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AQA Invitational Meeting Summary
AQA Mission and Governance
John Tooker, American College of Physicians
John Tooker discussed the AQA Steering Committee's ongoing efforts to develop a system and a structure for governance of the AQA. He noted that the AQA was founded as a broad-based collaborative with multiple stakeholders—and that over 150 people representing more than 80 organizations were in attendance at the meeting. He said that, as attendance has grown, the challenge for the AQA is to remain a relatively informal organization while allowing everyone to continue working together to improve health care quality and patient safety.
Tooker explained that the AQA Steering Committee was proposing to make changes for two key reasons: growth and complexity. Regarding complexity, he noted that the AQA is addressing not only measurement and quality improvement but also the relationships with measure developers and with the health information technology community.
At the request of the AQA Steering Committee, Tooker-along with Nancy Nielsen (American Medical Association) and George Isham (Health Partners)-developed a series of preliminary recommendations in four key areas:
- Workgroup processes and voting.
Tooker asked participants to approve the governance report in principle, as a first step toward finalizing new governance procedures for the AQA.
Tooker indicated that once the draft governance report is adopted, the next step will be to form a new AQA Governance Workgroup to review the language and bring back a final report for a vote at the October AQA meeting. The Governance Workgroup would be open to all AQA members who choose to participate.
As part of the review process, Tooker indicated that he intended to schedule a conference call, open to all AQA members, to address any questions about the governance document and/or the review process. He also announced that the AQA would have a 30-day review period for comments on the document.
The draft governance document contains the following recommendations:
Top-Tier Governance Recommendations
- The criteria for membership and voting membership in the AQA shall be established.
- Steering Committee membership shall be established and should be representative of the categories of the voting members of the AQA, with substantial physician representation, and the committee should be sufficiently nimble to make timely decisions on behalf of the AQA. A process should be established to provide scheduled turnover of the Steering Committee members, and that candidates for Steering Committee membership be subject to approval by the AQA voting membership.
- The AQA mission and the scope and charge of the workgroups and committees should be periodically reviewed.
- The short- and long-term financing of the AQA should be reviewed, consistent with the AQA mission and work plan, and recommendations made as to how the AQA should best be financed. Multiple funding streams should be considered, including administrative fees, key stakeholder support, foundation support, and public funding.
- The AQA Steering Committee, or its designees, should establish an ongoing dialog with the key quality measurement entities, such as—but not limited to—the Physicians Consortium for Performance Improvement (PCPI), the National Committee for Quality Assurance (NCQA), the National Quality Forum (NQF), and the Hospital Quality Alliance (HQA).
Meeting Procedure Recommendations
- The agenda materials for each AQA meeting should include the AQA mission and goals, a description of the consensus process (particularly for new attendees), and a conflict-of-interest statement.
- All reasonable effort shall be made to ensure that agenda materials are made available 2 weeks prior to full AQA meetings.
- The workgroup reports at each AQA meeting should reflect workgroup activity since the prior AQA meeting, and include recommendations ready for decision by the full AQA. The AQA meetings should not be used primarily to inform members about the workgroup's activities since the last AQA meeting. It is the responsibility of the voting AQA members to read the reports in advance of the meetings to inform the debate prior to making decisions.
- There should be a separate seating gallery for nonvoting attendees at the meeting.
- All attendees should be identified by name tags.
- Membership categories shall be determined by the AQA membership and include, but not necessarily be limited to (in alphabetical order): consumers, government, health plans, hospital membership organizations, other providers, physician membership societies, purchasers, and quality measurement organizations.
- The AQA meetings should be chaired consistently-the workgroup chairs should be asked to give their reports but not chair the discussion and voting. Parliamentary procedure should be used to focus the discussion on the issue at hand and manage the voting process.
- There should be an evaluation of the AQA meetings to provide information that can be acted upon to improve meeting quality.
Recommendations Regarding Voting Procedures
- The voting membership of the AQA shall be established.
- The method of voting should be standardized. Possibilities include a simple paddle method or an audience response system, taking into consideration the cost implications.
- Close votes, by their nature reflecting a lack of consensus, should give pause to the AQA before decisions of the membership become final.
Recommendations Regarding Workgroup Processes and Voting
- The scope and charge of the workgroup should be periodically reviewed.
- A process should be established for measure developers to submit measures to the Performance Measure Workgroup.
- A process should be developed to obtain stakeholder comment on draft performance measures.
- A workgroup voting process should be established for each workgroup.
- A formal adjudication process for workgroup decisions should be established.
The discussion opened with a question about the AQA's relationship with other organizations, including the HQA and the NQF. In response, Tooker discussed the need to align the work of various organizations but said it was not clear there would be a collaborative governance process because each is an independent entity. Carolyn Clancy added that these collaborations were very valuable as other organizations have experience that the AQA can tap into.
Another participant expressed concern about the need to balance the influence of different stakeholders on the AQA process. Tooker said it was not clear yet how that would occur-but that the vote on the draft document was intended to approve a process for looking at that and other governance questions.
One participant asked whether Tooker envisioned the AQA becoming a dues-paying organization. Tooker responded that short- and long-term financing clearly needed to be addressed but that he had no preconceived idea of where financing would come from in the future. He thanked America's Health Insurance Plans for its ongoing financial support of the AQA.
Finally, a participant expressed support for expanding the list of stakeholder categories to include suppliers.
Motion: To approve the draft governance document and allow a Governance Workgroup to move forward.
Result: The motion was approved unanimously.