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Components as colleagues: strategies that take your association from parent to partner; A conversation between Adrienne A. Bien, CAE, and Cynthia D'Amour.

HOW DO YOU VIEW YOUR COMPONENTS? WHAT type of relationship do your policies and plans create? Are your components children to be told what to do, teens who constantly challenge and roll their eyes, or are they colleagues and partners working side-by-side with you to achieve your association's mission?


If your answer is anything but partner, it may be time to redefine your relationship and allow your components to reach their potential with you on their team. Like any life change, shifting from parents to partners can be frustrating, puzzling, and exciting all at once.

The Medical Group Management Association, Englewood, Colorado, has experienced these changes first-hand. Adrienne A. Bien, CAE, vice president of the learning and networking center at MGMA, recently discussed the association's strategy for re-examining its relationship with its components with Cynthia D'Amour, president, People Power Unlimited, Ann Arbor, Michigan. Her insights might be helpful to you in evaluating your association's relationship with its components.


Reviewing the history

Cynthia D'Amour: How many components does the Medical Group Management Association have? And how are they set up?

Adrienne A. Bien, CAE: MGMA has 50 state affiliates, many dating back to the 1950s and all operating autonomously with their own governance, bylaws, and treasuries. MGMA affiliates cover the whole spectrum, with memberships ranging from 40 to 800. And their activities are just as varied as their membership sizes, and include sponsoring educational programs, publishing newsletters, hosting Web sites, and conducting industry-benchmarking surveys at the state level. Some also lobby at the state level and collaborate with state medical societies, government agencies, and health plans to make significant changes to the delivery of health care. Approximately 40 affiliates have paid staff working at least part-time.

D'Amour: What prompted MGMA to re-examine its relationship with its components?

Bien: Across the years, working with such diverse groups has proven problematic for MGMA. In 2002, national board members' concerns that state leaders were dissatisfied and saw no value in affiliation with MGMA came to a head. On the other side were board members who wondered why MGMA invested resources in the states and asked, "What is MGMA getting in return?" In 2003, the board asked the national staff to create mutually beneficial and mutually satisfactory relationships with all 50 state affiliates in the next three to five years. I was assigned to lead this effort.

D'Amour: How has the relationship evolved?

Bien: In the 1980s, MGMA's national-state relationship was marked by distrust--the states suspected that the national organization wanted to take them over. In the early 1990s, MGMA national decided to initiate a program to offer association management services (database support, newsletter publication, and so forth) to the states as a way to build rapport and trust. However, MGMA did not conduct any market research to determine what services the states wanted or needed because, of course, the mother house knew what was best.

Like the parent of any teenager quickly learns, MGMA could do no right. Nothing was ever done soon enough, good enough, or cheap enough. And after a taste of support, the states wanted a more in-depth level of service, which was difficult to achieve long-distance and with the available resources.

D'Amour: How did MGMA address the issues?

Bien: MGMA made the decision in the late 1990s to phase out the direct association management support program and encourage the state officers to hire local assistance. We decided to focus on providing global services such as creating a liability insurance group-purchasing program.

Pulling back from association management services improved the relationship but created an at-arm's-length dynamic. This distancing meant that MGMA and the states were following separate paths, making any joint efforts harder to leverage. As a result, there was low awareness among state leaders as to what MGMA does and little connection with MGMA headquarters staff.

D'Amour: As a component relations professional, what did you think of all of this?

Bien: I have observed the maturation of the state affiliates in the past 20 years. The state affiliates of today are not the organizations of the 1980s; yet MGMA related to them as if they were. The caliber of state programs and publications has risen impressively, and some state conferences are drawing more than 500 attendees.

I observed my colleagues here in Colorado who lead state associations in other industries, and they have large staffs and even their own buildings. I saw no reason why our state affiliates could not reach this level as well. I wanted MGMA to be the partner that helps them reach that tipping point sooner rather than later--with our help and not despite us.

D'Amour: Were there economic implications as well?

Bien: Although I have worked with state leaders for two decades and want to see them succeed, there was also a business reason behind redefining the relationship--the states compete with MGMA for dues and education dollars. As budgets tighten, members must make decisions to spend their money where it brings them the most value. Many state educational programs rival ours for quality, and they have the added benefits of local networking and cheaper registration fees. State registration fees are a third of national's fees if not less. The same is true of state dues.

However, I didn't want to hold back state development out of fear that affiliates may be a threat to us. Instead, I wanted MGMA to be their partner as they move to the next stage. By clearly defining state-national roles, we complement each other instead of competing against each other. This way we both use our resources wisely and better serve our members.

In addition, when we work together, we are in a better position to address competition from for-profit educational companies, which are coming in at the state level and positioning themselves as competition to both the state associations as well as MGMA. By combining forces and working collaboratively, we present a united front and maintain our turf. MGMA can't match the lower fees these for-profits charge, but the state organizations can.

Researching for success

D'Amour: I'm sure many associations can relate to your reasons for reexamining your relationship with your components. What was the next step?

Bien: Before crafting what a new relationship might look like, we undertook an extensive research effort. I wanted to understand who the state affiliates are today, what they want, and what they see as their envisioned future. I also wanted to understand how other associations relate to their state components. During my research, I discovered two insights that I believe apply to all associations with components:

Autonomy works. Because we do not mandate what services affiliates can provide, each state has been able to focus on the key services their members want--not what we decide they should offer. Our decision to encourage our affiliates to hire paid staff also aided their success. This was validated by research conducted by Peggy H. Hoffman, president, Mariner Management and Marketing, LLC, Laurel, Maryland, which shows the key determinants of strong components are committed leadership, engaged members, paid staff (at least part-time), and a focus on two to three services. (See "Bright Lights, Vibrant Components" in the February 2004 issue of ASSOCIATION MANAGEMENT.)

Values should be expressed. By conducting focus groups, we initiated what I call the what-if dialogue. What would be missing for national if there were no state affiliates? What would the states miss if there were no relationship with national? During this dialogue, we learned that as a national organization, we value our state affiliates as a source of future leaders, as well as of grassroots advocacy support, expanded visibility for the national brand, sales to non-national members, and input from the grassroots level about emerging trends in the industry.

On the other hand, we learned that our state affiliates value the national organization as a source of leadership training, national leadership opportunities, opportunities for networking with leaders from other states, increased visibility and credibility, education and legislative resources, and expertise and advice on association management.

Identifying the values statements for affiliation between the national organization and the state components was an important first step in building a true partnership.

Identifying trends

D'Amour: You mentioned a desire to understand how other associations related to their components. How did you get that?

Bien: To get an association industry perspective, I conducted interviews with the paid staff of other associations' state components. Across industries, here is what state components want and expect from the national association:

* administrative efficiencies without the loss of autonomy (e.g., group purchasing programs for insurance coverage);

* access to expertise--templates, advice, idea sharing from other states;

* leadership training and educational support; and

* acknowledgment for what the state contributes.

Most important, components want headquarters to solicit meaningful input from them. This cannot be lip service. Components want headquarters to truly listen to what they say. Repeatedly I heard from staff, "National only calls when they want something." I was as guilty of this as anyone else.

D'Amour: What other interesting discoveries did you make?

Bien: One of the most interesting pieces of research we did was to look at why we had national members who never participated at the state level and conversely why there are state members who never become national members. Basically, the size of the organization and the job title of the member were the key determinants.

Occupational title was the best predictor of whether an individual belonged to MGMA at both the state and national levels. Members with titles of CEO, president, executive director, physician, and medical director had the highest propensity to belong at both levels. Conversely, respondents with titles of manager, administrative assistant, or coordinator were least likely to belong at both levels. Further, members at the state and national levels were more likely to come from larger practices. State-only members tended to be from smaller practices and less likely to be higher up in their organizations.

In addition, our research showed that when an individual participates at both levels retention rates are higher. In fact, there is a spillover effect. When a national member attends a state meeting, he or she feels good about both the state and national organizations. The same phenomenon happens when a state member goes to a national program or event. Therefore, it is to the advantage of national to promote state membership and vice versa.

Getting satisfaction

D'Amour: With the research complete, what was your next step? How did you launch your effort to establish mutually beneficial and mutually satisfactory relationships?

Bien: As we completed the research phase, I conducted phone interviews and focus groups with our state leaders and staff to better understand their needs. I asked them what they needed to be even better. Basically, it boiled down to three areas that they wanted to improve upon:

1. recruiting and retaining members;

2. recruiting and retaining leaders; and

3. providing affordable and accessible education for their members.

We also developed a satisfaction survey that we now send to our state affiliates annually (see sidebar, "In Search of Satisfaction"). The first survey was conducted in 2003 and established our baseline for future comparisons. The first year 80.6 percent of our states indicated that they were satisfied with their relationship with MGMA.

In addition, we synthesized all of our research and came up with a long list of potential initiatives, detailing programs and services that we could provide for the states. We made sure that every proposal related to the states' three key needs. We took the proposals to the state officers and staff for discussion and solicited input at various leadership meetings. We also sent out a mail survey to be sure that everyone had an opportunity to provide input. Taking all comments into account, we developed a plan of action (see sidebar, "Take Action") that we felt addressed state needs and was mutually beneficial to headquarters.

Implementing the plan

D'Amour: Your plan of action included a lot of potential change. How did the states react to your new proposals?

Bien: The incredible aha for me was that the proposals I expected the states to pounce on--such as the revenue-sharing ideas--scored low. The states wanted things such as practice management content that they can use in newsletters, access to MGMA market research data, and better calendaring functions showing future national and state meetings. These were strategies that were relatively easy to implement.

D'Amour: I'm not surprised by that. I've been in several situations where the staff has struggled to create wow-type initiatives, and in feedback the components focus on initiatives that make their volunteer efforts easier. How were your states feeling about MGMA after they got to give feedback on your initiatives?

Bien: By then it was one year later and time for our second satisfaction survey. Bear in mind that we were still conducting research and devising our program, and nothing had been implemented yet. Using our survey format from the baseline year, we surveyed the states again. Our satisfaction score jumped to 91 percent satisfied or very satisfied with their relationship with MGMA. In my mind, this is a phenomenal lcap.

D'Amour: That's more than a 10 percent increase in satisfaction. Your experience is quite a testament for inviting components to co-create as partners. What was your biggest take-away from your experience with your components?

Bien: There were two major takeaways for me:

1. Communicate and communicate some more. The path to a good relationship with components is paved with ongoing and honest communication. In our case, we asked component leaders what they wanted and built our plans on those expressed needs. We acknowledged the good work they do and the high quality of their educational programs. Inevitably, communication can't always be good news. If we are going to take an action we anticipate a state may not like, we make sure their leaders hear it from us first. It all boils down to continuous and candid communication, which creates trust.

2. Focus on the right stuff. The other big revelation for me was that you don't have to do big stuff, but you do have to do the right stuff. By this I mean that you must be attuned to the states to understand what they truly want. Often the key to a successful national-component relationship is far simpler than you think.


The Medical Group Management Association provides a variety of services and resources to its 50 state affiliates. As the national organization worked to enhance its relationship with its components, MGMA developed a state affiliate national services and resources evaluation form. State officers are sent the evaluation annually, and their feedback assists national in putting staff and volunteer resources where they will bring the greatest value to the state organizations.

State officers are asked to rate the services and resources provided by MGMA national according to their level of satisfaction, ranging from very satisfied to very unsatisfied or don't use/don't know. Here are some of the products and services they are asked to evaluate:

* State MGMA leadership and resources manual.

* Complimentary national MGMA membership for one state staff member.

* Opportunity to participate in the national MGMA/state MGMA shared database.

* MGMA government affairs staff as speakers at state conferences.

* Opportunity to be the local partner for national MGMA seminars and annual conference when these events are offered in an affiliate's state.

* Opportunity to purchase state MGMA liability and officers' and directors' insurance through MGMA purchasing program.

* State Web site links from the national MGMA site.

* Leadership report from MGMA's CEO.

* MGMA's table-top display and booth for state conferences.

* Free MGMA membership materials for state conferences.

* Communication to states about MGMA services and products.

In addition, MGMA state officers are asked to answer questions such as these:

1. What resources or services do you value most?

2. What resources or services do you value least?

3. What are the key challenges you see facing your state organization in the future?


Putting a plan of action in place was key to the Medical Group Management Association's state relationship-building initiative. MGMA's board of directors approved the following steps:

1. Make more practice management content available to the states.

2. Improve processes for avoiding seminar scheduling conflicts and sharing education calendars among states as well as with national.

3. Share market research information.

4. Build linkages with state staff as well as support the linkages already in place between the section officers and state officers.

5. Continue the planning for the 2005 section conferences, with the understanding that these will be the last section conferences in the current format.

6. Begin work with the sections to develop the new national leadership conference format.

7. Develop guidelines and a business model for online education delivered in collaboration with the state affiliates. Put in place a pilot course in fiscal year 2005 with full implementation in fiscal year 2006.

8. Conduct the state satisfaction survey annually and compare the results with the baseline (80.6 percent) established last year.

Adrienne A. Bien, CAE, is vice president of the learning and networking center for the Medical Group Management Association, Englewood, Colorado, and chair of ASAE's Component Relations Section Council. Cynthia D'Amour is president of People Power Unlimited, Ann Arbor, Michigan, and vice chair of ASAE's Component Relations Section Council. E-mails: and
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Publication:Association Management
Geographic Code:1USA
Date:May 1, 2005
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