Demystifying Policymaking

The transparent manner in which the ACR makes policy distinguishes it from other radiology professional societies.

August Images 4 web10.jpgChristoph Wald, MD, PhD, FACR, chair of Reference Committee II for ACR 2019, presides over an opening hearing at the Council session

A representative body of 373 individuals elected or selected by ACR chapters and other organizations, the ACR Council is empowered by our bylaws to “establish official actions and policies for the College.” Convening each spring in Washington, D.C., our council debates a variety of resolutions — for example, several may
pertain to practice parameters and technical standards, and others relate to meatier and sometimes controversial issues such as board certification and firearms safety.

Inclusive and representative policymaking is hard work. ACR Councilors — who are all volunteers — are expected to be informed and engaged at each year’s
annual meeting. Councilors carefully review 40 to 50 resolutions in advance of each meeting, and then caucus with colleagues across the country to ensure that
proposed policies are most relevant to their constituents, profession, and patients. Effective councilors devote dozens — and sometimes hundreds — of hours each
year to these important duties.

The council’s policymaking processes (at least at first) can seem as daunting as they are laborious. In the remote past, those councilors adept in parliamentary sportsmanship had the upper hand in formal debate. Neophytes to the process often found themselves too intimidated to speak — which effectively silenced many valuable and important opinions and perspectives.

In recent years, deliberate efforts have focused on making council meetings more inclusive and welcoming — and also more efficient. Multiple opportunities for
online input from all ACR members (i.e., not just councilors) now exist during the development and refinement of practice parameters and technical standards, which now go through multiple rounds of digital field review comment and pre-meeting reconciliation. Those ongoing and iterative processes help ensure that substantive issues are identified — and hopefully representatively addressed — before council meetings, so that the council can focus its debate exclusively on outstanding thorny issues still requiring reconciliation. Additionally, policy resolutions are distributed electronically months in advance of each annual meeting, so councilors can be true representatives and confer with their colleagues back home before arriving in Washington, D.C. And at each annual meeting, all members in attendance (not just councilors) are encouraged to participate in reference committee open hearings — well-attended venues intentionally unencumbered from the Byzantine formalities of parliamentary rules, designed to tease out the “will of the Council” and catalyze meaningful and productive formal debate.

While our council is still legally required to follow formal parliamentary procedure when adopting policies, these antecedent informal processes streamline that formal debate considerably. Our goal has been — and continues to be — ensuring that every member has a chance to speak in a manner that is most meaningful and inviting.

All in all, we’ve made a lot of progress over the years as we strive to make our council debates more inclusive. But we can still do better. Portions of the council’s historic standing rules and procedures are not as clear as they could (or should) be. As the council’s presiding officers, we would prefer not to make on-the-fly rulings to correct unnecessary ambiguity during formal proceedings. Declaring a well-meaning member to be “out of order” on the council floor unnecessarily stifles further engagement. That’s why we are now forming a work group on council rules and procedures. Our goal over the next two years will be to work with our new parliamentarian and our entire CSC to revise these important documents that guide how we conduct business each year. As your newly elected speaker and vice speaker, we are committed to doing this inclusively and transparently. As such, we anticipate sharing draft documents with all councilors through ACR Engage for review and comment.

Our hope is that this approach will not only demystify our current policymaking processes, but also make them better. If you have comments or suggestions, please reach out to us, as your elected leaders, or to ACR staff Trina Behbahani at This email address is being protected from spambots. You need JavaScript enabled to view it. and Catherine Herse at This email address is being protected from spambots. You need JavaScript enabled to view it..

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