Allan L. Klein, MD, FASE, FRCP (C), FACC, FAHA, and FESC

I am on a plane going to England and Ireland for a nice vacation with my wife. I can’t sleep and start reading a downloaded New York Times paper on my iPAD and am struck by the large headlines: BREXIT: UK Leaving the European Union. I am trying to figure out why it happened and what it means for the governance of Europe and Britain as well as Ireland. What happens if England leaves the European Union but Northern Ireland stays? What happens to the economies of these countries and exchange of goods and peoples through the borders? What a huge change in the governance of Europe!

On a closer to home front, the ASE is changing its governance structure in order for the ASE Board to be more diverse, efficient, responsive, and engaged. The basis for these changes is to make ASE more transparent in its strategic decisions as well as allow better communication among the committees, councils, and taskforces. There will also be an emphasis on standardization among the councils in terms of standard operating procedures and leadership. Also, there will be ongoing changes in the ASE foundation in the coming years.

We made these changes based on membership surveys and discussions with the council, Board, and committee chairs. What does this mean for the general ASE membership who are doing echoes in Traverse City, Michigan or Island Health, British Columbia? (I actually received questions from sonographers from these diverse areas of our membership.)

Currently the governance of the ASE authorizes 29 members to serve on the Board of Directors, including seven serving as officers on the executive committee and 22 as regular Board members. There may be a common perception that the executive committee “runs the show” and that perception may be right. The Board is quite large, and members attend up to three meetings a year including the Scientific Sessions and the November and February retreats. The executive committee has one and a half hour conference calls every two weeks to handle the more urgent issues that arise between the meetings of the larger Board. In contrast, the other Board members are not as in tune with these issues as we would like, perhaps due to the large number of members. In addition, there is a perception of a lack of diversity in the Board’s membership, without representation from other specialties engaged in echocardiography, like the POC users, as well as those that are internationally based (this segment of membership now makes up 17% of our members), and young leaders. Things had to change.

In the last year and a half, there was a governance taskforce led by past president, Neil Weissman, MD, FASE. After many conference calls and meetings, the taskforce proposed a major shift in the governance of ASE to make it a more active and nimble organization. This shift may be not as dramatic as Britain pulling out of the European Union but rather similar to what the ACC has proposed to do with a major shrinking of their board. Let me outline the key changes in ASE governance.

The executive committee will remain the same with a president, president-elect, and vice president as well as past president. This will be similar to before since there is a significant learning curve in the ladder to the presidency. In addition, the executive committee will be composed of a treasurer, secretary, and Council representative, as well as the CEO as an ex-officio member. Based on the importance and large representation of sonographers in the organization, the secretary of the executive committee will be a representative position, always slated to be filled by a sonographer. Of note, this guaranteed position was in the past the council representative. All the other positions on the executive committee will be open to both physicians and sonographers, and they can be from any segment of the membership (they just need to have attained an FASE designation). There is no reason why a sonographer cannot be treasurer, council representative, or on the presidential track. Currently, a pediatrician is the treasurer and the council representative is a sonographer. The councils will change also with smaller and more diverse membership and leadership positions open to all members. There will be standardized council terminology that can be used across all council steering committees and be used for newer councils, like Point of Care (POC), as they are added in the future.

The Board structure will shrink gradually from 29 down to 20 over five years. The terms will now be two years at a time (from the current three years) and can be renewed for good behavior (like doing time!!) and engagement. There will be more frequent Board conference calls which will demand greater attention of every board member. The makeup of the Board will gradually shift to be more diverse including a POC representative (from the Council chairman’s position), international representative, and young leadership (through a leadership academy). Qualified sonographers (as well as physicians or allied health professionals) will be highly represented in the future structure as long as they apply and have the necessary skills to represent the ASE. The nomination structure will have to adapt to these changes in the governance. The Nominating Committee is aware of these changes and is working now to help solicit and promote these new avenues.

What will the ASE governance look like? By 2021, the Board would be composed of seven executive committee members, five members at large, five council chairs, one international representative, one leadership academy representative, and one past president.

ASE is going through a mild ASEXIT which is a recalibration of the direction of the society rather than a major BREXIT. In the long run, the Board will be smaller and very active with less emphasis on the executive which will make the society stronger, more productive, and collaborative in the coming years.

Allan L Klein, MD, FASE, FRCP (C), FACC, FAHA, and FESC, is the Director of the Center for the Diagnosis and Treatment of Pericardial Disease and Staff Cardiologist at the Cleveland Clinic and Professor of Medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.