To the Editor

Readers of John Milam and James Carson's1  comprehensive yet concise history of the College of American Pathologists (CAP) House of Delegates (HOD) might conclude, as did we, that for most of the HOD's existence, its relationship with the CAP has been ill defined and adversarial. We describe the HOD's recent 4-year journey (2010–2014) to repair that relationship and to integrate the HOD into the organizational fiber of the CAP.

THE HOD

The CAP HOD is an elected body of CAP fellows who represent to the leadership of the CAP the views and needs of its 18 000-plus members.2  Delegates serve 3-year terms, elected by CAP fellows residing in their home states, apportioned 1 delegate per 50 CAP fellows. To manage the affairs of the HOD, delegates elect a steering committee (HODSC) comprising the speaker, vice speaker, secretary, 2 sergeants-at-arms, and 2 members-at-large.3  Twice yearly, the HOD convenes for 1-day meetings, one of which is held in conjunction with the CAP annual meeting and other of which is held in the spring.

ORIGINS OF THE HOD: A WELL-INTENTIONED IDEA EXECUTED POORLY

The CAP is a baby boomer, founded 12 days before Christmas, 1947. Incorporated under the laws of the state of Illinois, CAP bylaws placed the responsibility for establishing and executing CAP policy in the hands of its Board of Governors (BOG).2  It did not take long before the rank and file of CAP fellows articulated their desire to share in CAP policy making.1  The dialogue dragged on for 23 years, culminating in the passage of CAP bylaws establishing the HOD as the “legislative body” of the CAP, and hence a vehicle by which non-BOG members could have a hand in crafting CAP policy.2 

This assignment of the HOD as a legislative body turned out to be one in name only, having perhaps political but certainly not functional purpose, as there exist nowhere in CAP bylaws provisions requiring anyone to enact or implement any “legislation” that might emanate from the HOD. For the better part of half a century, this disconnect appears to have been the root of mutual frustration and irritation among members of the HOD and BOG.1  Delegates seemed to have had only vague notions about their roles, the HOD's role, and the purpose of HOD meetings, if indeed they attended those meetings at all. Prior to 2011, HOD meeting registration had dropped to its lowest levels (Figure 1).

Figure 1. 

House of Delegates membership.

Figure 1. 

House of Delegates membership.

House leadership and delegates' engagement in the HOD seemed to be limited to a relatively small number of delegates, perhaps regarded by some as “insiders.”

In 2010, the HODSC (Table 1) set out to repair this fractured relationship, revive pride in and the purpose of the HOD, and forge a cooperative working relationship with the rest of the CAP. Driving this determination was the HODSC's opinion that the HOD was the only body within the CAP available to and capable of coalescing and representing to the CAP leadership the collective views of CAP's membership.

Table 1. 

College of American Pathologists (CAP) House of Delegates Steering Committee Members Serving Between October 2010 and September 2014

College of American Pathologists (CAP) House of Delegates Steering Committee Members Serving Between October 2010 and September 2014
College of American Pathologists (CAP) House of Delegates Steering Committee Members Serving Between October 2010 and September 2014

ESTABLISHING OUR MISSION, VISION, AND STRATEGY

Speculating that delegates lacked a unified sense of mission and vision for the HOD, the HODSC offered definitions for both. They interpreted the mission of the HOD, namely the voice of the membership, as articulating to the BOG the needs of the CAP membership and apprising the BOG on the success with which delegates believed the BOG addressed those needs. They defined a vision for the HOD as One College, the intention that the HOD and the rest of the college—the BOG, councils, and committees—work cooperatively as a single unit.

EXECUTING THE MISSION: HOD STRATEGY

In order to achieve its mission, the HODSC designed a strategy to accomplish 3 objectives:

  1. 1.

    Remove the unworkable notion of the HOD as “the legislative body” of the college (or for that matter the wisdom of having an organization with more than one policy-making arm).

  2. 2.

    Engage delegates in the operation of the HOD.

  3. 3.

    Engage the BOG in partnering with the HOD.

The HODSC replaced the HOD's fabricated legislative role with one that established the HOD as the “customer,” apprising the board as to how well HOD delegates believe college activities and policies meet the needs of the CAP's 18 000-plus members. To legitimize this role, HOD delegates voted to remove from their HOD rules (2011), and to have the BOG request that the CAP membership remove from the college bylaws (2014), verbiage that designated the HOD as a legislative body.

To engage their fellow delegates, HOD members wrote job descriptions for all HOD positions. To hold delegates accountable for performing those jobs, HOD leadership posted on the HOD Web site delegates' performance compliance statistics.4  House leadership created opportunities for delegates to involve themselves in HOD operations by initiating a series of projects, all designed to build the infrastructure necessary to execute the HOD's mission, achieve its vision, and provide value to the CAP. Each project was performed by an HOD action group (AG), chaired and staffed by rank and file delegates. House leadership assigned to each AG a charge, deliverables, and deadlines by which to complete their projects. House leadership reconstituted with new members those AGs that were unable to complete their assignments within their deadlines.

House leadership created a platform upon which delegates could articulate their voices. Once yearly, the HODSC presents to the BOG essential membership needs as brought forward by delegate chairs. CAP governors then describe what they are doing to address those issues. The HODSC places governors' responses on the HOD Web site in a location dedicated specifically for that purpose, and where delegates may debate those responses.5 

House leadership created a second platform that allows delegates to express their assessments of how well they believe the BOG addresses essential membership needs. Once yearly, delegates complete a survey evaluating BOG performance. The results are tallied onto a BOG report card and posted on the HOD Web site (Table 2).6 

Table 2. 

2013 House of Delegates Report Card Summarya

2013 House of Delegates Report Card Summarya
2013 House of Delegates Report Card Summarya

Revising HOD strategy included revising the format of biannual HOD meetings. Rather than present, as they did formerly, topics that HOD leadership believed might interest delegates, HOD leadership now arranges presentations that address issues according to preferences that delegates rank on yearly surveys. At spring HOD meetings, candidates for CAP governor and officer positions no longer present, as they have done in the past, their bios and campaign speeches, but instead spend the entire session answering unedited questions put to them by delegates.7 

ACHIEVING THE VISION

The HODSC reasoned that in order to realize the vision of One College, the HOD would have to provide the CAP with tangible value. In considering what that value might be, the HODSC alit upon the notion of linking this value to activities that they believed embodied the motivation that drove fellows to become delegates in the first place, namely to have voices in shaping CAP policy, to become CAP leaders, and to be involved in CAP activities.

Delegates influence CAP policy by voicing to the BOG the needs of their constituents. For most issues, we believe the grades that delegates give to governors on yearly BOG report cards suggest that college governors are listening to that voice and incorporating its message into the policies that they create and implement.

The HOD has always provided delegates a portal by which to enter positions of leadership throughout the CAP. Historically, about a third of the CAP's presidents and two-thirds of its governors have initiated their leadership careers in the HOD. Currently, two-thirds of HOD delegates serve on CAP councils and committees. To provide additional opportunities for delegates to engage in leadership roles, the HODSC assembled AGs to serve as think tanks or customer research arms for the CAP. In the past 2 years, these AGs have produced 9 topics for future CAP practice guidelines, identified 67 conversation leaders for the CAP Peer2Peer program, characterized the composition of 234 pathology practices, profiled specific attributes and talents of 253 delegates, and advised the Council on Education on ways to improve its new learning management system.8,9  These activities provide value by assisting college leaders in their selection of qualified people to serve on CAP councils and committees and by ensuring that CAP programs meet the needs of its members.

MEASURING SUCCESS

Prior to launching its initiatives, the HODSC established outcome metrics by which to gauge its successes or failures. The former have outweighed the latter.

Engaging Delegates

Since September 2010 HOD membership has increased by 37% (Figure 1), the number of filled delegate positions by 26%, annual HOD meeting registration by 159% (Figure 2), and delegates' satisfaction with those meetings by 40% (Figure 3). The HOD archives do not include metrics by which to assess delegates' involvement in HOD activities prior to 2010; however, since 2010 the HODSC has provided 169 engagement opportunities for delegates.

Figure 2. 

House of Delegates fall and spring meeting registration. Reprinted from College of American Pathologists Web site10  with permission from College of American Pathologists.

Figure 2. 

House of Delegates fall and spring meeting registration. Reprinted from College of American Pathologists Web site10  with permission from College of American Pathologists.

Figure 3. 

House of Delegates' (HOD) satisfaction with meeting format. Scores are mean scores of delegates' responses to the following survey questions: (1) joint session with residents effective; (2) format allows HOD input to College of American Pathologists leadership; (3) format was appropriate and encouraged participation; (4) meeting met stated objectives. 5.0 = strongly agree, 4.0 = agree, 3.0 = neither agree nor disagree, 2.0 = disagree, 1.0 = strongly disagree. Reprinted from College of American Pathologists Web site10  with permission from College of American Pathologists.

Figure 3. 

House of Delegates' (HOD) satisfaction with meeting format. Scores are mean scores of delegates' responses to the following survey questions: (1) joint session with residents effective; (2) format allows HOD input to College of American Pathologists leadership; (3) format was appropriate and encouraged participation; (4) meeting met stated objectives. 5.0 = strongly agree, 4.0 = agree, 3.0 = neither agree nor disagree, 2.0 = disagree, 1.0 = strongly disagree. Reprinted from College of American Pathologists Web site10  with permission from College of American Pathologists.

One College

Yearly, the HODSC surveys delegates and governors to determine their assessment of the HOD's effectiveness, including its abilities to influence CAP policy and articulate the voice of the membership. The perception of effectiveness among both delegates and governors has increased steadily since 2010 (Figure 4).10 

Figure 4. 

House of Delegates' (HOD) and Board of Governors' (BOG) perceptions of HOD effectiveness. Scores are mean scores of delegates' and governors' responses to the following survey questions: (1) ample opportunities for delegates to participate; (2) College of American Pathologists leadership is receptive to HOD opinions; (3) HOD is an effective body and meets its obligations; (4) HOD input instrumental in influencing policy; (5) HOD functions well in articulating voice of membership. 5.0 = strongly agree, 4.0 = agree, 3.0 = neither agree nor disagree, 2.0 = disagree, 1.0 = strongly disagree. Reprinted from College of American Pathologists Web site10  with permission from College of American Pathologists.

Figure 4. 

House of Delegates' (HOD) and Board of Governors' (BOG) perceptions of HOD effectiveness. Scores are mean scores of delegates' and governors' responses to the following survey questions: (1) ample opportunities for delegates to participate; (2) College of American Pathologists leadership is receptive to HOD opinions; (3) HOD is an effective body and meets its obligations; (4) HOD input instrumental in influencing policy; (5) HOD functions well in articulating voice of membership. 5.0 = strongly agree, 4.0 = agree, 3.0 = neither agree nor disagree, 2.0 = disagree, 1.0 = strongly disagree. Reprinted from College of American Pathologists Web site10  with permission from College of American Pathologists.

RECOMMENDATIONS FOR THE FUTURE

By removing the incongruities in its charter, serving the needs of its delegates, and creating value for the CAP, the HOD has finally come to terms with its mission. To continue growing, provide value to the CAP, and realize its vision of One College, HOD leadership must capitalize on this momentum. In order to sustain the value that the HOD brings to the CAP, we suggest that future HODSCs consider the following recommendations.

Get a Job

The HOD needs to perform some task that the CAP views as being essential to function. The CAP must hold the HOD, and the HOD must hold its delegates, responsible and accountable for some function that creates mutual dependence and inexorably integrates the HOD into the infrastructure and operation of the CAP.

Broaden Our Network

The HOD must develop a communication network in which delegates can connect with their constituents, CAP leadership, and their peers in state pathology societies. The greater those bonds, the louder and more productive will be the HOD's voice.

Elevate the Stature

We believe that it is in the CAP's best interests to establish HOD leadership as a goal to which fellows aspire, just as fellows aspire to leadership roles in councils, committees, and the BOG. Perhaps providing the speaker a masthead in some CAP publication, similar to that occupied by the CAP president in CAP Today, might be the nidus about which to generate such enthusiasm.

Reverse the Direction

For the past 4 years, the HOD has engaged in activities designed to embrace the college. Now, the college needs to embrace the HOD. The BOG and its councils and committees, as a routine matter of business, must engage the HOD's assistance with and assessment of their activities. We suggest that CAP councils and committees begin by adding as a line item to their meeting agendas the consideration of partnering activities with the HOD.

Demand a Metric

Delegates must hold HOD and CAP leaderships accountable not for what they've done, but for what they've accomplished. They must require that their leaders provide measurable outcomes and mileposts for ventures and projects before they commit resources to initiate them. In the same manner in which the HOD evaluates and reports the effectiveness with which the BOG meets its responsibilities to the HOD and the CAP membership, so must the BOG evaluate and report on the effectiveness with which the HOD meets its responsibilities to the BOG and the CAP membership.

The HOD has gained much ground in the last 4 years. Unless the HOD continues to provide value to the CAP and its members, the HOD could revert to its former uncomfortable but familiar role as CAP antagonist. In their vision of One College, delegates have embraced their partnership with their physician and staff peers who make up the CAP. In order to sustain the value that the HOD provides the CAP, the HOD must now demand that the CAP embrace a partnership with the HOD.

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Author notes

The authors have no relevant financial interest in the products or companies described in this article.