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Rehabilitation research: The new focus of the American congress of rehabilitation medicine
1287
ACRM PRESIDENTIAL
ADDRESS
Rehabilitation Research: The New Focus of the American Congress of Rehabilitation Medicine Karen A. Hart, PhD
A
S PRESIDENT OF the American Congress of Rehabilitation Medicine, and on behalf of the 11 other Board members, I welcome you to the 74th annual meeting of the ACRM. This has been a year of huge steps for ACRM, and it has been a privilege to serve as your President. In this Presidential address I will do two things: 1. Bring you up to date on what has been happening with our organization since we were last together at the annual meeting in Chicago, and 2. Challenge you with some possible actions to begin to take during this meeting. On the update, I ask the indulgence of those of you who have read the Open Line to the President column in the last three Rehabilitation Outlook newsletters and the letter that was mailed to each member last month. As I begin, I want you to know that throughout every action and decision made this year, it was clear that there was a background commitment shared by each individual member of the ACRM Board-that our purpose was and is to improve the lives of people with chronic disabling conditions. Now, for a review of some of the issues of the past 3 years.
THE PAST 3 YEARS For several years now, since our beginning as a totally independent organization, ACRM has been struggling with identifying and languaging a strong statement that identifies who we are and what we stand for that is unique from other rehabilitation organizations. This year, the Board recognized that the lack of such a strong, clear identity had created a problem requiring immediate attention if we were to survive as an organization. Like many of today’s health care organizations, ACRM found it difficult to maintain its financial viability, its membership base, and member benefits. Why was this happening? First, our members had encountered changes in health care resulting in decreased time and funding for their memberships and attendance at organizational meetings. In addition, many of our physician members began to experience ACRM as an organization independent from the American Academy of Physical Medicine and Rehabilitation, their “professional trade” organization, so more time and funding was required for them to attend ACRM’s now separate annual meeting. In each of the past 3 years, the Board has asked, “What can we do to provide members with greater value for their membership, and what is needed to attract new members?” We sent our usual many mailings to lists of thousands of potential member clinicians, educators, administrators, and researchers in the various rehabilitation disciplines. But as our membership continued to decrease, the funds were no longer available for these mass mailings, from which there was an expected low yield of new members. From Baylor College of Medicine, The Institute for Rehabilitation and Research, Houston, TX. Presented at the 74th Annual Meeting of the American Congress of Rehabilitation Medicine, Boston, September 12, 1997. Reprint requests to Karen A. Hart, PhD, The Institute for Rehabilitation and Research, 1333 Moursund Avenue, Houston, TX 77030. 0 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation 0003-9993/97/7812-0001$3.00/O
A SENSE OF URGENCY
NOW
Early in this ACRM fiscal year, when the Board was attempting to balance revenues and expenses at the budget meetings, it became apparent that something had to be done now. We had developed a vision statement last year, but it was not specific enough to guide our budgetary decision-making. Frustration was mounting as our inability to turn this around continued. Why couldn’t we find the answers? Weren’t we marketing effectively? Didn’t we have the right management company to advise us and carry out our requests? We needed help now and nothing seemed to be bringing us together. So we decided to invest substantial effort in creating a request for proposals to see what other management companies might offer. Although we received several reasonable responses about how other companies could manage ACRM, one response was particularly intriguing-one firm actually told us that it was premature to consider management company issues. It was clear to that firm that we had a much bigger problem. First, we needed to develop a specific organizational focus that was manageable in size and scope. They proposed this as a necessary precursor to identifying the right management company. The Board of Governors was intrigued. We could no longer espouse being all things to all areas in rehabilitation. The Board Members decided we needed to assess the field and determine if there was a current niche for an organization with ACRM’s values around which we could develop a focus. In preparation for this assessment we listed our values-beliefs that ACRM has had over the years: l The importance of the team. l The value of diversity among our many disciplines. l The uniqueness of function as our rallying point. l The importance of quality of life as a measure of our truth. l The creation of outcome measures. l The involvement of the family in our work with people with disabilities. l The essential nature of working with the spirit of the person in pursuing goals that are selected by the person and the family. l The implementation of wellness and prevention themes for patients and clients. Now we were ready for the next step.
OPENNESS TO CONSIDER ANY OPTION We commissioned the firm of Smith Bucklin and Associates to obtain from the ACRM membership and other organizations and leaders in the field, their perceptions of our uniquenesses and their recommendations for the future for ACRM. This was a very bold move by the Board. We agreed that the situation was urgent enough and important enough that we would be willing to seriously consider radical recommendations such as: 1. Close down the organization, acknowledging that it no longer served a useful purpose to the field; 2. Focus on a purpose that might reduce our numbers to a very few-but committed-members; 3. Merge with another group;
Arch
Phys Med
Rehabil
Vol 78, December
1997
1288
ACRM
PRESIDENTIAL
4. Do whatever it might take to turn around the current decline. With the assistance of Pat Kitchell-Landrum, an ACRM member and a professional facilitator, we primed ourselves to be very open-minded and gave Smith Bucklin encouragement to explore everything and anything as possibilities. THE DECISION FOR A NEW FOCUS Prior to the face-to-face Board meeting in June, the Board members each had a copy of the Smith Bucklin and Associates report and their multiple recommendations, but no one knew what the discussion and outcome would be, ie, which recommendation, if any, the Board would decide upon. The report stated: “Two unique aspects of ACRM membership that continued to be emphasized (by those surveyed) were: 1. ACRM’s multidisciplinary emphasis and the sharing of information among multiple rehabilitation disciplines in all of the various ACRM forums-the annual meeting, articles in the Archives, and the opportunity to meet, share, and network with all individuals involved with the rehabilitation team; and 2. ACRM’s continued emphasis on rehabilitation research and the forum that the Congress provides for the sharing of that information. It was agreed that these two items were unique to ACRM and were not available through any other rehabilitationrelated professional association.” Smith Bucklin nronosed four ontions for ACRM’s future: Dismantle the ACRM and distribute its assets to some other rehabilitation organization, perhaps for research fellowships bearing the ACRM name; Merge ACRM’s resources with another rehabilitation organization and retain our identity by becoming a special interest group (SIG) or council of that organization; Become a nonmember organization within rehabilitation medicine that sponsors a rehabilitation week by holding a weeklong biennial mega meeting, attracting various disciplines and organizations within rehabilitation; or Become an organization that concentrates its efforts on issues related to research in rehabilitation. These were the options for discussion. To avoid influencing one another, every Board member put in writing their preferred option and a brief explanation for their selection. At the Board meeting, these were read aloud by each member before any discussion. Although the members gave careful consideration to each option (and some combination of options), there was a convergence on the option of ACRM becoming focused on clinically relevant rehabilitation research. What, then, a fitting theme for this conference: “Rehabilitation Outcomes: Transforming Science into Reality.” I must say, as I assumed the presidency last year, it never occurred to me that we would undergo such an investigation of ourselves, let alone come to this conclusion. I have become very excited about this focus as I imagine possibilities of how we can operationalize it. STEPS TO ACTIVATE THE NEW FOCUS What are the possibilities of how ACRM might look with this new focus as an emphasis? We could provide think tanks for clinicians, administrators, educators, consumers, etc, to talk about what research information they need, what they think should be done, how they can participate or partner with researchersto get the type and quality of research that is of value to them, etc. Arch
Phys
Med
Rehabil
Vol78,
December
1997
ADDRESS,
Hart
We could create ways for ACRM to help funding sources formulate requests for proposals, ensure that monies are still appropriated for key areas of research, and continue to increase the quality of rehabilitation research and the respect that it has in the research, medical, payer, and consumer communities. Our annual meeting could look radically different if we identified and invited researchers and clinicians at the cutting edge of our field not just to present their findings, but to conduct full inquiries into particular topics and, perhaps, develop papers summarizing those inquiries. We could devise ways for newcomers to the field of rehabilitation to interact with and learn from those of us with experience through mentorship programs-both short- and long-term. How many of us were fortunate enough to have learned from people such as Sheldon Berrol or Irving Zola because of ACRM? Your Board has taken on the challenge of moving the ACRM into the future, creating an organization that has something powerful and meaningful to contribute to our members and to the people we are committed to serving. Yet it is not something the 12 Board members can do alone. There are some possibilities that seem obvious and easy to implement. For example, the Board has discussed and approved two levels of interdisciplinary special interest groups (ISIGs). Level 1 is similar to the current Brain Injury-ISIG structure, where some officers and self-directed goals and projects sustain the group throughout the year. Level 2 is a networking group-individuals with a common area of interest who meet informally. A networking group may or may not choose to take on the form and substance of an ISIG. There are other possibilities that will need time to evolve and take shape before we can move to the next step. Possibilities for the future always result in many questions. We are counting on the help of all ACRM members as we begin to look at the ways in which these and other possibilities can be developed. Help us find the answers to the many questions we all have: l Should the research committee be divided into multiple groups to address specific issues more comprehensively? l How much should we focus versus stay broad on the research agenda we address? l What sorts of creative ways for dissemination of research can we use? How can we be a model for doing this? l Who, if anyone, should we partner with, and in what ways? Possiblepartners include the National Institute for Disability and Rehabilitation Research, National Center for Medical Rehabilitation Research, and the research committees of other discipline-specific or diagnosis-specific groups. Answers and actions on these questions and others are the next steps if ACRM’s commitment to a focus of rehabilitation research is to be alive, palpable, energizing, and irresistible. Are you willing to stand and be a part of this? ACRM is moving into the future, and you are invited to come along. CONTINUITY FOR THE FUTURE One goal this year has been to develop a oneness as a Board and to put things into place so that there is a continuity from year to year, from president to president. This has been achieved. Each Board member is a potential president of the organization after 3 years of service. After the decision to focus ACRM on rehabilitation research, Board members were offered an opportunity to consider the extent of their personal commitment to lead the organization around this new focus. I want you to know that each Board member has recommitted to the ACRM and to its new focus. The 1997-98 nominees for Board members and officers have likewise committed to this new focus. ACRM will move forward as a purpose/goal-driven organzation rather than a personality-driven organization. Ted Cole,
ACRM
PRESIDENTIAL
President-elect and Kate Fralish, nominee for President-elect, are particularly committed to this. Thus, the focus on clinically relevant rehabilitation research is here to stay. It is worth it for you to spend time to think about how this can manifest within ACRM. YOUR CHALLENGE AT THIS MEETING There are now many many decisions to be made and this 1997 meeting is occurring at a critical time in the process of developing the focus. Your challenge here is to participate and to discuss and offer suggestions within our committees and ISIGs and in conversations with the ACRM leaders. If you are unable to speak with a member of the Board at this meeting or if you have thoughts after the meeting, call or e-mail us.
ADDRESS,
1289
Hart
The time to speak up is now. In October/November the Board will review the many ideas received. We will begin to build the structure to bring forth the new focus on clinically relevant rehabilitation research. The ACRM has become a work in progress-it is a pliable form of clay with its shape and substance clearly outlined. But our future is yet to be sculpted-the details are yet to be set. This is the meeting at which we all must create. My hope is that next year, in Seattle at the 75th Anniversary of ACRM, the oldest multidisciplinary rehabilitation organization in the world, we will see the significant changes in our work of art and we will all able to say, “It wasn’t easy, but it was worth it!”
Arch
Phys Med
Rehabil
Vol78,
December
1997
ACRM PRESIDENTIAL
ADDRESS
Rehabilitation Research: The New Focus of the American Congress of Rehabilitation Medicine Karen A. Hart, PhD
A
S PRESIDENT OF the American Congress of Rehabilitation Medicine, and on behalf of the 11 other Board members, I welcome you to the 74th annual meeting of the ACRM. This has been a year of huge steps for ACRM, and it has been a privilege to serve as your President. In this Presidential address I will do two things: 1. Bring you up to date on what has been happening with our organization since we were last together at the annual meeting in Chicago, and 2. Challenge you with some possible actions to begin to take during this meeting. On the update, I ask the indulgence of those of you who have read the Open Line to the President column in the last three Rehabilitation Outlook newsletters and the letter that was mailed to each member last month. As I begin, I want you to know that throughout every action and decision made this year, it was clear that there was a background commitment shared by each individual member of the ACRM Board-that our purpose was and is to improve the lives of people with chronic disabling conditions. Now, for a review of some of the issues of the past 3 years.
THE PAST 3 YEARS For several years now, since our beginning as a totally independent organization, ACRM has been struggling with identifying and languaging a strong statement that identifies who we are and what we stand for that is unique from other rehabilitation organizations. This year, the Board recognized that the lack of such a strong, clear identity had created a problem requiring immediate attention if we were to survive as an organization. Like many of today’s health care organizations, ACRM found it difficult to maintain its financial viability, its membership base, and member benefits. Why was this happening? First, our members had encountered changes in health care resulting in decreased time and funding for their memberships and attendance at organizational meetings. In addition, many of our physician members began to experience ACRM as an organization independent from the American Academy of Physical Medicine and Rehabilitation, their “professional trade” organization, so more time and funding was required for them to attend ACRM’s now separate annual meeting. In each of the past 3 years, the Board has asked, “What can we do to provide members with greater value for their membership, and what is needed to attract new members?” We sent our usual many mailings to lists of thousands of potential member clinicians, educators, administrators, and researchers in the various rehabilitation disciplines. But as our membership continued to decrease, the funds were no longer available for these mass mailings, from which there was an expected low yield of new members. From Baylor College of Medicine, The Institute for Rehabilitation and Research, Houston, TX. Presented at the 74th Annual Meeting of the American Congress of Rehabilitation Medicine, Boston, September 12, 1997. Reprint requests to Karen A. Hart, PhD, The Institute for Rehabilitation and Research, 1333 Moursund Avenue, Houston, TX 77030. 0 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation 0003-9993/97/7812-0001$3.00/O
A SENSE OF URGENCY
NOW
Early in this ACRM fiscal year, when the Board was attempting to balance revenues and expenses at the budget meetings, it became apparent that something had to be done now. We had developed a vision statement last year, but it was not specific enough to guide our budgetary decision-making. Frustration was mounting as our inability to turn this around continued. Why couldn’t we find the answers? Weren’t we marketing effectively? Didn’t we have the right management company to advise us and carry out our requests? We needed help now and nothing seemed to be bringing us together. So we decided to invest substantial effort in creating a request for proposals to see what other management companies might offer. Although we received several reasonable responses about how other companies could manage ACRM, one response was particularly intriguing-one firm actually told us that it was premature to consider management company issues. It was clear to that firm that we had a much bigger problem. First, we needed to develop a specific organizational focus that was manageable in size and scope. They proposed this as a necessary precursor to identifying the right management company. The Board of Governors was intrigued. We could no longer espouse being all things to all areas in rehabilitation. The Board Members decided we needed to assess the field and determine if there was a current niche for an organization with ACRM’s values around which we could develop a focus. In preparation for this assessment we listed our values-beliefs that ACRM has had over the years: l The importance of the team. l The value of diversity among our many disciplines. l The uniqueness of function as our rallying point. l The importance of quality of life as a measure of our truth. l The creation of outcome measures. l The involvement of the family in our work with people with disabilities. l The essential nature of working with the spirit of the person in pursuing goals that are selected by the person and the family. l The implementation of wellness and prevention themes for patients and clients. Now we were ready for the next step.
OPENNESS TO CONSIDER ANY OPTION We commissioned the firm of Smith Bucklin and Associates to obtain from the ACRM membership and other organizations and leaders in the field, their perceptions of our uniquenesses and their recommendations for the future for ACRM. This was a very bold move by the Board. We agreed that the situation was urgent enough and important enough that we would be willing to seriously consider radical recommendations such as: 1. Close down the organization, acknowledging that it no longer served a useful purpose to the field; 2. Focus on a purpose that might reduce our numbers to a very few-but committed-members; 3. Merge with another group;
Arch
Phys Med
Rehabil
Vol 78, December
1997
1288
ACRM
PRESIDENTIAL
4. Do whatever it might take to turn around the current decline. With the assistance of Pat Kitchell-Landrum, an ACRM member and a professional facilitator, we primed ourselves to be very open-minded and gave Smith Bucklin encouragement to explore everything and anything as possibilities. THE DECISION FOR A NEW FOCUS Prior to the face-to-face Board meeting in June, the Board members each had a copy of the Smith Bucklin and Associates report and their multiple recommendations, but no one knew what the discussion and outcome would be, ie, which recommendation, if any, the Board would decide upon. The report stated: “Two unique aspects of ACRM membership that continued to be emphasized (by those surveyed) were: 1. ACRM’s multidisciplinary emphasis and the sharing of information among multiple rehabilitation disciplines in all of the various ACRM forums-the annual meeting, articles in the Archives, and the opportunity to meet, share, and network with all individuals involved with the rehabilitation team; and 2. ACRM’s continued emphasis on rehabilitation research and the forum that the Congress provides for the sharing of that information. It was agreed that these two items were unique to ACRM and were not available through any other rehabilitationrelated professional association.” Smith Bucklin nronosed four ontions for ACRM’s future: Dismantle the ACRM and distribute its assets to some other rehabilitation organization, perhaps for research fellowships bearing the ACRM name; Merge ACRM’s resources with another rehabilitation organization and retain our identity by becoming a special interest group (SIG) or council of that organization; Become a nonmember organization within rehabilitation medicine that sponsors a rehabilitation week by holding a weeklong biennial mega meeting, attracting various disciplines and organizations within rehabilitation; or Become an organization that concentrates its efforts on issues related to research in rehabilitation. These were the options for discussion. To avoid influencing one another, every Board member put in writing their preferred option and a brief explanation for their selection. At the Board meeting, these were read aloud by each member before any discussion. Although the members gave careful consideration to each option (and some combination of options), there was a convergence on the option of ACRM becoming focused on clinically relevant rehabilitation research. What, then, a fitting theme for this conference: “Rehabilitation Outcomes: Transforming Science into Reality.” I must say, as I assumed the presidency last year, it never occurred to me that we would undergo such an investigation of ourselves, let alone come to this conclusion. I have become very excited about this focus as I imagine possibilities of how we can operationalize it. STEPS TO ACTIVATE THE NEW FOCUS What are the possibilities of how ACRM might look with this new focus as an emphasis? We could provide think tanks for clinicians, administrators, educators, consumers, etc, to talk about what research information they need, what they think should be done, how they can participate or partner with researchersto get the type and quality of research that is of value to them, etc. Arch
Phys
Med
Rehabil
Vol78,
December
1997
ADDRESS,
Hart
We could create ways for ACRM to help funding sources formulate requests for proposals, ensure that monies are still appropriated for key areas of research, and continue to increase the quality of rehabilitation research and the respect that it has in the research, medical, payer, and consumer communities. Our annual meeting could look radically different if we identified and invited researchers and clinicians at the cutting edge of our field not just to present their findings, but to conduct full inquiries into particular topics and, perhaps, develop papers summarizing those inquiries. We could devise ways for newcomers to the field of rehabilitation to interact with and learn from those of us with experience through mentorship programs-both short- and long-term. How many of us were fortunate enough to have learned from people such as Sheldon Berrol or Irving Zola because of ACRM? Your Board has taken on the challenge of moving the ACRM into the future, creating an organization that has something powerful and meaningful to contribute to our members and to the people we are committed to serving. Yet it is not something the 12 Board members can do alone. There are some possibilities that seem obvious and easy to implement. For example, the Board has discussed and approved two levels of interdisciplinary special interest groups (ISIGs). Level 1 is similar to the current Brain Injury-ISIG structure, where some officers and self-directed goals and projects sustain the group throughout the year. Level 2 is a networking group-individuals with a common area of interest who meet informally. A networking group may or may not choose to take on the form and substance of an ISIG. There are other possibilities that will need time to evolve and take shape before we can move to the next step. Possibilities for the future always result in many questions. We are counting on the help of all ACRM members as we begin to look at the ways in which these and other possibilities can be developed. Help us find the answers to the many questions we all have: l Should the research committee be divided into multiple groups to address specific issues more comprehensively? l How much should we focus versus stay broad on the research agenda we address? l What sorts of creative ways for dissemination of research can we use? How can we be a model for doing this? l Who, if anyone, should we partner with, and in what ways? Possiblepartners include the National Institute for Disability and Rehabilitation Research, National Center for Medical Rehabilitation Research, and the research committees of other discipline-specific or diagnosis-specific groups. Answers and actions on these questions and others are the next steps if ACRM’s commitment to a focus of rehabilitation research is to be alive, palpable, energizing, and irresistible. Are you willing to stand and be a part of this? ACRM is moving into the future, and you are invited to come along. CONTINUITY FOR THE FUTURE One goal this year has been to develop a oneness as a Board and to put things into place so that there is a continuity from year to year, from president to president. This has been achieved. Each Board member is a potential president of the organization after 3 years of service. After the decision to focus ACRM on rehabilitation research, Board members were offered an opportunity to consider the extent of their personal commitment to lead the organization around this new focus. I want you to know that each Board member has recommitted to the ACRM and to its new focus. The 1997-98 nominees for Board members and officers have likewise committed to this new focus. ACRM will move forward as a purpose/goal-driven organzation rather than a personality-driven organization. Ted Cole,
ACRM
PRESIDENTIAL
President-elect and Kate Fralish, nominee for President-elect, are particularly committed to this. Thus, the focus on clinically relevant rehabilitation research is here to stay. It is worth it for you to spend time to think about how this can manifest within ACRM. YOUR CHALLENGE AT THIS MEETING There are now many many decisions to be made and this 1997 meeting is occurring at a critical time in the process of developing the focus. Your challenge here is to participate and to discuss and offer suggestions within our committees and ISIGs and in conversations with the ACRM leaders. If you are unable to speak with a member of the Board at this meeting or if you have thoughts after the meeting, call or e-mail us.
ADDRESS,
1289
Hart
The time to speak up is now. In October/November the Board will review the many ideas received. We will begin to build the structure to bring forth the new focus on clinically relevant rehabilitation research. The ACRM has become a work in progress-it is a pliable form of clay with its shape and substance clearly outlined. But our future is yet to be sculpted-the details are yet to be set. This is the meeting at which we all must create. My hope is that next year, in Seattle at the 75th Anniversary of ACRM, the oldest multidisciplinary rehabilitation organization in the world, we will see the significant changes in our work of art and we will all able to say, “It wasn’t easy, but it was worth it!”
Arch
Phys Med
Rehabil
Vol78,
December
1997