ASSH presidential address: Power of inclusion

TY - JOUR

T1 - ASSH presidential address

T2 - Power of inclusion

AU - Lee, W. P.Andrew

N1 - Funding Information: As a membership organization, the ASSH is also a large team of like-minded people with the shared goal of advancing the field of hand surgery. To make us a more effective organization, we should look toward the latest science in team building. Sandy Pentland, Director of the Massachusetts Institute of Technology Human Dynamics Laboratory, studied team behavior and performance in a variety of setting including banks, hospitals, and backroom operation teams. 2 Using wearable electronic sensors called “sociometric badges,” the research team studied how people communicate in real time, to determine the characteristics that make up great teams. They then correlated team performance with the observed communication patterns and found that how people communicate turns out to be the most important predictor of team success, and as important as all other factors combined, including intelligence, personality, skill, and even the content of discussions. According to Dr. Pentland, the old adage that it is not what you say, but how you say it, turns out to be mathematically correct. Specifically, they found that the high-performing teams share 4 common elements: • They communicate frequently in short, focused conversations. • They communicate with everyone equally and listen as much as, or more than, they talk. • They talk outside formal settings, such as during lunch breaks or social occasions. • They frequently seek ideas and information outside the group. In contrast, lower-performing teams have dominant members, teams within teams, and members who either talk or listen, but do not do both. The key to high performance lies not in the content of a team's discussions, but in the manner in which it is communicating. The best way to build a great team is not to select individuals for their smarts or accomplishments, but to learn how they communicate and to shape and guide the team so that it follows successful communication patterns. Professor Jeanne Brett from the Kellogg School of Management described the advantages of what she called “fusion teamwork,” which prevents domination of a single subgroup. 3 Fusion teams can often be achieved by breaking a large team into smaller subgroups, encouraging informal conversations and input from quiet team members. The trust and respect generated within the subgroups then make it easy to facilitate collaboration and obtain meaningful participation from all team members. The ASSH members indeed make up a large, diverse team. Not only are we composed of orthopedic, plastic, and general surgeons, we have different degrees of academic affiliation. Our survey showed various distributions of anatomic areas, as well as different extents of activities outside the upper extremity. Although we no longer have a 2-tiered system in membership, some still regard the ASSH as a closed and even elitist organization: an old boys' network, if you will. An inclusive model has been shown in business to get the best performance from a diverse group. In his book Power of Inclusion , Michael Hyter noted that there is an enormous amount of wasted potential within organizations today because most do not adequately tap into the wealth of human capital available to them. 4 He argued that organizational meritocracy is often a myth that masks unequal opportunities perpetuated by exclusionary tendencies. Such tendencies are often built into leadership, with leaders training and developing those most like themselves. He urged creation of a culture of inclusion and development, to unlock employee potential and productivity. Inclusion can help to achieve consensus. Leadership consultant Deborah Chambers Chima wrote that inclusion is the sharing of ideas from all perspectives. 5 Inclusion is people working together despite differences, to create success for a common cause. Inclusion is the creation of a culture in which differences of thought and opinions are embraced with enthusiasm and are celebrated. An environment of inclusion is present when everyone feels free to offer his or her perspective in a professional manner without fear of rejection or loss of position. Being inclusive means becoming comfortable with allowing disagreements to surface, so that the best strategies can be determined after all opinions are heard. Chima also described examples of the power of inclusion: When everyone's opinions are truly valued, the goals of the organization can be achieved in an accelerated manner. An inclusive environment minimizes the opportunity of an insider versus outsider culture to gain traction. When people feel that they contribute to the greater good, they are more likely to go the extra mile. Finally, Glenn Tecker, a renowned consultant for nonprofit organizations, described a “high performing inclusive organization” as one whose governance is based on knowledge, trust, and nimbleness. 6 It takes initiatives that have embedded diverse points of view and makes decisions that anticipated impact on inclusion of diversity. Is the ASSH a high-performing inclusive organization? That was one of the questions examined by the identity task force this year led by former President Steve Glickel. Examining membership data, we found that the ASSH membership trend continues to be strong, now at 3,333 in total ( ). However, the slope of increase has been much slower for plastic and general surgeons, which accounts for a steadily lowering percentage of plastic and general surgery members, now at 17% and 6%, respectively, in contrast to 76% for our orthopedist members. Fig. 4 Breakdown by practice type showed that 43% of our members are in “pure” private practice, whereas another 26% are in private practice with university affiliation and/or teaching responsibilities ( ). Fig. 5 Only 21% of ASSH members are solely academic. Our members were asked in a survey whether ASSH programs and services are more focused on private practice or academic member needs. Whereas more academicians thought the emphasis was equally balanced, a significant majority of those in private practice, with or without academic affiliation, believed ASSH programs and services are more focused on academic members ( ). Table 2 Why is there such a dichotomy in perception? There are obviously enormous talents among our private practice members. Many ASSH private practice members are leaders of other societies, state boards, and practice groups. Serving on our identity task force, for example, was Andy Gurman, the current Speaker of the American Medical Association House of Delegates. Yet, some private practice members believe that our Society opportunities are preferentially given to those in the “academic club.” It is the Council's belief that private practitioners should have the same access to participation in committees, education, and leadership. To encourage inclusion of private practice members, the Council revised application for Council Division Directors to allow private practitioners to highlight their involvement in service and non-academic leadership activities. It was thought that applications for the current Council Division Director positions were written in a way that allowed academic applicants to promote their qualifications and accomplishments, but did not do the same for private practitioners who might apply for the Director positions. Therefore, the applications were modified to try to level the playing field for private practitioners. A new Private Practice Committee was established this year that aimed to enhance the experience of our private practice members and identify areas of unique concerns to be addressed by the Council. The Committee will identify private practice members interested in educational activities for chapter authors, course instructors, and annual meeting presenters, and those interested in ASSH committee and leadership participation. This new committee will be chaired by Charlie Eaton, with members including Young Leaders and many who had not been previously involved in ASSH activities. Another important aspect of ASSH identity is our membership criteria, which should fulfill our long-term goals and needs. After asking a lot of hard questions and careful deliberation, the Council reached consensus that our Society should preserve its brand integrity as the premier organization representing hand surgeons with Certificate of Added Qualification (CAQ). In the meantime, our educational offerings are accessible to anyone with an interest in upper extremity surgery. Finally, we established membership pathways under special circumstances for those who have made significant contributions to hand surgery but are not eligible for CAQ because of training or other extenuating factors. To ensure continued inflow of members, we then examined the sequence of becoming an ASSH member. As everyone knows, after hand fellowship, one needs to obtain primary Board certification before obtaining the CAQ, which is the requisite for becoming an active member in the ASSH. With much hard work by our Member Capture task force, led by Council member Chuck Goldfarb, we studied the percent conversion from fellowship graduation to obtaining the CAQ to becoming ASSH members. We obtained some alarming results. Of those graduates of hand fellowship from 2000 to 2007, only 58% went on to obtain CAQ, and only 50% of those graduates eventually became ASSH active members ( ). In other words, Fig. 6 we are capturing one half of the fellowship graduates as our members . We are in the process of identifying and addressing causes for the significant drop-off for CAQ takers becoming our active members. As a start, the Council has made recommendation to the American Boards of Orthopedic Surgery, Plastic Surgery, and Surgery, respectively to modify requirements for the CAQ examination to accommodate those who, just as with over 40% of our members, may not have an exclusive practice in hand surgery. With regard to leadership selection, I learned that the phrase “smoke-filled room” originated from the same Blackstone Hotel where our Society was founded. It is perhaps no coincidence that it fits the perception by some of the ASSH Nominating Committee. The Council believes that it is in the long-term interests of our organization for the leadership to be selected in an open, objective, and transparent fashion, and has taken steps to modify the nominating process: • For the first time, candidates for 2 members of the Nominating Committee were nominated at Members Business Meeting earlier today and will be voted by ASSH membership. • Any Nominating Committee member with potential conflicts of interest is recused from discussion and voting for the position. • With the exception of the Immediate Past President chairing the Committee, Past Presidents and current Council members cannot serve on the Nominating Committee. • Nominating Committee voting will be conducted confidentially without peer pressure. • The chair of Nominating Committee should explain the qualifications of the recommended nominees. • Council may pull nominees from the proposed slate for focused review. Finally, in this political season, my talk would not be complete without discussing the gender gap. In the ASSH, the gender gap has closed from 100% to 76% (88% male and 12% female members) overall, with increasing percentages of women members in each younger age group ( ). To celebrate and achieve further diversity, the ASSH Women's Hand Surgery Group has been created this year. The group already has 246 members and will hold its kickoff event this evening. Furthermore, a list of underrepresented members interested in serving on ASSH committees will be compiled for consideration. A member of Diversity Committee will participate in Young Leader selection, the Committee Advisory Group, and the Nominating Advisory Group. Table 3 According to Henry Ford, “coming together” is a beginning, “staying together” is progress, and “working together” is success. This quote has been elaborated by Hall and Thompson as follows: For a team to come together, its members must share a common goal. 7 For a team to stay together, its members must recognize the different strengths people bring to complement each other. For a team to work together successfully, its members must become proficient in collaboration. A great example of our coming together with a common goal is the American Foundation for Surgery of the Hand. With our member contribution during the past 10 years, the Foundation has awarded more funding to hand and upper extremity research grants than any other medical society or the Orthopedic Research Education Foundation. This year, in the spirit of inclusion and engagement, the Foundation Board and Council have expanded the mission of the Foundation to incorporate research, education, and outreach. In honor of the 25th anniversary of our American Foundation for Surgery of the Hand, we are announcing the launch of a new capital campaign called Our Future in Hand, with a goal of $5 million. We will be increasing the potential size of grants for research, as demonstrated by the $100,000 we awarded for the first time this year. We will be funding new initiatives in education, many of which will be technology-driven and allow more effective and broad-based communication of new ideas and advances in the practice of hand surgery. We have created an outreach program, called the Touching Hands Project, which will enable many of us to serve in 1- to 2-week missions to share our talents in underserved communities. I hope each and every one of you will choose at least 1 of these areas and lend your support to these efforts. This evolution of our Foundation is truly amazing—who would have thought 25 years ago that we would be looking out at the next 25 years with the ideas and ability to make such impact, research with expanded clinical application, the ability to create breakthrough innovations that will help us all be better educated, and the chance to take our skills as doctors back to communities? Our own future is indeed in our hands. This capital campaign is a chance for all of us to step up and really be a part of the future of our profession.

PY - 2013/12

Y1 - 2013/12

UR - http://www.scopus.com/inward/record.url?scp=84888402350&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84888402350&partnerID=8YFLogxK

U2 - 10.1016/j.jhsa.2013.08.121

DO - 10.1016/j.jhsa.2013.08.121

M3 - Editorial

C2 - 24275053

AN - SCOPUS:84888402350

SN - 0363-5023

VL - 38

SP - 2437

EP - 2449

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

IS - 12

ER -