Lessons Learned During
James R. Gay, MD
BACKGROUNDThe circumstances that resulted in the formation of a new scientific society in 1951, The Congress of Neurological Surgeons, are not expected to occur again any time soon, but the management principles learned by the organizers are likely to endure.
World War II produced a dramatic change in the world of neurological surgery. Some physicians learned neurosurgery while on active duty in one of the armed services. Others experienced either abbreviated training, or had their program interrupted when called to active duty. After the war these young mature neurosurgeons needed to add academic and scientific polish to their training and experience. Existing neurosurgical training programs welcomed them back from the theaters of war, and the number of training sites proliferated.
Thus, in the late 1940s and 1950s there was an explosion in the numbers of young neurosurgeons surfacing in communities and seeking recognition from organized neurosurgical societies.
Established neurosurgical practices were challenged and many newcomers encountered intense resistance from the old timers. There was concern about the problem of too many neurosurgeons!
The existing neurosurgical societies were frightened by the prospect of becoming too large, complicating meeting arrangements, and disturbing the camaraderie. Common reactions to this predicament included raising admission requirements, scheduling scientific meetings at expensive resorts or remote places, and postponing action on new membership applications.
Meanwhile the neurosurgical youngsters were conscious of the fact that their intense training was far from complete as they entered clinical practice or academic life. They began to discuss the unexpected hostility they were encountering. Concerns were expressed about the content of many neurosurgical meetings that was either too esoteric or too randomized to be useful for beginners building a career.
Most of the discussions took place at the Interurban Neurosurgical Society organized by neurosurgeons Adrian Verbruggen and Harold Voris meeting at the University Club in Chicago. The society was open to all neurosurgeons living no more than one travel day away from Chicago. It met for one day only (Saturday). There was a mailing list but no dues, by-laws, officers or publications.
About 150 neurosurgeons attended once a year. Most attendees were from the northeast, mid atlantic, southeast, and midwest. One or two discussion topics were introduced in the morning and one or two different topics were considered in the afternoon. Most of the meeting time was devoted to lively audience discussion and the conversations continued over lunch and dinner.
There was ample time for smoked filled hotel room talk about the plight of young neurosurgeons and the prospect of organizing a new and different neurosurgical society.
Calls and letters went out to anyone thought to be interested in a new society. Twenty two neurosurgeons responded and met in St. Louis, Missouri. They became the Founding Members of the CNS. Many others were interested, but were unable to attend. Later in the year, the first formal organizing and scientific meeting was convened in Memphis, Tennessee, attended by 121 neurosurgeons.
The process of organizing the CNS continued at an intense pace between and during the annual meetings that followed and, in fact, the process has never ceased.
The early organizers learned some important lessons about managing a scientific society that continue to guide the CNS leadership. Many of these principles are being applied to improve the performance of other scientific societies by CNS members.
The management principles that follow are listed in random order.
PLANNED SPONTANEITYThis method provokes instant responsiveness from an audience or group. It was learned in part from experiencing the awkward delay that occurs when discussion of an address or paper is expected from an audience, and in part from studying the techniques used by subversives to disrupt meetings.
The writer watched a meeting of deans of medical schools (Palmer House in Chicago) destroyed by distraught medical students. They entered the room silently, filled every vacant seat and stood in lines along the walls on each side of the audience. Then they occupied the podium and took over the public address system. There was no violence and no meeting. A search of a Chicago book store revealed the published manual they were using as a guidebook. It contained other information useful for producing successful meetings.
One method in vogue at the time was to designate a discussant for each paper, but the planned spontaneity approach proved to be much more effective. It works this way.
Two to eight persons (numbers proportional to size of audience) are instructed to study the subject matter of the paper or address in advance and to rise instantly when discussion is called to make a comment or ask a pertinent question.
These secret first responders provoke instantaneous audience responsiveness and they fade from the action as regular members of the audience continue the discussion.
Planned spontaneity evokes the conspiracy potential in each o us and it scintillates a meeting. This is the principle of planned spontaneity.
ROUND TABLESRound tables seating eight to ten persons are prescribed for luncheons and banquets, and the elevated head table is eliminated. Announcements and speeches (if any) are presented from an elevated free standing podium using a public address system.
The traditional straight line elevated head table is obsolete. The dignitaries are on involuntary display and they are miserable with no one with whom they can converse. The Chair cannot resist the temptation to introduce all of the officers and dignitaries in the had table line up. When everyone is seated in a circle, they enjoy each other and the event and they are grateful to be themselves.
The CNS touch is to scatter the officials and official guests at tables around the room to interact with members at large. Only the Chairman's table is reserved for the principal speaker and a few designated members.
The best system is to designate seating for everyone. This plan breaks up the individual cliques and builds the identify of the organization. A computer makes this task easier to accomplish, but a table map and seat assignment ticket (or place card) are necessary. This is the principle of diplomatic seating.
At the first meeting of the World Federation of Neurosurgical Societies in Brussels over a thousand neurosurgeons and guests were present at a banquet. Each person was assigned a designated place at a table sating 24 persons. Husbands and spouses were separated and seated within conversation range was someone who spoke your own language. This complex seating plan was accomplished manually without the assistance of a computer.
The round table provokes the primitive memory of sitting around a campfire in safety and together. This arrangement is the campfire principle.
RESIDING IN SILENCEIt is not necessary to announce events at a banquet or luncheon. The best plan is to provide a printed program. At prescribed intervals, the designated person mounts the speaker's platform and addresses the audience.
Conversations are interrupted by sounding a trumpet or musical accolade, ringing a school bell, rapping a gavel or flickering the room lights.
The principal then does his or her thing, retires, and the function moves along smoothly and silently. Of course, each person with a part in the program receives full written instructions in advance.
At an American College of Surgeons banquet in Oslo, each event was announced by four trumpeters performing on a balcony. The principals were scattered at different places around the room and by the time each person reached the free standing podium, the audience was ready to listen. This is the principle or presiding silently.
IDENTIFICATIONIt is awkward to enter a meeting room and not be sure it is your organization. Hotels routinely label their lecterns with their name or logo so it will be prominently displayed in news photos.
Scientific and social groups need to practice the principle of identification. It is a useful habit to display the name or logo of the organization in every meeting room, usually in the front of the room on a lectern or easel, or on the wall. It provides an identity and contributes to organizational pride.
THE MEETING MANUALThe leaders of professional societies are often much less precise about managing the organization than when operating their clinical practice or performing research. Reinventing the wheel each year an annual meeting was planned was not part of the management style of the Founders.
A Meeting Manual was produced before the Memphis meeting in 1951 and it was revised and extended annually during the early years of the CNS. It provided a written meeting memory to guide successive Arrangements and Program Chairmen. This practice contributed to the continuity and precision of CNS operations. This is the principle of the Meeting (or Organization Operations) Manual.
WHERE SHALL WE MEET?Large organizations had a limited number of places to meet. Only Atlantic City, New York, Miami, Chicago, Las Vegas, Los Angeles, and San Francisco could accommodate such giants as the AMA and the ACS in the 1950s.
Medium sized societies in the 300 to 500 attendance range like neurosurgical groups had many more choices.
There was a tendency for established societies to meet somewhere the organization had never met before and resorts were often favored over metropolitan areas. There was a hidden agenda (expressed privately) that the more expensive and remote the meeting site, the less likely that the youngsters could afford (time and money) to attend. The writer attended one Meeting Site Selection Committee meeting in which there was a serious effort made to schedule the next meeting in Tahiti -- a place everyone on the committee wanted to go, where no had ever been, and there was a good chance few of the newcomers could afford to attend.
The CNS favored meeting in metropolitan areas in all regions of the USA and Canada (by rotation); places where housing and transportation was easy and affordable. In addition, an opportunity was provided for larger numbers of practicing neurosurgeons (members and non-members alike) and neurosurgical residents to attend and learn. This is the principle of selecting meeting sites that are in the best interest of the profession as a whole.
WHAT ABOUT SPOUSES?In the 1950s and 1960s, workaholic neurosurgeons attended alone, stayed up too late, drank too much, and brought expensive guilt presents for spouses left at home. The CNS changed the culture by encouraging spouses to attend and enjoy social, educational, and recreational opportunities. The target of 75% spouse attendance was achieved and the neurosurgical society culture was altered forever.
AVOIDING ELITISMCongress men and women establish lifelong friendships in the CNS. These cherished relationships are especially strong among the officer corps. The CNS leadership recognized the risk of creating elite groups early in the life of the organization. Several measures were taken to combat elitism including the following:
It is important to embrace the principle of combating elitism constantly.
HONORING DISTINGUISHED NEUROSURGEONSThe CNS organizers recognized the principle that there are far too few honors available to compensate for the daily dedication and selflessness of so many scientists.
An early idea was to honor the best and the brightest neurosurgeons living anywhere in the world. All of the Founders and most of the early members were under 45 years of age. Thus in the beginning, we selected honorees from among high achievers in older age brackets. It was recognized that later on some CNS members would grow into giant status and be honored at an Annual Meeting.
It was not easy to pay the expenses of overseas honorees, and resist the pressures applied by older professionals to capture our honorees for their own private agenda.
TIME OUTNeurosurgeons work and worry more than most professionals. It is difficult for them to plan an Annual Meeting with some time out for relaxation and fun. The early CNS leaders attempted to protect neurosurgeons from themselves by avoiding over programming, scheduling some social and recreational relief, and offering interesting post meeting travel opportunities. Battles were fought successfully over this principle, but the war is not yet won.
WHAT'S IN A NAME?Principle: The name is everything! How can the American College of Surgeons be international in scope? Who knows what the Trudeau Society is all about? How can the Lehigh County Medical Assistants Association attract and hold members from four nearby counties (Lehigh Valley would be better)?
The Founders avoided limiting words like American or National, or North American because we envisioned the society to be world-wide in scope.
We noted that the initials CNS also signified the Central Nervous System.
The word Congress was all inclusive -- American, European, Asian, South American (intercontinental). It was anticipated that at some future time it might be called The World (or International) Congress of Neurological Surgeons.
It was not a federation of societies so the emphasis was placed on individual professionals -- neurological surgeons.
The only objections came from the Europeans who viewed the word Congress as an occasional convening of professionals from more than one discipline or from several countries. It has not stopped them from attending or joining.
The writer Chaired a restructuring committee of the AANS during the Frank Mayfield Presidency. They were having problems with The Harvey Cushing Society name. What was it? Who was Harvey Cushing? Was it an alumni club (it started that way)? It was a sentimental name for neurosurgeons, but the politicians and the public did not know that it was a prestigious professional society. So we changed the name to the AANS -- proudly adding the American to designate its origin and domestic focus.
The name CNS was distinctive -- we knew the CNS would be different!
The writer also participated in the naming of the World Federation of Neurosurgical Societies. It is a true federation of organizations and was so named.
We gave up the designation World (for now). There may be room for a World CNS at some future time!
DON'T SAY IT -- WRITE IT!The above caption often appeared on the memo pads of engineers. We adopted the principle as engineers of the nervous system. Early on, the organizers were determined to capture the information being presented at the CNS Annual Meetings. Since you can remember less than 10% of what you hear, we wanted our members and other to refresh their memory by reading Clinical Neurosurgery. The principle of anything worth saying is worth publishing.
TW MEMBERSAt earlier neurosurgical meetings (not CNS), there were many TW Members (or AA, UA, US, DL, CO, NW). Attendance at annual meetings was required. These TW Members flew into the meeting site, registered, and flew home the same day. A few never attended a meeting for years. Some attended the luncheon without paying for it (no ticket) and the society picked up the deficit.
The CNS maintained an attendance record (we required attendance too), but we avoided being a meeting cop. Instead, we gave almost everyone a job to do. Our target was 75% active participation in the annual meeting -- this was achieved from the beginning.
The jobs were important to the vitality of the society like the following:
Multiple persons were assigned to these kinds of tasks so no one was burdened with the same task for the entire meeting.
Hosts at social events included members and spouses. At the first few meetings, spouses were in charge of the Registration function.
Principle: members with something important to do attend and stay for the whole meeting.
Incidentally, there were (and may still be) TW Professors, who spend more time in the air than on campus (usually at taxpayers expense).
PROGRAM CONTENTIt was customary for neurosurgical societies (not CNS) to call for papers for the next Annual Meeting. The offerings were triaged by a Program Committee and the winners were awarded a place on the program. The only control exercised by the Committee was some of the following options:
The result was a program of random topics seldom related to each other and most often no related to everyday clinical practice. Sometimes the speaker had a hard time explaining how his esoteric research was related to the discipline of medicine.
The CNS decided to control the program content. A theme (or a limited number of themes) was selected for each annual meeting.
The Scientific Program Committee invited the speakers from a pool of experts nationwide (actually worldwide). The topics were slanted toward clinical neurosurgical practice. Our members were young and still learning. They needed to add to their diagnostic prowess and treatment expertise. Almost all of the early speakers were non-members, but they soon joined our ranks.
The CNS early adopted the principle of controlling the program content to promote to the intellectual growth of its members and thereby benefit individual patients and the society as a whole.
PUBLIC RELATIONSThe CNS organizers were aware of the importance of public relations. We established a news room at annual meetings and assigned a member to watch over it. We asked speakers to provide a manuscript before the meeting (many responded) and copies of their papers were available for the news media.
Local news agencies were alerted and invitations were mailed to science writers using a national mailing list. The Program Committee selected some program items that were expected to be newsworthy (difficult but possible). The early Honored Guests were from abroad and they attracted considerable attention from TV reporters.
We encountered several impediments that are chronic afflictions of scientific societies:
At the time the CNS was founded, there were some dramatic examples of neurosurgeons making themselves newsworthy with dramatic announcements or claims that were soon discredited by peers. One neurosurgeon developed a cure for Parkinsonism and made the mistake of talking to the press before he made his dramatic announcement at a national neurological society (attendees read about it in The New York Times at breakfast several hours before his presentation at the meeting). He never recovered his place in scientific circles and his claims later proved to be overstated.
Principle: Public Relations is a necessary obligation and service to both the scientific community and the public. It takes hard work to be effective. The same high ethical standards of science applies to PR.
BUILDING A MEETINGAn Annual Meeting creates momentum in a society that needs to be captured and sustained until the next meeting. The Officers and Chairs are in shock and then they busy themselves with preparations for the next annual event. The members enter a state of hibernation if left undisturbed. It is useful to continue a steady flow of information targeting the membership including some of the following items:
It is possible to build excitement for the coming meeting, starting with generalities and moving on to more detailed information, plus increasing the frequency of mailings as the next meeting approaches. This can be done with straight mail or a newsletter.
Principle: provoke anticipation and excitement for the next annual meeting beginning within hours after the last meeting.
REDUNDANCYRedundancy was built into the CNS from the beginning -- standby Honored Guest, substitute speakers, back up Presiding Officers, Hosts and Meeting Workers appointed in pairs, duplicate equipment (projectors, chart holders, screens, pointers, easels, etc.).
Principle: expect everything about a meeting to go wrong and prepare for it -- that is Redundancy! (Members will report it as the best organized meeting they ever attended, while the redundancy monitors become basket cases).
NAME BADGESCNS Members follow the practice of preparing name badges that are readable at a distance and wearing them on the right side (most persons are right handed and cannot read a badge worn on the left side when shaking hands).
Wearing the badge at all functions is a courtesy to others who may not know you, and is a barrier against free loaders (inside or outside the organization). CNS badges are worn with pride.
In some meeting sites, like Washington, D.C., professional free loaders dress well and take their meals everyday at unmonitored convention meals.
Principle: Annual Meetings are transient events and there is no advantage to keeping your identity a state secret.
CAMP FOLLOWERSThe Camp Followers of scientific societies are the alumni officers that never quit trying to run the organization.
There were plenty of them at other neurosurgical societies, occupying the long head table and shedding tears over past remembrances. They knew how to block or delay membership, blackball unworthy peers, select meeting sites at remote and expensive sites, and erect barriers to thwart program innovations.
The CNS format was to promote workers to positions of leadership before they were 45 years of age and then retire them from the officer corps. Some organizational memory was lost, but new history was expected to be made every year by fresh heroes.
Memory in the CNS is sustained by the hands on work of its members (remembering by working through several changes of officers).
The growth of the CNS was, in part, due to the involvement of large numbers of members in its operations and in innovations introduced by fresh leadership. The program format and content was, of course, equally important.
Principle: select young leaders from the ranks of the worker bees and retire them promptly from office with thanks and token honors.
The real thanks from the CNS is derived from the satisfaction of providing unusual and willing service to the organization, refinement, or inspiration.
INSTRUCTIONSAt the CNS, there were written instructions for everything and everyone with a job:
Principle: educated people (neurosurgeons are super educated) are used to following rules and game plans if they know what game they are playing and the rules and plans (instructions) are in writing.
Early in the CNS game, the organizers did not know how to spell "Chamber of Commerce" and lacked the resources for hiring professional meeting managers, so everything was done by members and their spouses. This is the origin of the CNS tradition of hands on leadership. It later led to CNS graduates infiltrating and changing (improving) other generalist and specialist societies as change agents.
HOSTINGAnyone who has every attended a Reception knows the coldness of no one greeting you at the door. (CNS seldom uses the word "Cocktail" -- we are more interested in the conversation than the cocktails).
The CNS had Hosts at the door (3 or 4 couples), and silent Circulating Hosts (3 or 4 couples). They became professional hosts in one evening (as instructed, of course).
Hosts were assigned to the Honored Guest and all the speakers who were non-members (almost all the early speakers were invited guests).
Principle: Friendliness can be spontaneous at any time (if provoked, practiced, and genuine).
MORE CNS LORE
REFLECTIONSNeurosurgeons who participate in the CNS are never the same persons they were before and the change is even more apparent in the elected officers.
Walk into an Annual Meeting of the CNS and the experience is different from attending other scientific societies. The meeting is alive and breathing! Part of it is the attention to details, and the feeling of belonging to an extended family. Each Annual Meeting is different -- not so much one set of officers trying to outdo the next -- more a sense of providing another different experience in the life of dedicated professionals.
The Founders and early organizers expected the CNS to succeed, but its performance has far exceeded their expectations.
Each succeeding President, officers, committees and memberships have made significant historical contributions to the progress of the CNS.
IN THE BEGINNINGThere were 22 Founders and many more who entered into the conversations that led to organizing the CNS. At the first scientific meeting, there were over 100 and now there are several thousand members. How did it all happen?
First, there was a need for the CNS and second there were the conspirators.
Some of the early organizers were more active than others. It is possible to name a few persons (some living and some deceased) who might have been justifiably hanged, expelled, excommunicated or disgraced as being the ringleaders of the conspiracy. That act might have made a statement, but there would be others left alive and well to continue the cause.
The organizers were good listeners. They collated and wrote down ideas that came from everywhere. Some of them became early CNS Presidents. Their personalities changed from a straight to a blend from working intensely together.
So many ideas came from some many different persons that it was difficult then (and now) to sort out the original author of a particular CNS idea. The organizing group changed frequently and was always expanding as the CNS grew in size and influence.
Free from any artificial constraints we were able to use the organization as an experimental social laboratory. The CNS also became a training center for future academic, community, and scientific leaders.
It was a once in a lifetime experience for the CNS organizers and that same experience is repeated for others each year since its founding 1951.