Modernizing Our Culture

Editor's note: This article is the third in a four-part series dedicated to understanding and implementing the new AAOS Strategic Plan. Parts one and two, which focused on the Members and Patients goals, respectively, were published in the August/September and October issues. Part four will be published in an upcoming issue.

In February 2024, the AAOS Board of Directors (BoD) approved a new 2024–2028 Strategic Plan, building on the successful foundation of the prior 5 years. The new plan prioritizes four strategic goals—Members, Patients, Culture, and Musculoskeletal (MSK) Community. This article will explore the Culture goal, helping members build a strong understanding of our evolving strategic direction.

The Culture goal forges a path forward to increase AAOS’ ability to navigate a changing environment on behalf of our Fellows and their patients. The overall goal description, “Modernize governance to ensure an adaptive, inclusive, and sustainable organization,” reflects such a path forward, ensuring AAOS can act with commitment and adaptability and provide longevity. The Culture goal is comprised of three Strategic Objectives to clarify direction and focus over the next 5 years.

Strategic Objective: Advance our governance to improve our organization’s efficacy
To be a better-informed and highly effective BoD and a more stable and future-proof organization, AAOS must reorganize its governance structure and bylaws. AAOS has a rich history of leadership in orthopaedics and remarkable volunteer support from its members. Volunteers participate in a governance structure of councils, committees, workgroups, and the BoD, all of which operate under a set of bylaws that have not had a major update for almost 30 years. However, orthopaedics as a profession continues to evolve through varied employment models, government regulations, and changes in care-delivery models. Similarly, professional associations are changing across myriad membership models to adapt to differences between generations and career stages and incorporate emerging technology, education, and advocacy topics. AAOS’ governance must evolve along with the landscape in which we operate.

Unlike policies and procedures that can be easily revised as the environment changes, bylaws are fixed. At AAOS, a bylaws change today requires up to 7 steps to adopt. The process is led by the Bylaws Committee, which may recommend final changes to proposed bylaws even after Board of Councilors (BOC), Board of Specialty Societies (BOS), and BoD assessments. Additionally, the Bylaws Committee has no fiduciary responsibility to the organization. Our bylaws are also overly detailed, containing specifics that are typically not seen in other organizations’ bylaws but are often found in policy manuals of effective organizations. These specificities affect the ability to make changes to adapt to the needs of the members and organization.

AAOS is advancing its governance in many ways. The Board has been assessing its performance over the past 3 years with the goal of understanding how it can improve its function. The area most in need of improvement is the way in which Board members are recruited. There is a need to recruit Board members and other volunteer leaders based on their skills and competencies, to best take AAOS into the future.

For example, AAOS has had a public board member for many years, someone who is not an orthopaedic surgeon who offers deep expertise and a different perspective. Lisa Masters, MBA, is a current public Board member with strong expertise in finance and organizational efficiency. AAOS recently searched for a second public Board member, looking for someone with complimentary skill sets. As a result, the Board engaged Lilly Marks, who brings substantial experience in organized medicine, policy, and leadership. Surgeon positions on the BoD have not been selected in this way. The BoD now characterizes its members by skill sets as well as practice type, specialty, location, age, gender, and race. The BoD has recommended a process that will lead to service less dependent on popularity and more on the skills and experience that the Board needs at that time. This new approach will open leadership opportunities to more members and create a BoD that is more capable of offering varied opinions to lead to the best decisions.

AAOS member volunteers bring incredible expertise, energy, and valuable perspective to bear on strategy, products, and operations. The Board believes that the proposed bylaws changes (see the Sidebar) will allow AAOS to be as adaptive and effective as possible for continued success in the future.

Strategic Objective: Establish inclusive and equitable pathways for all qualified candidates to thrive and develop as leaders
AAOS remains committed to diversity, equity, and belonging in its leadership, our membership, and the profession. In the prior Strategic Plan, diversity was part of the Culture goal. In the present plan, in which patients are an additional focus, these diversity concepts are seen in multiple pillars: in the Members goal, “to recruit and retain a diverse membership”; in the Patients goal, through advocacy “to improve health equity”; in the MSK Community goal, by “partnering with specialty societies”; and in this Culture goal, to “broaden pathways for leadership.”

The AAOS Leadership Institute (ALI) gives all members open access to Levels 1 and 2, encouraging more members to volunteer and gain governance experience, increasing the pool of future leaders, familiarizing members with AAOS’ structure, and increasing member engagement. ALI Levels 3 and 4 offer leadership development with the goal of fostering future AAOS leaders. Our Governance Committee will be monitoring and improving this program.

AAOS has increased participation in the Resident Assembly and expanded the ability for all members to apply for positions through the Committee Appointment Program (CAP).

AAOS is also committed to improving the orthopaedic pipeline, offering Inclusion, Diversity, Equity, and Access (IDEA) Grants to promote diversity throughout the profession, along with hosting Town Halls and similar forums to listen to member perspectives. AAOS connects all levels of the profession, from our Fellows to recent new members such as physician assistants and now medical students.

Strategic Objective: Build trust through data-driven strategic decision-making, two-way communication, and transparency
The Academy attempts to be strategic and data driven when making decisions to navigate our rapidly changing ecosystem and best respond to our members’ needs. All decisions that are made by the Board, councils, and committees require accurate data upon which to act. A data-driven approach helps to level our own biases and provides a backbone for future Boards and council/committee members to understand and put prior decisions in context. Data are the strongest institutional memory that we have, and these metrics help future leaders see the changes we need to address for our members.

Bidirectional communication is another clear focal point, referenced not only in the Culture goal but also in the Members goal; it is also a Key Enabler. AAOS is enhancing its ability to listen to members and partners from a variety of sources, including the Annual Meeting and the Combined National Orthopaedic Leadership Conference/Fall Meeting and BOC and BOS meetings. Feedback is also shared via aaos.org, the AAOS Membership App, social media, and member forums such as Diversity Town Halls. Under the leadership of Joel Mayerson, MD, FAAOS, chair of the BOC, this year was the first in which he and the AAOS Presidential Line hosted regional meetings (a “listening tour”) that included all states and invited all BOC and state society members. Communication is the most important way that the Board, councils, and committees can be well informed and adapt to our collective challenges as they occur.

All of these efforts are meant to build trust and increase transparency, enabling AAOS to maintain long-term sustainability and effectiveness and successfully support members and their patients. The Strategic Plan and its goals are available for our members to see at aaos.org/StrategicPlan.

The new AAOS Strategic Plan first and foremost reflects a focused commitment to members. We have added patients and patient engagement as major pillars, along with the goals of modernizing our governance and engaging with the MSK community. In particular, partnering with our BOS societies is a major area of emphasis that has begun at the Board level and will include all councils and committees. The Culture goal is a foundational piece of the larger plan that allows all of the other goals to be successful. It provides AAOS with a strong base from which to pursue its mission to serve the profession and achieve its vision as the trusted leaders advancing MSK health.

Paul Tornetta III, MD, PhD, FAAOS, is the 2024-2025 AAOS president and the director of orthopaedic trauma at Boston Medical Center. He is also professor and chair of the Department of Orthopaedic Surgery at the Chobanian & Avedisian School of Medicine of Boston University.

Coming together to modernize governance

AAOS is proposing changes to modernize its governance to ensure that it is better able to face the challenges ahead in serving our members, their patients, and the profession. The proposed changes were developed through an extensive, collaborative, comprehensive, and transparent review process led by the AAOS Board of Directors, which included input from many AAOS Fellows.

The last comprehensive update of AAOS bylaws was approved in 1996, but the scope and pace of change in the musculoskeletal community and throughout healthcare have accelerated. The bylaws have become heavy with additions and detail over time. In this dynamic environment, governance changes are necessary to break down barriers to thoughtful leadership and efficiency; streamline roles and responsibilities; and equip the AAOS Board with a quicker, more agile, flexible decision-making process.

The Board has worked for more than a year to generate new bylaws. The goal of this process was to rewrite the bylaws from the ground up and create a minimal set of bylaws under Illinois state law. In addition to the required elements, the advisory bodies of the Board of Councilors (BOC) and Board of Specialty Societies (BOS) are also codified, as they are necessary for two-way communication with the Board. Other changes include:

• focusing on active members by allowing only active Fellows to vote
• revamping the Nominating Committee to include Board members, who can provide institutional memory, and to frame the current needs of the Board clearly
• creating a Bylaws Committee with fiduciary responsibility to the organization
• attempting to amplify the representational nature of some of the BOC and BOS board members
• changing the way that future bylaws amendments will occur (although with the minimal set of bylaws, this should not be needed for a very long time)