and quantitative technique. A word cloud is an image composed of words used in a particular text or subject—in this case,
Am J Geriatr Psychiatry &&:&&, && 2019
responses to our stake holder survey questions. The size of each word indicates its frequency of use or importance. All feedback data/text for each individual survey question were processed through a word cloud generator and the following images (Figs. 1−3) are the results from text submitted by AAGP stakeholders in response to each survey question. The resultant “word cloud” images are not meant to be interpreted as an absolute quantitative analysis of the feedback survey results but are included to provide a general qualitative sense of the feedback. 1. Based on what you know about AAGP, whether limited or extensive, what did the association do really well this past year? (Fig. 1) Feedback for this question focused on the quality of the AAGP Annual Meeting and the American Journal of Geriatric Psychiatry, providing education and CME opportunities, achieving financial stability, and operational transparency. As noted above, the “word cloud” method primarily illustrates a qualitative view of the prominence of themes in the responses provided in the survey in the absence of a contextual analysis. The context for the responses to what the AAGP “does well” overwhelmingly
3
ARTICLE IN PRESS American Association for Geriatric Psychiatry—Strategic Thinking
FIGURE 1. “Word Cloud” of responses for “What did AAGP do really well this past year?”
spoke to an appreciation for the quality and services provided by the AAGP Annual Meeting. Specific comments in some responses noted that the meeting offers a highly valued opportunity to obtain continuing education credits and practicerelevant information, as well as affording useful networking opportunities. The value of the work of the AAGP addressing public policy and advocacy, the training pipeline and the scientific value of the American Journal of Geriatric Psychiatry was also noted among the responses. 2. What trends or societal issues do you believe will affect AAGP in the next 2−3 years? (Fig. 2)
4
The context of the survey responses regarding societal trends affecting the AAGP most prominently called attention to the crisis in the workforce shortage for geriatric mental health providers. The “word cloud” affiliated with this response noted a concern over the low “number” of qualified providers and trainees to be profoundly lacking relative to the rapidly growing numbers of elderly individuals with dementia and other significant care needs. Recurring themes in addition to the shortage of geriatric mental health professionals, included reimbursement issues and changes in the overall practice of medicine. Specific comments on
Am J Geriatr Psychiatry &&:&&, && 2019
ARTICLE IN PRESS Tampi et al.
FIGURE 2. “Word Cloud” of responses for “What societal trends will affect the AAGP?”
workforce issues noted the decline of geriatric psychiatrist certifications, continued difficulty in filling fellowship positions, workforce development struggles, and a graying workforce. In addition to comments referencing the exploding geriatric population, notation was also made regarding new issues for older adults arising from the substance use epidemic. 3. If money were no barrier, what are the key issues/areas AAGP should devote resources to in the next 2−3 years? (List up to three key issues/ areas) (Fig. 3)
Am J Geriatr Psychiatry &&:&&, && 2019
In response to the query regarding the optimal focus of resources, the context for the majority of responses addressed “expanding” the scope of the organization to enhance the workforce and practice capacity of qualified geriatric providers. Almost all responses revolved around the issues of developing the workforce pipeline in the areas of research, training, and clinical care. Most emphasized were increased training, opening membership to other medical disciplines (general psychiatrists, nurses, neurologists, neuropsychologists, primary care providers, psychologists,
5
ARTICLE IN PRESS American Association for Geriatric Psychiatry—Strategic Thinking
FIGURE 3. “Word Cloud” of responses for “What activities should AAGP devote resources to address in the next 2−3 years?
social workers, etc.), a competency-based certification process for medical providers, lobbying for fast-tracking geriatric fellowships within psychiatry training, loan forgiveness, CMS reimbursement reform, and advocacy on federal and state levels. 4. Are there any programs, services, or initiatives the AAGP should stop doing or eliminate? Many respondents indicated there was no clear activity that warranted elimination by the AAGP, suggesting an overall satisfaction with AAGP services. Only 13 respondents provided specific
6
feedback which included comments on redesigning the AAGP Scholars Program for diversity of candidates and programs and efforts to recruit medical students earlier. Other comments suggested a need to promote engagement and recognition for nonacademician members. 5. What do you believe positions the AAGP as a unique or compelling organization? Nearly all respondents identified a compelling strength of the AAGP that reflected positive views of its members, mission and timeliness of its efforts to help our graying population. To
Am J Geriatr Psychiatry &&:&&, && 2019
ARTICLE IN PRESS Tampi et al. summarize generally, it was noted that the AAGP has a welcoming, warm, membership that cares passionately about providing exceptional care to older people with psychiatric conditions. Topics touched on by respondents noted that mental health and aging are trending issues for the general public and healthcare systems and AAGP is at the intersection of both. Some comments addressed opportunities to promote the voice of AAGP in policy, research, and global recognition. 6. What do you believe AAGP should aspire to become? Feedback was notable for the confidence that respondents felt in the ability of AAGP to promote its standing as the premier global source of expertise in geriatric mental health and its potential to expand its reach to be inclusive of like-minded colleagues. All feedback revolved around collaborating with other allied organizations and medical disciplines to become THE leading voice and global leader in geriatric mental health education, training, research, and advocacy. 7. Additional comments, observations, or suggestions? In response to the request for any additional comments or feedback, responses focused on suggestions for improving programing, advocacy efforts, attracting students, and ways to keep AAGP relevant and sustainable. While the comments were very broad in nature, many of them reflected a sense of the importance of the organization to many of the respondents and concern that it must work diligently to maintain its relevance and expand its scope and membership.
APPROACH AND SUMMARY OF THE PLANNING RETREAT ACTIVITY; KEY FINDINGS The strategic planning session conducted by the leadership group employed the SOAR (Strengths; Opportunities; Aspirations; Results) Framework.2 SOAR planning is substantially different from traditional strategic planning. Key differences include the following: SOAR is future oriented placing greater weight of desired outcomes associated with both organizational opportunities and the organization’s
Am J Geriatr Psychiatry &&:&&, && 2019
aspirational perceptions. This focus is complemented by the fact that the organization is required to define measures of success, both quantitative and qualitative. Among the outcomes of the SOAR framework discussion, the following aspirations were identified 1) assert the AAGP as the “go to” organization for “all things” related to geriatric mental health, 2) prioritize activities that enhance the inclusivity/diversity of membership, and 3) collaborate across disciplines focused on geriatric mental health (Table 2). From this initial framework, the group developed four general themes to guide AAGP’s strategic future: 1) collaboration, 2) advocacy, 3) inclusivity, which encompassed growth, return on investment and workforce development, and 4) high purpose, which encompassed engagement, purpose, branding, communication, and expertise. SOAR’s approach to strategic planning avoids the excess focus on an organization’s internal weaknesses and external “threats.” These factors are identified when the SOAR findings are considered with a discussion of “change catalysts” (drivers or inhibitors of change) as outlined below from the AAGP Strategic Planning (Table 3). Change catalysts may also help define quantitative and qualitative outcome measures which are discussed further in the Summary portion of this report. The group identified four strategic areas that the AAGP needed to address in the near future. These four areas were: collaboration, advocacy, inclusivity, and high purpose. Additionally, high-level goals were developed with tactics to galvanize and focus the association’s priorities moving forward. Process Overview: With the intent to capture and maximize the group’s feedback in an accelerated timeframe, the participants were divided into small groups reviewing the results from the four trend areas as well as the SOAR Framework to distill the Key Strategy Areas moving forward. The group developed four general themes to guide AAGP’s strategic future which are listed below: Collaboration Advocacy High Purpose: encompassing engagement, purpose, branding, communication, and expertise Inclusivity:: encompassing inclusivity, growth, return on investment, and workforce development
7
1. Strengths
Am J Geriatr Psychiatry &&:&&, && 2019
Top Four Strengths Enthusiastic, welcoming and generative membership (“nice” and “smart”) Annual meeting Noble/unimpeachable mission and focus Expertise and dissemination of expertise (Journal, media interfaces, annual meeting, testimony on Capitol Hill)
3. Aspirations
4. Results
Expansion of membership to other disciplines Expand identity—professional, science Rebrand Shaping quality metrics Liaise with other organizations and consumers Becoming go to organization for all things geriatric mental health Advocacy as leaders Strategic media exposure Increase life quality for older adults Collaboration with other organizations and within organization Development of standards across multiple levels of care Educational materials Certification Advocacy for staff, patients/clients Dementia (in some capacity) More inclusive in attracting various professionals Linking science with technology Increase connection/communication within organization Policy (shaping) Top Three Opportunities Expansion to other disciplines, etc. Collaboration Advocacy as leaders
Voice for geriatric psychiatry Global organization Collaboration and other allied health agencies and professionals Thought leader (consulted by policy makers, leg) Welcoming home for all Increase numbers—membership $ to fund and improve value Incorporating technology Become go to organization for all things geriatric mental health Inclusivity/diversity of membership Example for other organizations similar to ours Healthy Brain Aging Collaboration
Membership (number, diversity of professional disciplines, attrition Income (dues, meeting registration) fiscal stability Evaluation—survey results (affiliated group) Stage of training (membership) Annual meeting attendance Donors Social media presence, website hits, information on website Product sales Number of advocacy meeting New blood—trainees—qualified workforce (conceptual) Increase recognition Cross membership—leadership Journal submissions Journal impact Journal submissions from other clinical professions Participation (numbers) in interest groups and list serve Funding of scholarships Enrollment of non-MD scholars
Top Three Aspirations Go to organization for all things related to geriatric mental health Inclusivity/diversity of membership Collaboration (transdisciplinary)
Top Three Results Membership Fiscal Stability Social Media/Web Presence
With intent to capture and maximize individual perspectives, the group was divided into small groups with the task of identifying the four elements of the SOAR Framework (Strengths; Opportunities; Aspirations; Results). Results. Each group had the opportunity to brainstorm each element. The top 3−4 responses/ideas as identified by the small groups appear at the end of each list.
ARTICLE IN PRESS
Enthusiastic membership Expertise Unimpeachable cause Annual meeting Journal Trainee programs Welcoming/friendly organization/networking Generative Annual meeting CME Journal Mentorship Community Home for professional identity Noble mission Increased need for AAGP Collaboration Science behind work we do (evidence based) Reputation Agility/nimble
2. Opportunities
American Association for Geriatric Psychiatry—Strategic Thinking
8 TABLE 2. SOAR Framework Process Overview
1. Regulation and Legislation B Advocacy B Payor constraints B Medicare for all B Medicare risk based/pop health/valuebased care B CMS quality metrics/guidelines B National assisted living accreditation /LTC B Telehealth regulation/payment B Nursing home regulations B Older Americans Act B Paying for LTC B End of life care B Non-physician prescribers B Certifications B Parity for mental health B Cannabinoids, THC, hallucinogens B Pharma funding B Loan re payment B Housing discrimination (i.e., psychotropics, dx) B Hospital policies re: persons w/cognitive impairment B Guardianship/DPOA across state lines B Ligature risk, psychotropics B Need to set standards of care B Gun safety
2. Economy/Financial B Reimbursement B Collaborative care B MH parity B Telemedicine B E-consults B Research funding B Slowing of economy B Other AAGP sources of income B Merger of health systems B Population health B Healthcare coverage B Change in service lines B Insufficient retirement savings B Financial penalties against providers B Recruitment—$ salary, loan repayment, etc. B ACO’s B Academic med centers—economic health B Economic uncertainty B Loss of solo care. Consolidation of health systems B VA care, mission act, non-VA care B Recession B Rural vs urban differences in economy and access B Access B Job change related to NP/PA work force B Downward pressures on MD
3. Culture/Society B Aging population/demographics B Diversity/inclusion B Resources B Changes in aspects of aging—less $, not owning own home, family no longer local B More diverse B Guns/violence B Increase substance B Stigma still B Death with dignity—hospice/palliative care B Millennials—joining workforce, life choices, generational shifts B Home based care and isolation B Age friendly communities B Homelessness B Substance use B Food industry B Loneliness/isolation B Retirement/caregivers B Income in security/fixed incomes B Diversity/inclusivity B Transportation B Intergenerational issues B Climate change B Organizational culture B Physician—centric B Language—patients vs clients, elderly vs old B LGBTQ B Ageism
4. Technology/Virtual B Telehealth/AI/Avatar B Artificial intelligence B Avatar therapy B Social networking/social media B Virtual training programs/ Assessment/CME B Apps for therapy training care B Organization apps/website B Tech companies investing in healthcare B TMS/ECT/VNS/DBS B Neuro-stimulation B Curriculum about technology B Confidentiality, liability B Leveraging EMR/HER B Bioinformatics B Virtual reality treatments B Bibliotherapy apps—screenings, etc. B Self-monitoring RVN’s, productivity B Training of students, resident, etc. over web B Quality dashboards B Robot care B Access of elder friendly tech (‘Alexa’ for elders) B Care management—technology apps B Virtual family support—education B Virtual apps to decrease social isolation B G-harmony for elders
ARTICLE IN PRESS
Am J Geriatr Psychiatry &&:&&, && 2019
TABLE 3. Change Catalysts (Drivers or Inhibitors of Change) Process Overview
With the intent to capture and maximize individual perspectives, the group was divided into small groups with the task of identifying general change catalysts affecting the association. For the purpose of this activity, change catalysts were defined drivers or inhibitors of change in the following areas: society/culture; regulations/legislative; technology/virtual; and economy/ financial. The groups brainstormed in all four areas. The top responses/ideas as identified in bold type.
Tampi et al.
9
ARTICLE IN PRESS American Association for Geriatric Psychiatry—Strategic Thinking These four strategic areas are described in detail followed by a summary of possible next steps. 1. Collaboration Collaboration was defined as developing relationships and connections with individuals and organizations (stakeholders) invested in the mental and cognitive health of older adults. Goals: 1. Build partnerships with other professional organizations a. Further strengthen relationships with the American Psychiatric Association and the American Medical Association b. Build strong relationships with key constituencies that align with strategic priorities such as: - American Geriatrics Society (AGS) Academy of Consultation-Liaison Psychiatry (ACLP) - National Council on Behavioral Health (NCBH) - International Psychogeriatric Association (IPA) - The Society for Post-Acute and Long-Term Care Medicine (AMDA) - American Neuropsychiatric Association (ANPA) - American Academy of Family Physicians (AAFP) American College of Psychiatrists (ACP) - American Academy of Hospice and Palliative Medicine (AAHPM) - American Academy of Neurology (AAN) - Look at opportunities to participate in one another’s professional meetings including presentations and specific geriatric psychiatry tracks - Co-membership discounts - Shared communication avenues (email groups) - Assist in developing standard guidelines across organizations 2. Build relationships with local, state, and federal governmental agencies a. Identify and meet with key congressional staff to advance our strategic agenda b. Promote our partnership with APA to work on regulatory/legislative efforts c. Identify liaison between AAGP and national Agency on Aging
10
d. Establish annual “day on the Hill” meeting in DC in collaboration with APA to advance our common agenda e. Develop forum for NIH/NIA/NIMH to present at the AAGP Annual Meeting 3. Build relationships with patient advocacy organizations a. Establish relationships with leadership at NAMI, AARP, Alzheimer’s Association b. Increase presence of these organizations at annual meeting 4. Build upon our relationships with industry (pharmaceutical, biotech, long-term care, medical technology, etc.) a. Establish additional key industry partners b. Further strengthen established relationship with industry partners c. Develop industry supported educational products 5. Build relationships with non-traditional entities a. Identify 3−4 promising healthcare technology companies b. Identify other entities to present at annual meeting 2. Advocacy: Advocacy was defined as being the passionate (authoritative) voice for causes, policies, and opinions that advance the mental health of older adults and those who serve them. Goals:
1. Engage more members in advocacy a. Establish a policy and advocacy committee (committee status) (leadership pipeline entices joining) b. Initiate New Member Orientation and advocacy training at the annual meeting c. Promote additional annual meeting content on policy and advocacy 2. Increase and strengthen the number of advocacy partners a. Identify patient/caregiver partners b. Identify partner organizations c. Identify prominent spokesperson(s) d. Develop advocacy tool kit
Am J Geriatr Psychiatry &&:&&, && 2019
ARTICLE IN PRESS Tampi et al. e. Partner with Consultation-Liaison psychiatry on common areas of interest f. Create AAGP marketing packet (one-pager, videos, social media) on our “why”—to share with partners and elected officials (applies to goal 3 as well) g. Create marketing packet dissemination plan (applies to goal 3 as well) 3. Improve capacity to engage in advocacy (regulatory/legislative, wealth systems) a. Establish rapid response teams to address key regulatory/legislative advocacy for rapidly emerging policy issues b. Budget for legislative and governmental advocacy on short notice c. Identify key elected officials who support geriatric mental health causes and establish/build/ strengthen relationships d. Identify and cultivate constituent members that match the key elected officials e. Cultivate member “policy experts” f. Establish linkages with key health system and health system advocacy groups (VA, AHA) g. Establish DC advocacy meeting (1.5−2 days) for key member advocates 3. High Purpose: High purpose was described as the compelling purpose statement for the association: “We are geriatric health professionals committed to reducing mental suffering and promoting emotional and cognitive health in older adults.” Goals: 1. Increase visibility of AAGP as an organization a. Promote expertise b. Create topical consensus statements (leader among several organizations) c. Develop marketing plan d. Develop faces and champions (publicly recognizable advocates) 2. Expand pipeline a. Two years free registration for all students and members in training in MD and DO medical schools, residency programs and allied healthcare training and graduate programs b. Marketing plan to MD and DO medical students c. Revise current programs to increase inclusivity
Am J Geriatr Psychiatry &&:&&, && 2019
d. Develop our own competency-based certificate program 3. Improve communication with current and new stake holders a. Identify new stake holders b. Initiate meaningful conversations c. Develop needs assessment for current stake holders d. Review focus and content of newsletter 4. Facilitate dissemination of cutting-edge research to clinicians a. Annual meeting—encourage/prioritize presentations b. Establish “master class” 4. Inclusivity Inclusivity was defined as the welcoming of members from all professions involved with mental health services for older adults. Goals: 1. Expand membership to include other disciplines including advanced practice nurses, social workers, psychologists, etc., through: a. Links to other organizations b. Promote AAGP at the local, state and regional levels c. Expanded outreach to general psychiatrists 2. Increase diversity among membership a. Establish interest groups that promote diversity and membership 3. Improve/increase financial stability a. Membership pay structure b. Annual meetings (remote option) c. Educational products exploration d. National and global educational outreach to under resourced areas i. Endorsed webinars ii. Podcasts iii. Virtual attendance at annual meeting 4. Develop the geriatric mental health workforce a. Develop national standards for teaching and training across all disciplines of geriatric mental healthcare b. Restructure committees to include and promote additional disciplines c. Facilitate attendance at annual meeting by inviting trainees from relevant disciplines d. Virtual education
11
ARTICLE IN PRESS American Association for Geriatric Psychiatry—Strategic Thinking e. Mentorship (face-to-face, telephone, skype) f. Offer pathway to clinical expertise for clinicians g. Advocate for early and greater exposure to geriatric mental health field (in healthcare professional curriculum) 5. Expand educational offerings to increase annual attendance a. Research at annual meeting b. Virtual attendance c. Develop educational product line (practical documentation) d. Endorsed webinars (no cost/cost association) e. Podcasts on website f. Selling training materials and educational materials to other countries
SUMMARY This strategic planning meeting concluded that the AAGP’s strengths are a welcoming and generative membership, the annual meeting, the noble and unimpeachable mission and focus of geriatric mental health, the content expertise, and the dissemination of this expertise in the form of the AAGP Journal, media interfaces, annual meeting, and testimony on Capitol Hill and other legislative bodies. The opportunities for AAGP identified include the sharing of our expertise to other disciplines, collaboration with other disciplines, and the development of advocacy. The aspirations for AAGP include the development of the association’s status as the premier organization for all matters related to geriatric mental health, the inclusivity/diversity of membership, and collaboration with other disciplines involved with geriatric mental health. From this initial framework and identifying aspirations, the group developed four general themes to guide AAGP’s strategic future: 1) collaboration, 2) advocacy, 3) inclusivity, which encompassed growth, return on investment, and workforce development, and 4) high purpose, which encompassed engagement, purpose, branding, communication, and expertise. With the intent to capture and maximize individual perspectives, the group was divided into small groups with the task of identifying general change catalysts affecting the association. For the purpose of this activity, change catalysts were defined as drivers or
12
inhibitors of change: society/culture; regulations/legislative; technology/virtual; and economy/financial. The groups brainstormed in all four areas and the results are presented in Table 3. To accomplish the goals set forth in the meeting, the AAGP needs to pursue the following: growth of its membership, greater financial stability, active social medial presence, and a dynamic and relevant website. At the conclusion of the meeting, two working groups were established to discuss two key areas that require immediate attention based on this planning meeting’s outcomes. Group 1 will develop a purpose statement and review methods that serve to achieve the aspiration of inclusivity and collaboration to expand the reach of the AAGP. Methods discussed by this group will include exploring the concept of an organizational name change or a tag line added to the current name of the association to reflect the principles of inclusion. This group will serve to build on the extensive discussion during the meeting that included the longstanding debate within the organization in defining the demarcations of the field while also trying to focus on the wider mission of the advancement of all aspects of geriatric mental health. The importance of membership feedback was discussed and will be inherent to procedures recommended by this group. Working Group 2 will develop a proposal for expanding and revising the membership classifications for the AAGP. Much like the charge assigned to Group 1, there will be attention to member feedback as well as careful examination of trends in current membership application, renewals, and longevity. The group recognizes that potential colleagues and stakeholders include a range of individuals in general psychiatry, medicine, neurology, psychology, nursing, and social work. The two groups will deliver their final products to AAGP executive leadership by December 31, 2019. A membership survey will be sent prior to the 2020 Annual Meeting to request feedback regarding next steps toward inclusivity and revision of the AAGP membership classifications. The AAGP Board of Directors will also hold a townhall meeting at the Annual Meeting to discuss these two major issues as well as invite feedback on other mechanisms for inclusivity including potential AAGP-sponsored certification programs. The AAGP Board of Directors will prioritize strategic initiatives and tactics based on feedback gained from the membership survey and discussion at the 2020 AAGP Annual Meeting.
Am J Geriatr Psychiatry &&:&&, && 2019
ARTICLE IN PRESS Tampi et al.
CONCLUSIONS Over the past several years, the AAGP has achieved financial stability and maintained its membership. The annual meeting of the AAGP continues be a significant strength and member-valued benefit. Additionally, the AAGP has maintained its position as a premier thought leader in geriatric mental health. This strategic planning meeting provided a platform from which the association can continue to evolve and grow as a leader in geriatric mental health. A growth in membership, greater fiscal stability, and improved social media presence are three key areas for the association to address in the near
future. Finally, despite numerous challenges faced by the field of geriatric psychiatry, the dedication, motivation, and quality of the AAGP members is remarkable and predicts a very strong future for the AAGP. The authors would like to acknowledge Melinda Lantz MD whose pivotal leadership as AAGP Treasurer and President was crucial in making the current strategic planning a reality. The authors would also like to recognize Laura Degnon, President and CEO of Degnon Associates for recognizing the higher purpose of the AAGP at a critical time and providing a superb administrative team led by Christopher Wood.
References 1. Tampi RR: Learning from the past and creating the future: American Association for Geriatric Psychiatry (AAGP) and Geriatric Mental Healthcare in the United States. Am J Geriatric Psychiatry 2019, in press
Am J Geriatr Psychiatry &&:&&, && 2019
2. Stavos JM, Hinrichs G: The Thin Book of SOAR: Creating Strategy That Inspires Innovation and Engagement. 2nd edition Thin Book Publishing, 2019 https://www.thinbook.com
13
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.ajgponline.org
Special Article
American Association for Geriatric Psychiatry—Strategic Thinking Rajesh R. Tampi, M.D., Brent P. Forester, M.D., Christopher N. Wood, B.A., Josepha A. Cheong, M.D., Christopher C. Colenda, M.D., Susan K. Schultz, M.D. ARTICLE INFO
ABSTRACT
Article history: Received November, 5 2019 Accepted November, 5 2019
Never has there been a more pressing time for the American Association for Geriatric Psychiatry (AAGP) to articulate a unified strategy to meet the challenges of our aging world. To this end, this report summarizes an AAGP leadership meeting that reviewed the results from a recent membership survey and launched a strategic planning process on behalf of AAGP members and stakeholders. This meeting was the first step in drafting a blueprint for the future that may serve as our guide in the context of finite resources to meet the infinitely complex and growing need for education, research, public advocacy, and clinical practice support. The following report serves to invite our valued colleagues to provide feedback and actively participate in defining our mission. Among the outcomes of the planning session, the following aspirations were identified by the participants 1) assert the AAGP as the “go to” organization for all things related to geriatric mental health, 2) prioritize activities that enhance the inclusivity/diversity of membership, and 3) collaborate across disciplines focused on geriatric mental health. From this initial framework, the group developed four general themes to guide AAGP’s strategic future: 1) collaboration, 2) advocacy, 3) inclusivity, 4) high purpose. Inclusivity was further defined as encompassing growth, return on investment, and workforce development. Higher purpose was further defined as encompassing engagement, purpose, branding, communication, and expertise. The AAGP affirmed its commitment to serving the needs of its members and widening its scope of impact in view of staggering demands for better access to geriatric mental healthcare. (Am J Geriatr Psychiatry 2019; &&:&&−&&)
Key Words: Strategic thinking
From the Cleveland Clinic (RRT), Akron, OH; Harvard Medical School, McLean Hospital (BPF), Belmont, MA; Degnon Associates Inc. (CNW), McLean, VA; University of Florida (JAC), Gainesville, FL; West Virginia University Health Sciences (CCC), Morgantown, WV; and the University of South Florida (SKS), Tampa, FL. Send correspondence and reprint requests to Christopher N. Wood, Degnon Associates Inc., American Association for Geriatric Psychiatry, 6728 Old McLean Village Dr., McLean, VA 22101. e-mail: [email protected] © 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jagp.2019.11.002
Am J Geriatr Psychiatry &&:&&, && 2019
1
ARTICLE IN PRESS American Association for Geriatric Psychiatry—Strategic Thinking
INTRODUCTION
C
linical practice in geriatric mental health has evolved greatly over the recent decades with ongoing changes in public health policy, models of care, and reimbursement procedures. Further, advances in technology have revolutionized the way we educate the field, conduct research, document patient care, and communicate with patients, colleagues, and health systems. Amidst these myriad changes, the field faces a workforce crisis with a decline in the number of board-certified geriatric psychiatrists. These challenges were elaborated in recent commentary in this journal1 that provides a backdrop for the results of the strategic planning meeting presented here.
BACKGROUND The history of the association formally began in 1978, as interest in mental health and the process of aging grew, and older adults were increasing in number and as a percentage of the US population, a small group of visionaries met to discuss late-life mental health needs and the field of geriatric psychiatry. From this meeting, the American Association for Geriatric Psychiatry (AAGP) was born. What began as the vision of 11 leaders in the field of psychiatry grew to a society of several hundred by the end of its first year. Today, the AAGP is an established membership association of nearly 1,400 geriatric psychiatrists and other healthcare professionals in the United States, Canada, and abroad, dedicated to the mental well-being of older adults. Over the past 6 years, the AAGP has faced and overcame significant organizational challenges. Beginning in 2011, the AAGP recognized financial concerns with the existing organizational process. In 2013, The AAGP Board of Directors, following considerable deliberation, took action to reorganize and achieve financial stability. Most significant among these changes was the transition from a traditional association staff model to an association management company model. This resulted in the move of the AAGP office from Bethesda MD to the McLean, Virginia-based office of Degnon Associates. Since 2014,
2
Degnon Associates employee, Christopher Wood, has served as the AAGP Executive Director managing the day-to-day operations for the association along with the staff team at Degnon Associates. From 2014 to 2016, the association’s primary focus included achieving financial sustainability, planning, and directing a successful Annual Meeting, implementing a newly redesigned AAGP website, and publishing the American Journal of Geriatric Psychiatry. Through concerted efforts of the AAGP Board of Directors, general members and staff, the association made a remarkable recovery. Over the past 6 years, there have been many additional areas of success to highlight including a growing AAGP membership, expansion of the Annual Meeting, and a continued rise in the impact factor of the American Journal of Geriatric Psychiatry. As the future for AAGP is bright with numerous opportunities for further growth and development, the Board of Directors and the executive director determined the need for a 3−5-year strategic plan to assure the future of the AAGP, an organization that has helped to define and support the field of geriatric psychiatry and mental health over the past 40 years. Following an extensive search and review, Leadership Outfitters, LLC, was selected to guide the strategic planning process for the AAGP’s future. Leadership Outfitters, LLC is a leadership coaching program led by Drs. Steve Swafford and Jill McCrory who, combined, have over 60 years of experience working for and with nonprofits, small businesses, volunteer-based organizations, corporations, universities, and public agencies. Leadership Outfitters specialize in various areas of leadership development, strategic planning, communication, group facilitation, and staff training. On September 21−22, 2019, current and former AAGP leadership, volunteers, staff, and Drs. Swafford and McCrory from Leadership Outfitters, convened in Washington, DC, to explore professional issues affecting AAGP and to identify strategic priorities for the next 3−5 years. Specific participants in the process are noted in Table 1. While we are currently refining and prioritizing goals and developing an implementation plan, this article describes high-level goals, potential tactics to achieve those goals, processes, themes, and discussions identified at the strategic planning meeting.
Am J Geriatr Psychiatry &&:&&, && 2019
ARTICLE IN PRESS Tampi et al. TABLE 1. Strategic Planning Meeting Participants Roles Facilitators
Names
Affiliations
Steven W Swafford, EdD, IOM Jill McCrory, PhD
Leadership Outfitters Leadership Outfitters
Howard Aizenstein, MD Josepha A. Cheong, MD
University of Pittsburgh Malcom Randall VAMC/University of Florida Departments of Psychiatry and Neurology Emeritus—West Virginia University Health Sciences and WVU Medicine Degnon Associates, Inc. Oscar G. Johnson VA Medical Center Yale School of Medicine McLean Hospital, Harvard Medical School, Partners HealthCare University of Texas Southwestern Medical Center Mount Sinai Beth Israel/Icahn School of Medicine at Mount Sinai Johns Hopkins University School of Medicine Massachusetts General Hospital & Harvard Medical School University of Rochester James A. Haley Veterans Hospital/ University of South Florida University of California San Diego Duke University Medical Center Palmetto Health—University of South Carolina Medical Group Diamond Healthcare Cleveland Clinic Santa Rosa Community Health Department of Veterans Affairs University of Connecticut Degnon Associates, Inc.
Participants
Christopher C. Colenda, MD, MPH Victoria Cooper Marie DeWitt, MD Ebony Dix, MD Brent P. Forester, MD, MSc Mustafa M. Husain, MD Melinda Lantz, MD Susan Lehmann, MD Olivia I. Okereke, MD, MS Elizabeth J. Santos, MD, MPH Susan K. Schultz, MD Daniel D. Sewell, MD Moria Smoski, PhD Shilpa Srinivasan, MD, DFAPA Deena Tampi, MSN, MBA, HCA Rajesh R. Tampi, MD, MS, DFAPA Alexander Threlfall, MD Ilse Wiechers, MD, MPP, MHS David C. Steffens, MD, MHS Christopher N. Wood
STRATEGIC PLANNING RETREAT METHODS AND RESULTS Preliminary Survey of AAGP Membership and Board of Directors Prior to the strategic planning meeting, a survey was sent out to the board of directors and the AAGP membership addressing key issues that AAGP is or will be facing. An electronic survey was emailed to all current AAGP members and the board of directors. Both groups were asked to complete a seven-question survey with the intent of capturing advance feedback for the Association’s upcoming strategic thinking process. A total of 57 stakeholders and board members responded and completed the survey. While there were 57 responses, some individuals skipped or did not provide comments to certain questions. The answers from this survey were compiled and reviewed in depth at the meeting and can be found below. The results of the surveys were analyzed using a “Word Cloud” qualitative and quantitative technique. A word cloud is an image composed of words used in a particular text or subject—in this case,
Am J Geriatr Psychiatry &&:&&, && 2019
responses to our stake holder survey questions. The size of each word indicates its frequency of use or importance. All feedback data/text for each individual survey question were processed through a word cloud generator and the following images (Figs. 1−3) are the results from text submitted by AAGP stakeholders in response to each survey question. The resultant “word cloud” images are not meant to be interpreted as an absolute quantitative analysis of the feedback survey results but are included to provide a general qualitative sense of the feedback. 1. Based on what you know about AAGP, whether limited or extensive, what did the association do really well this past year? (Fig. 1) Feedback for this question focused on the quality of the AAGP Annual Meeting and the American Journal of Geriatric Psychiatry, providing education and CME opportunities, achieving financial stability, and operational transparency. As noted above, the “word cloud” method primarily illustrates a qualitative view of the prominence of themes in the responses provided in the survey in the absence of a contextual analysis. The context for the responses to what the AAGP “does well” overwhelmingly
3
ARTICLE IN PRESS American Association for Geriatric Psychiatry—Strategic Thinking
FIGURE 1. “Word Cloud” of responses for “What did AAGP do really well this past year?”
spoke to an appreciation for the quality and services provided by the AAGP Annual Meeting. Specific comments in some responses noted that the meeting offers a highly valued opportunity to obtain continuing education credits and practicerelevant information, as well as affording useful networking opportunities. The value of the work of the AAGP addressing public policy and advocacy, the training pipeline and the scientific value of the American Journal of Geriatric Psychiatry was also noted among the responses. 2. What trends or societal issues do you believe will affect AAGP in the next 2−3 years? (Fig. 2)
4
The context of the survey responses regarding societal trends affecting the AAGP most prominently called attention to the crisis in the workforce shortage for geriatric mental health providers. The “word cloud” affiliated with this response noted a concern over the low “number” of qualified providers and trainees to be profoundly lacking relative to the rapidly growing numbers of elderly individuals with dementia and other significant care needs. Recurring themes in addition to the shortage of geriatric mental health professionals, included reimbursement issues and changes in the overall practice of medicine. Specific comments on
Am J Geriatr Psychiatry &&:&&, && 2019
ARTICLE IN PRESS Tampi et al.
FIGURE 2. “Word Cloud” of responses for “What societal trends will affect the AAGP?”
workforce issues noted the decline of geriatric psychiatrist certifications, continued difficulty in filling fellowship positions, workforce development struggles, and a graying workforce. In addition to comments referencing the exploding geriatric population, notation was also made regarding new issues for older adults arising from the substance use epidemic. 3. If money were no barrier, what are the key issues/areas AAGP should devote resources to in the next 2−3 years? (List up to three key issues/ areas) (Fig. 3)
Am J Geriatr Psychiatry &&:&&, && 2019
In response to the query regarding the optimal focus of resources, the context for the majority of responses addressed “expanding” the scope of the organization to enhance the workforce and practice capacity of qualified geriatric providers. Almost all responses revolved around the issues of developing the workforce pipeline in the areas of research, training, and clinical care. Most emphasized were increased training, opening membership to other medical disciplines (general psychiatrists, nurses, neurologists, neuropsychologists, primary care providers, psychologists,
5
ARTICLE IN PRESS American Association for Geriatric Psychiatry—Strategic Thinking
FIGURE 3. “Word Cloud” of responses for “What activities should AAGP devote resources to address in the next 2−3 years?
social workers, etc.), a competency-based certification process for medical providers, lobbying for fast-tracking geriatric fellowships within psychiatry training, loan forgiveness, CMS reimbursement reform, and advocacy on federal and state levels. 4. Are there any programs, services, or initiatives the AAGP should stop doing or eliminate? Many respondents indicated there was no clear activity that warranted elimination by the AAGP, suggesting an overall satisfaction with AAGP services. Only 13 respondents provided specific
6
feedback which included comments on redesigning the AAGP Scholars Program for diversity of candidates and programs and efforts to recruit medical students earlier. Other comments suggested a need to promote engagement and recognition for nonacademician members. 5. What do you believe positions the AAGP as a unique or compelling organization? Nearly all respondents identified a compelling strength of the AAGP that reflected positive views of its members, mission and timeliness of its efforts to help our graying population. To
Am J Geriatr Psychiatry &&:&&, && 2019
ARTICLE IN PRESS Tampi et al. summarize generally, it was noted that the AAGP has a welcoming, warm, membership that cares passionately about providing exceptional care to older people with psychiatric conditions. Topics touched on by respondents noted that mental health and aging are trending issues for the general public and healthcare systems and AAGP is at the intersection of both. Some comments addressed opportunities to promote the voice of AAGP in policy, research, and global recognition. 6. What do you believe AAGP should aspire to become? Feedback was notable for the confidence that respondents felt in the ability of AAGP to promote its standing as the premier global source of expertise in geriatric mental health and its potential to expand its reach to be inclusive of like-minded colleagues. All feedback revolved around collaborating with other allied organizations and medical disciplines to become THE leading voice and global leader in geriatric mental health education, training, research, and advocacy. 7. Additional comments, observations, or suggestions? In response to the request for any additional comments or feedback, responses focused on suggestions for improving programing, advocacy efforts, attracting students, and ways to keep AAGP relevant and sustainable. While the comments were very broad in nature, many of them reflected a sense of the importance of the organization to many of the respondents and concern that it must work diligently to maintain its relevance and expand its scope and membership.
APPROACH AND SUMMARY OF THE PLANNING RETREAT ACTIVITY; KEY FINDINGS The strategic planning session conducted by the leadership group employed the SOAR (Strengths; Opportunities; Aspirations; Results) Framework.2 SOAR planning is substantially different from traditional strategic planning. Key differences include the following: SOAR is future oriented placing greater weight of desired outcomes associated with both organizational opportunities and the organization’s
Am J Geriatr Psychiatry &&:&&, && 2019
aspirational perceptions. This focus is complemented by the fact that the organization is required to define measures of success, both quantitative and qualitative. Among the outcomes of the SOAR framework discussion, the following aspirations were identified 1) assert the AAGP as the “go to” organization for “all things” related to geriatric mental health, 2) prioritize activities that enhance the inclusivity/diversity of membership, and 3) collaborate across disciplines focused on geriatric mental health (Table 2). From this initial framework, the group developed four general themes to guide AAGP’s strategic future: 1) collaboration, 2) advocacy, 3) inclusivity, which encompassed growth, return on investment and workforce development, and 4) high purpose, which encompassed engagement, purpose, branding, communication, and expertise. SOAR’s approach to strategic planning avoids the excess focus on an organization’s internal weaknesses and external “threats.” These factors are identified when the SOAR findings are considered with a discussion of “change catalysts” (drivers or inhibitors of change) as outlined below from the AAGP Strategic Planning (Table 3). Change catalysts may also help define quantitative and qualitative outcome measures which are discussed further in the Summary portion of this report. The group identified four strategic areas that the AAGP needed to address in the near future. These four areas were: collaboration, advocacy, inclusivity, and high purpose. Additionally, high-level goals were developed with tactics to galvanize and focus the association’s priorities moving forward. Process Overview: With the intent to capture and maximize the group’s feedback in an accelerated timeframe, the participants were divided into small groups reviewing the results from the four trend areas as well as the SOAR Framework to distill the Key Strategy Areas moving forward. The group developed four general themes to guide AAGP’s strategic future which are listed below: Collaboration Advocacy High Purpose: encompassing engagement, purpose, branding, communication, and expertise Inclusivity:: encompassing inclusivity, growth, return on investment, and workforce development
7
1. Strengths
Am J Geriatr Psychiatry &&:&&, && 2019
Top Four Strengths Enthusiastic, welcoming and generative membership (“nice” and “smart”) Annual meeting Noble/unimpeachable mission and focus Expertise and dissemination of expertise (Journal, media interfaces, annual meeting, testimony on Capitol Hill)
3. Aspirations
4. Results
Expansion of membership to other disciplines Expand identity—professional, science Rebrand Shaping quality metrics Liaise with other organizations and consumers Becoming go to organization for all things geriatric mental health Advocacy as leaders Strategic media exposure Increase life quality for older adults Collaboration with other organizations and within organization Development of standards across multiple levels of care Educational materials Certification Advocacy for staff, patients/clients Dementia (in some capacity) More inclusive in attracting various professionals Linking science with technology Increase connection/communication within organization Policy (shaping) Top Three Opportunities Expansion to other disciplines, etc. Collaboration Advocacy as leaders
Voice for geriatric psychiatry Global organization Collaboration and other allied health agencies and professionals Thought leader (consulted by policy makers, leg) Welcoming home for all Increase numbers—membership $ to fund and improve value Incorporating technology Become go to organization for all things geriatric mental health Inclusivity/diversity of membership Example for other organizations similar to ours Healthy Brain Aging Collaboration
Membership (number, diversity of professional disciplines, attrition Income (dues, meeting registration) fiscal stability Evaluation—survey results (affiliated group) Stage of training (membership) Annual meeting attendance Donors Social media presence, website hits, information on website Product sales Number of advocacy meeting New blood—trainees—qualified workforce (conceptual) Increase recognition Cross membership—leadership Journal submissions Journal impact Journal submissions from other clinical professions Participation (numbers) in interest groups and list serve Funding of scholarships Enrollment of non-MD scholars
Top Three Aspirations Go to organization for all things related to geriatric mental health Inclusivity/diversity of membership Collaboration (transdisciplinary)
Top Three Results Membership Fiscal Stability Social Media/Web Presence
With intent to capture and maximize individual perspectives, the group was divided into small groups with the task of identifying the four elements of the SOAR Framework (Strengths; Opportunities; Aspirations; Results). Results. Each group had the opportunity to brainstorm each element. The top 3−4 responses/ideas as identified by the small groups appear at the end of each list.
ARTICLE IN PRESS
Enthusiastic membership Expertise Unimpeachable cause Annual meeting Journal Trainee programs Welcoming/friendly organization/networking Generative Annual meeting CME Journal Mentorship Community Home for professional identity Noble mission Increased need for AAGP Collaboration Science behind work we do (evidence based) Reputation Agility/nimble
2. Opportunities
American Association for Geriatric Psychiatry—Strategic Thinking
8 TABLE 2. SOAR Framework Process Overview
1. Regulation and Legislation B Advocacy B Payor constraints B Medicare for all B Medicare risk based/pop health/valuebased care B CMS quality metrics/guidelines B National assisted living accreditation /LTC B Telehealth regulation/payment B Nursing home regulations B Older Americans Act B Paying for LTC B End of life care B Non-physician prescribers B Certifications B Parity for mental health B Cannabinoids, THC, hallucinogens B Pharma funding B Loan re payment B Housing discrimination (i.e., psychotropics, dx) B Hospital policies re: persons w/cognitive impairment B Guardianship/DPOA across state lines B Ligature risk, psychotropics B Need to set standards of care B Gun safety
2. Economy/Financial B Reimbursement B Collaborative care B MH parity B Telemedicine B E-consults B Research funding B Slowing of economy B Other AAGP sources of income B Merger of health systems B Population health B Healthcare coverage B Change in service lines B Insufficient retirement savings B Financial penalties against providers B Recruitment—$ salary, loan repayment, etc. B ACO’s B Academic med centers—economic health B Economic uncertainty B Loss of solo care. Consolidation of health systems B VA care, mission act, non-VA care B Recession B Rural vs urban differences in economy and access B Access B Job change related to NP/PA work force B Downward pressures on MD
3. Culture/Society B Aging population/demographics B Diversity/inclusion B Resources B Changes in aspects of aging—less $, not owning own home, family no longer local B More diverse B Guns/violence B Increase substance B Stigma still B Death with dignity—hospice/palliative care B Millennials—joining workforce, life choices, generational shifts B Home based care and isolation B Age friendly communities B Homelessness B Substance use B Food industry B Loneliness/isolation B Retirement/caregivers B Income in security/fixed incomes B Diversity/inclusivity B Transportation B Intergenerational issues B Climate change B Organizational culture B Physician—centric B Language—patients vs clients, elderly vs old B LGBTQ B Ageism
4. Technology/Virtual B Telehealth/AI/Avatar B Artificial intelligence B Avatar therapy B Social networking/social media B Virtual training programs/ Assessment/CME B Apps for therapy training care B Organization apps/website B Tech companies investing in healthcare B TMS/ECT/VNS/DBS B Neuro-stimulation B Curriculum about technology B Confidentiality, liability B Leveraging EMR/HER B Bioinformatics B Virtual reality treatments B Bibliotherapy apps—screenings, etc. B Self-monitoring RVN’s, productivity B Training of students, resident, etc. over web B Quality dashboards B Robot care B Access of elder friendly tech (‘Alexa’ for elders) B Care management—technology apps B Virtual family support—education B Virtual apps to decrease social isolation B G-harmony for elders
ARTICLE IN PRESS
Am J Geriatr Psychiatry &&:&&, && 2019
TABLE 3. Change Catalysts (Drivers or Inhibitors of Change) Process Overview
With the intent to capture and maximize individual perspectives, the group was divided into small groups with the task of identifying general change catalysts affecting the association. For the purpose of this activity, change catalysts were defined drivers or inhibitors of change in the following areas: society/culture; regulations/legislative; technology/virtual; and economy/ financial. The groups brainstormed in all four areas. The top responses/ideas as identified in bold type.
Tampi et al.
9
ARTICLE IN PRESS American Association for Geriatric Psychiatry—Strategic Thinking These four strategic areas are described in detail followed by a summary of possible next steps. 1. Collaboration Collaboration was defined as developing relationships and connections with individuals and organizations (stakeholders) invested in the mental and cognitive health of older adults. Goals: 1. Build partnerships with other professional organizations a. Further strengthen relationships with the American Psychiatric Association and the American Medical Association b. Build strong relationships with key constituencies that align with strategic priorities such as: - American Geriatrics Society (AGS) Academy of Consultation-Liaison Psychiatry (ACLP) - National Council on Behavioral Health (NCBH) - International Psychogeriatric Association (IPA) - The Society for Post-Acute and Long-Term Care Medicine (AMDA) - American Neuropsychiatric Association (ANPA) - American Academy of Family Physicians (AAFP) American College of Psychiatrists (ACP) - American Academy of Hospice and Palliative Medicine (AAHPM) - American Academy of Neurology (AAN) - Look at opportunities to participate in one another’s professional meetings including presentations and specific geriatric psychiatry tracks - Co-membership discounts - Shared communication avenues (email groups) - Assist in developing standard guidelines across organizations 2. Build relationships with local, state, and federal governmental agencies a. Identify and meet with key congressional staff to advance our strategic agenda b. Promote our partnership with APA to work on regulatory/legislative efforts c. Identify liaison between AAGP and national Agency on Aging
10
d. Establish annual “day on the Hill” meeting in DC in collaboration with APA to advance our common agenda e. Develop forum for NIH/NIA/NIMH to present at the AAGP Annual Meeting 3. Build relationships with patient advocacy organizations a. Establish relationships with leadership at NAMI, AARP, Alzheimer’s Association b. Increase presence of these organizations at annual meeting 4. Build upon our relationships with industry (pharmaceutical, biotech, long-term care, medical technology, etc.) a. Establish additional key industry partners b. Further strengthen established relationship with industry partners c. Develop industry supported educational products 5. Build relationships with non-traditional entities a. Identify 3−4 promising healthcare technology companies b. Identify other entities to present at annual meeting 2. Advocacy: Advocacy was defined as being the passionate (authoritative) voice for causes, policies, and opinions that advance the mental health of older adults and those who serve them. Goals:
1. Engage more members in advocacy a. Establish a policy and advocacy committee (committee status) (leadership pipeline entices joining) b. Initiate New Member Orientation and advocacy training at the annual meeting c. Promote additional annual meeting content on policy and advocacy 2. Increase and strengthen the number of advocacy partners a. Identify patient/caregiver partners b. Identify partner organizations c. Identify prominent spokesperson(s) d. Develop advocacy tool kit
Am J Geriatr Psychiatry &&:&&, && 2019
ARTICLE IN PRESS Tampi et al. e. Partner with Consultation-Liaison psychiatry on common areas of interest f. Create AAGP marketing packet (one-pager, videos, social media) on our “why”—to share with partners and elected officials (applies to goal 3 as well) g. Create marketing packet dissemination plan (applies to goal 3 as well) 3. Improve capacity to engage in advocacy (regulatory/legislative, wealth systems) a. Establish rapid response teams to address key regulatory/legislative advocacy for rapidly emerging policy issues b. Budget for legislative and governmental advocacy on short notice c. Identify key elected officials who support geriatric mental health causes and establish/build/ strengthen relationships d. Identify and cultivate constituent members that match the key elected officials e. Cultivate member “policy experts” f. Establish linkages with key health system and health system advocacy groups (VA, AHA) g. Establish DC advocacy meeting (1.5−2 days) for key member advocates 3. High Purpose: High purpose was described as the compelling purpose statement for the association: “We are geriatric health professionals committed to reducing mental suffering and promoting emotional and cognitive health in older adults.” Goals: 1. Increase visibility of AAGP as an organization a. Promote expertise b. Create topical consensus statements (leader among several organizations) c. Develop marketing plan d. Develop faces and champions (publicly recognizable advocates) 2. Expand pipeline a. Two years free registration for all students and members in training in MD and DO medical schools, residency programs and allied healthcare training and graduate programs b. Marketing plan to MD and DO medical students c. Revise current programs to increase inclusivity
Am J Geriatr Psychiatry &&:&&, && 2019
d. Develop our own competency-based certificate program 3. Improve communication with current and new stake holders a. Identify new stake holders b. Initiate meaningful conversations c. Develop needs assessment for current stake holders d. Review focus and content of newsletter 4. Facilitate dissemination of cutting-edge research to clinicians a. Annual meeting—encourage/prioritize presentations b. Establish “master class” 4. Inclusivity Inclusivity was defined as the welcoming of members from all professions involved with mental health services for older adults. Goals: 1. Expand membership to include other disciplines including advanced practice nurses, social workers, psychologists, etc., through: a. Links to other organizations b. Promote AAGP at the local, state and regional levels c. Expanded outreach to general psychiatrists 2. Increase diversity among membership a. Establish interest groups that promote diversity and membership 3. Improve/increase financial stability a. Membership pay structure b. Annual meetings (remote option) c. Educational products exploration d. National and global educational outreach to under resourced areas i. Endorsed webinars ii. Podcasts iii. Virtual attendance at annual meeting 4. Develop the geriatric mental health workforce a. Develop national standards for teaching and training across all disciplines of geriatric mental healthcare b. Restructure committees to include and promote additional disciplines c. Facilitate attendance at annual meeting by inviting trainees from relevant disciplines d. Virtual education
11
ARTICLE IN PRESS American Association for Geriatric Psychiatry—Strategic Thinking e. Mentorship (face-to-face, telephone, skype) f. Offer pathway to clinical expertise for clinicians g. Advocate for early and greater exposure to geriatric mental health field (in healthcare professional curriculum) 5. Expand educational offerings to increase annual attendance a. Research at annual meeting b. Virtual attendance c. Develop educational product line (practical documentation) d. Endorsed webinars (no cost/cost association) e. Podcasts on website f. Selling training materials and educational materials to other countries
SUMMARY This strategic planning meeting concluded that the AAGP’s strengths are a welcoming and generative membership, the annual meeting, the noble and unimpeachable mission and focus of geriatric mental health, the content expertise, and the dissemination of this expertise in the form of the AAGP Journal, media interfaces, annual meeting, and testimony on Capitol Hill and other legislative bodies. The opportunities for AAGP identified include the sharing of our expertise to other disciplines, collaboration with other disciplines, and the development of advocacy. The aspirations for AAGP include the development of the association’s status as the premier organization for all matters related to geriatric mental health, the inclusivity/diversity of membership, and collaboration with other disciplines involved with geriatric mental health. From this initial framework and identifying aspirations, the group developed four general themes to guide AAGP’s strategic future: 1) collaboration, 2) advocacy, 3) inclusivity, which encompassed growth, return on investment, and workforce development, and 4) high purpose, which encompassed engagement, purpose, branding, communication, and expertise. With the intent to capture and maximize individual perspectives, the group was divided into small groups with the task of identifying general change catalysts affecting the association. For the purpose of this activity, change catalysts were defined as drivers or
12
inhibitors of change: society/culture; regulations/legislative; technology/virtual; and economy/financial. The groups brainstormed in all four areas and the results are presented in Table 3. To accomplish the goals set forth in the meeting, the AAGP needs to pursue the following: growth of its membership, greater financial stability, active social medial presence, and a dynamic and relevant website. At the conclusion of the meeting, two working groups were established to discuss two key areas that require immediate attention based on this planning meeting’s outcomes. Group 1 will develop a purpose statement and review methods that serve to achieve the aspiration of inclusivity and collaboration to expand the reach of the AAGP. Methods discussed by this group will include exploring the concept of an organizational name change or a tag line added to the current name of the association to reflect the principles of inclusion. This group will serve to build on the extensive discussion during the meeting that included the longstanding debate within the organization in defining the demarcations of the field while also trying to focus on the wider mission of the advancement of all aspects of geriatric mental health. The importance of membership feedback was discussed and will be inherent to procedures recommended by this group. Working Group 2 will develop a proposal for expanding and revising the membership classifications for the AAGP. Much like the charge assigned to Group 1, there will be attention to member feedback as well as careful examination of trends in current membership application, renewals, and longevity. The group recognizes that potential colleagues and stakeholders include a range of individuals in general psychiatry, medicine, neurology, psychology, nursing, and social work. The two groups will deliver their final products to AAGP executive leadership by December 31, 2019. A membership survey will be sent prior to the 2020 Annual Meeting to request feedback regarding next steps toward inclusivity and revision of the AAGP membership classifications. The AAGP Board of Directors will also hold a townhall meeting at the Annual Meeting to discuss these two major issues as well as invite feedback on other mechanisms for inclusivity including potential AAGP-sponsored certification programs. The AAGP Board of Directors will prioritize strategic initiatives and tactics based on feedback gained from the membership survey and discussion at the 2020 AAGP Annual Meeting.
Am J Geriatr Psychiatry &&:&&, && 2019
ARTICLE IN PRESS Tampi et al.
CONCLUSIONS Over the past several years, the AAGP has achieved financial stability and maintained its membership. The annual meeting of the AAGP continues be a significant strength and member-valued benefit. Additionally, the AAGP has maintained its position as a premier thought leader in geriatric mental health. This strategic planning meeting provided a platform from which the association can continue to evolve and grow as a leader in geriatric mental health. A growth in membership, greater fiscal stability, and improved social media presence are three key areas for the association to address in the near
future. Finally, despite numerous challenges faced by the field of geriatric psychiatry, the dedication, motivation, and quality of the AAGP members is remarkable and predicts a very strong future for the AAGP. The authors would like to acknowledge Melinda Lantz MD whose pivotal leadership as AAGP Treasurer and President was crucial in making the current strategic planning a reality. The authors would also like to recognize Laura Degnon, President and CEO of Degnon Associates for recognizing the higher purpose of the AAGP at a critical time and providing a superb administrative team led by Christopher Wood.
References 1. Tampi RR: Learning from the past and creating the future: American Association for Geriatric Psychiatry (AAGP) and Geriatric Mental Healthcare in the United States. Am J Geriatric Psychiatry 2019, in press
Am J Geriatr Psychiatry &&:&&, && 2019
2. Stavos JM, Hinrichs G: The Thin Book of SOAR: Creating Strategy That Inspires Innovation and Engagement. 2nd edition Thin Book Publishing, 2019 https://www.thinbook.com
13