Mirror, Mirror, Part II: Building a Bridge

I originally had this article scheduled for last week. Because this is sort of a delicate one, and because I didn't want to even give the appearance of trying to take the wind out of the sails of Virtual Lobby Week, I decided to push it back. It also ran into the Michigan Society for Respiratory Care Spring Conference, which I had the honor of helping organize due to it being in my hometown (yes, there really IS a Kalamazoo), and so it got pushed back a little further.

This is one of those times where I'm actually glad life got in the way.

The delay gave me an opportunity to observe two excellent presentations from a couple of our thought leaders in respiratory care; Frank Salvatore, the immediate past president of the AARC and Garry Kauffman, an expert in organizational leadership. These two presentations gave me much higher hopes that people are engaging in the ideas and plans that this particular post will focus on, and makes me far more optimistic about the future of respiratory care. In the original version, that optimism got sort of buried toward the end, but now I have a chance to reorganize the message and make sure that's loud and clear, right up front.

That said, this is a time for the entire profession to take honest stock, warts and all. For the last few weeks, these articles have mostly been focusing on what you can do for your profession. While it's true that we bear much of the burden of making the change we want to see (and the responsibility for not engaging enough to accomplish some of those things already), our professional organizations must shoulder some of that engagement burden as well. Great presentations and speeches and meetings won't matter without definitive action, and our leadership groups must embrace some very important truths:

• Perception is Reality. The AARC, NBRC, and CoARC actually do many things very well. Our professional journal, Respiratory Care, is one of the best around. Similarly, the International Respiratory Congress is unmatched for educational and networking opportunities. But these successes are often overshadowed by long-held misconceptions, preconceptions, and suppositions. Our groups are thought to be "old boys' networks," who are largely focused on internal needs and desires, and the accumulation of income in the form of membership fees. All three of these groups must recognize that they aren't fighting a battle from an objective point of view; they're fighting against reputations. For example, it may be objectively true that the CRT credential may eventually be phased out by "the market" (as multiple NBRC representatives have told me), creating a discrete pathway to phasing it out (while grandfathering experienced credential-holders) would go a long way to healing professional divisions. Sometimes, it's about DOING what's right, rather than BEING right.
• Communication is Fundamental. Many of these perception issues stem from the fact that these groups, the AARC and NBRC in particular, have historically been poor at outreach and communication. A perfect example is the NBRC's Continuing Competency Program. Launched in the early 2000s, this national continuing education requirement (beyond being a good idea and consistent with other health professions) was mandated by the organization that accredits credentialing bodies, called the Institute for Credentialing Excellence (ICE). Without ICE's accreditation, our hard-earned RRT, ACCS, NPS, and other credentials would be essentially meaningless. But the NBRC has done an abysmal job at communicating this to therapists, and without this important context, many of those therapists look at the sudden adoption of additional fees as a blatant money grab. I was one of those therapists for many years, until I discovered the truth of the situation. Even when I finally did learn about ICE, it was incidental to other research. Similarly, the AARC tends to take a rather paternalistic approach to communications. It's often left at, "Trust us, we know what we're doing." Once, when it was mentioned here on LinkedIn that a very well respected pillar of our profession (one might call him a godfather) had serious questions about the AARC's path and results, a representative from the organization replied, "[It] never hurts to check your facts in lieu of blindly following a blog. History has shown that people that blindly follow proverbial leaders or hearsay often have disastrous results." It's precisely this kind of casual dismissal of concerns, even concerns from our leading practitioners, that pushes people into having preconceived notions.
• Accountability matters. Almost a decade ago, the AARC created a task force specifically designed to look at the shape of the future healthcare workforce. That project, known as "2015 and Beyond," spent the next two years analyzing virtually every aspect of respiratory care and how we would fit into healthcare in the coming decades. At the end of the project, the team issued several recommendations, concerning things from credentialing to proficiency standards. Unfortunately, very few of the recommendations have become reality. For some, there have been solid logistical reasons. For others, the rationale much murkier. This has led to the perception that groups will only take the easy way out (and again, perception is reality) and, when this perception is questioned, those questions are met with brush-offs (as mentioned above). In order to recruit, potential members must be convinced that their dues and fees will be used wisely, and therefore a level of accountability and transparency must be maintained.

Again, I come today not to bury the AARC, or the NBRC, or CoARC, or any other group. I do, honestly, come to praise them. Supporting these groups, with your membership, your engagement, and your endorsements, is realistically the ONLY way for us to advance, and they do critical work that goes unrecognized. Just last week, during the aforementioned Virtual Lobby Week, over 100 AARC members and leaders traveled to Washington, D.C., advocating on YOUR behalf. But building support and trust is a two-way process. Our leadership must be willing to set aside old habits and methods, to adopt new and creative approaches, and to admit mistakes. I believe there has been steady improvement in this area over the past few years, as evidenced by the presentations above and the efforts of current AARC President Brian Walsh, who is building on that momentum. We must nurture that improvement with our support. We WILL make a difference, if we are of #OneBreath, together.