Association Best Practices

Biomeds interested in starting their own regional association have a tough, yet rewarding road ahead of them. Founding a lasting organization requires creativity, planning, and most importantly, a motivated team. Taking it one step at a time, prospective members should first call an areawide meeting to scope out whether there is enough local support to sustain an association. The next step: appoint a search committee to work on forming bylaws to present to members at a kickoff meeting. New associations will also need to incorporate themselves as not-for-profits with their state, typically done through the secretary of state Web site, and may choose to seek tax-exempt 501(c) status from the IRS, a more involved process. To find out how some of the industry’s most successful organizations got their start, 24×7 canvassed seasoned experts at a variety of associations for their trade secrets, experiences, and advice on how to start an association off on the right foot. We received a wealth of information but had limited space to print everything so be sure to read the full article online.

At the North Carolina Biomed Association (NCBA), 24×7 spoke with W. Glenn Scales, CBET, former president and board member.

What was the motivation to begin a biomedical association in North Carolina? There was no such thing at the time. The only thing of its sort was the Association for the Advancement of Medical Instrumentation (AAMI), but there was no real local representation that focused on BMETs. At the time, AAMI was much more focused on researchers and physicians; BMETs were such a new thing. AAMI had only been certifying BMETs for about 4 years, so there really wasn’t the impact that there is today.

We looked at what AAMI was doing and saw tremendous value there, but it wasn’t really focused on our needs. We felt that if we could put an organization together with educational programs and initiatives that were more grounded in the needs of the working technicians, it would give us an educational opportunity that didn’t exist anywhere else.

Why found it exclusively for NC, instead of for the whole country or the East Coast? It was kind of our little world at that point. Sometimes you’re living for the moment and you don’t understand that what you do will get bigger than ever you thought it could.

How did you decide on the one meeting per year format? If you look at what a lot of biomed organizations do, they have monthly or quarterly meetings, and we don’t do that. The board of directors meets on a regular basis, but the general membership only meets once a year, like the AAMI meeting. We modeled ourselves somewhat after it because it works. We saw that it worked and from our perspective by bringing a group of techs together from a lot of different hospitals. We all had jobs we had to pay attention to, and we didn’t feel we could organize activities, at least initially, on a recurring schedule, so we decided to go to an annual meeting format.

How does your membership work? You can join the NCBA like any other organization, but the bulk derives from attending the annual meeting. The bylaws were structured in a way that when you attended the meeting, a portion of your symposium registration fee was set aside to pay for your individual membership for the following year. Initially, there was a lot of pushback from BMETs that their employer might pay for them to go to a meeting, but they wouldn’t pay for membership to an organization they had never heard of. So we decided that if you go to the annual meeting, you’re a member for the following year. For that understanding, our membership is around 500, but that includes all the attendees, the students, and all the vendors that attend, as we consider them members too. They are a part of the organization, but they don’t have voting privileges.

How did you spread the word and grow your organization? Initially, it was just word of mouth. One person knows two or three others, and they just kind of spread the word. We made rather primitive little newsletters back in the late ’70s. I was the newsletter editor for a number of years and struggled trying to print newsletters on dot matrix printers—rather primitive technology by today’s standards—but we felt we had to publish a newsletter in some form or fashion. We got a hold of a list of all the hospitals in the state from the North Carolina Hospital Association and just slowly started building a mailing list where we could advertise symposiums.

How did the framework for the bylaws come about? One of our members had a wife who was a paralegal, and she had pulled together a variety of bylaws from various nonprofits that she had access to. Some of those were of a generic nature, and some of it was from specific organizations. We kind of liked the look of this and liked the look of that, and cobbled it all together with guidance from our paralegal. We got a hold of other bylaws from other similar-type organizations and looked at their structure and how they were organized in terms of defining membership requirements, how officers were selected, and how elections took place. Once you see half a dozen different bylaws from different organizations, you can get a sense of what the general requirements ought to be for your own.

One of the differences was that the board of directors was elected by the membership, but the membership did not elect officers. The board elected their own officers within themselves. So once the 10 members of the board are selected, those 10 people just got together to figure out whom the president, vice president, and treasurer would be. We structured the bylaws in such a way that we would have staggered terms. Five of the original board members had 2-year terms and five had 1-year terms. In the first year there were only 10 board members. The following year there was a new position, ex officio, the past president, who was a nonvoting member but intended to provide continuity from one board composition to the next.

What are some other perks of membership? A lot of times when we schedule education events, current NCBA members either get a discounted cost for the training program we put on or it’s free. We’ll frequently do programs throughout the year in which it’s free for NCBA members, but nonmembers have to pay a fee. They have to be a member at the beginning of the year to qualify, so if the class is $300 and it’s free to NCBA members, you can’t pay your $50 membership fee the day before and then get it free.

How does the NCBA handle its financial bookkeeping? Right now the NCBA contracts out basically all of our financial management. We’ve given them very explicit instructions on what to do with each individual category of mail, and we’ve created a laundry list of all the things they’re likely to encounter. If they’re not sure, they scan it and e-mail it to board members. First, we had to educate them about who we were and what our requirements were, and what we needed from them. Now, they pay all the bills and they collect all the funds for symposium registrations and vendor registrations. The first year it took them a while to catch on to all the things we’re involved in, but it’s gotten much better.

What motivated the decision to contract this service out? We did this because not many of us have strong financial backgrounds. There are some people in senior management positions that do who get on the board and stay for a couple years and then go away. While they’re there they are a great resource, but by and large most of us are not financial managers and the finances of the organization has always been the single most challenging element, namely keeping the records in a way that satisfies the auditors and the IRS.

We’re a 501(c) organization and, quite honestly, we made mistakes early on with how we dealt with the IRS and how we filed financial records. When you’re relying on working BMETs who have a 40-hour-or-more-a-week job to do your financial transactions as treasurer, it can get a little overwhelming. We’ve had very good treasurers who have good financial backgrounds and we’ve had treasurers who have gotten dropped into it, gotten overwhelmed and didn’t say anything, and we had to play catch-up. It probably is the area that organizations are going to have the most trouble with.

Would you recommend most biomed associations attain 501(c) status? It probably is beneficial to them in the long run. It makes it a bit easier in dealing with your finances. You do have to follow the IRS guidelines, but it’s probably worth doing that. The organization can receive donations more easily, and those funds can be targeted for educational programs. It makes it easier when dealing with things like donations and contributions from vendors.

What’s your best advice for a start-up or growing organization? When we got started, a lot of people looked at the NCBA. We’ve been very successful, and have been around for a long time, so people would ask: How did you get it right? And honestly, sometimes it’s just plain luck. It’s having the right people together at the right time, and having that energy come together.

I think the single most important thing that an organization can do for itself is that you have to understand who your customers are. You have to know the biomed community, how it’s structured, and what their needs are. Ask yourself: As an organization, what can I do to help meet those needs? It’s like any other business in that if you don’t understand what your customers need and want, you’re probably going to fail sooner or later. And I think part of the reason we’ve been successful is that we had a very clear vision of what we wanted to accomplish when we started this. We were lucky enough to have some very dynamic people involved in the early days that provided the leadership and guidance to get us on a good start.

I think the second thing people need to understand is that the focus is on long-term career development within the organization. You have to understand, you’re probably in it for the long haul. If you’re lucky, you’ll exist for the next 30 or 40 years. You have to do your homework and get your fundamentals in place in the very beginning and get things set up right the first time, so that you’re less likely to make some of the mistakes we made because we didn’t know any better.

Pat Lynch, CCE, CBET, board member and former president, NCBA, now a biomedical support specialist with GMI, has helped to start and revitalize 20 biomed associations over the years. He shares his ideas below.

How can new organizations spread the word to other biomeds? If you’re looking for your members to be working biomed technicians, either ones that are hospital based or ones that travel, you’ve got to contact the big hospitals in the area. That’s where the people work, and that’s where to find them. The other thing to do is to contact your salesmen. If you’ve got a salesman that travels around and visits all the hospitals in the area selling medical equipment, and if he’s a vendor that calls on the biomed department, use him to spread the word, kind of like a Paul Revere. He can go around and tell a lot of people about the new organization.

Drafting bylaws can be quite complex. How should associations get started? They can get complex, but there are some very simple ways to put bylaws together. I know the ones for California [California Medical Instrumentation Society (CMIA)] and Florida [Florida Biomedical Society] are extremely complex, because when you pay your dues you can either join a chapter or you can join the main unit. When you pay your money, part goes to the chapter and part goes to the state organization.

The way we’ve done it in most of our organizations recently is we’ve actually used the NCBA’s bylaws as a template. We started that organization 32 years ago, and there have only been three minor modifications in 30 years. The recently started Kentucky Association of Medical Instrumentation used the NCBA bylaws as a template, then added to them and made improvements—because obviously any time somebody looks at something they can come up with some way to improve upon it. Even right now there’s a group in South Carolina who is deliberating the Kentucky bylaws to start a biomed association.

Why don’t bylaws typically evolve? They really have not had to change since the goal of nearly every biomed association is threefold: to educate, to provide networking opportunities, and to raise the perception of the profession in the eyes of hospitals and employers.

How can associations simplify their overall organization? There’s one particular Web company that focuses on making life easier for associations called Wild Apricot (www.wildapricot.com). They allow members to join online, put their info online, pay online, and notify members when their membership is about to expire. They enable you, through their services, to put your events and meetings online and have people register. And you can send automatic e-mail notifications to your members about upcoming events. If you use it, it makes your life this much easier.

Should new associations seek 501(c) status right away? I think they should start on it very early because it’s a lot of paperwork. Anything with the IRS is complicated, and this is no different. Most organizations have actually gone out and hired someone to complete it for them because the IRS wants to know what you do with your money, if you get trusts, give scholarships, etc. There’s a lot of very detailed info there. You need an accountant.

The other alternative is to do it yourself by getting a copy of some other organization’s not-for-profit status and see how they answered the questions and modify it to suit your needs.

How would you advise a new association determine its membership fee? I would work backward from what you expect expenses to be. I think your out-of-pocket expenses would probably be in the neighborhood of maybe $1,000 a year, because you have to make a Web site and do bookkeeping. I would generally say $25 to $50 a year for working biomeds. For corporate members, if you want vendors and manufacturers to join, that should be $200 or $300 a year. Most places allow students to join for free or for $5 or $10 a year.

What should associations contract out, and what should they tackle themselves? It has been my experience that they should be able to do everything themselves. There are a lot of event planners that will offer their services, but they will charge you very much. You won’t make any money after your event because it will all go to your event planners. As far as bookkeeping, if you subscribe to QuickBooks online it costs $9.95 a month and it gives you a standard way of keeping books, even for a BMET who doesn’t have any accounting background. It makes it very easy to do. It’s online, so there are no paper records, and changing from one treasurer to the next is as simple as changing the login of the Web site, so there are no books to physically change hands.

What is a good way to train new people for leadership roles? In many organizations, the membership never elects the officers; the membership only elects the board of directors. They elect 10, 12, or 14 to the board, and then that board of directors gets together at the next meeting or in between, and they decide among themselves who is going to be president, vice president, secretary, and treasurer.

But you still have eight board members who said they would be active in the organization, but they’re not officers. They can participate at a very low level if they want, or at a very high level. It’s kind of a training, mentoring, or internship. We’ve had new people come on the board of the NCBA and they would literally sit there for 6 to 8 months—since the board is a 2-year term—at all the board meetings, basically just absorbing what’s going on and learning the ins and outs, building up a little bit of sweat equity in the process. Then, when they feel comfortable with the process, they start volunteering for things and getting active. That’s a good way to lure people in and get them involved.

The other way that I failed to mention is that the CMIA has a very good orientation manual. It’s about 130 pages long, and it’s a compilation of their history, their forms, their reports, and it is given to every new board member to orient them to the organization and how it works. Developing an orientation manual and patterning it after the CMIA is also a very good idea.

At the Colorado Association of Biomedical Equipment Technicians (CABMET), David Scott, CBET, board member and former president, weighed in on CABMET’s success.

How do you suggest new associations spread the word to biomeds? You’re probably going to need someone as an active leader for your group to call each hospital, unless you have an e-mail list already made up, which I can’t image you would have if you’re just starting. It takes a lot of legwork, communicating with everybody to let them know you’re going to start a new association.

How many members does CABMET have? Around 175—we’re not a huge organization, but we’re pretty successful.

How is CABMET structured? All four of our officers—president, vice president, secretary, and treasurer—are elected by our members, and we have a board appointed by our officers. Our board just started. We have a 3-year member, a 2-year member, and a 1-year member. We just redid our bylaws last year and started a board for that as well. We felt the bylaws were outdated. They were written in 1974, so we redid them in September of last year and our members voted on them. Our practice was different from what our bylaws said, so if we wanted to be in compliance with our bylaws, we needed to either change our bylaws or change our business, and we figured it would be easier to change our bylaws.

We had some of our members form a board to review our old bylaws and update them. Fred Jaramillo, who currently serves as our new president, was on that board. I mostly reviewed them and made suggestions. They would invite officers every now and then to sessions when they were reviewing and when we were finalizing it. We read everything out loud and discussed it.

What were your responsibilities when you were president? Originally, as president I did all of our meetings. I decided where they were going to be, since we rotate where we have our meetings, and who our vendor would be who was going to be presenting. I also helped get our Web site updated. Our Web site went from a one-page site to what it is today. Mostly it was my ideas on how it was set up, but we had a vendor who helped us set it up using one of their marketing people. Also, we never had an e-mail list and we didn’t have a way to verify members’ e-mail addresses. Now we have it all available online to all of our officers.

What kind of presentations do you look for at meetings? Usually it’s a vendor that presents, and usually we tell them how we want their presentation to go. We don’t want a sales presentation; we need it to be technical in nature, and we tell them that they’re presenting to a group of biomedical technicians. A lot of them bring in people that are experts on their equipment or the function or different pieces. We don’t have an official letter or anything that we send, so usually we tell them over the phone.

Is CABMET a 501(c) organization? I know we’re nonprofit. I don’t know of any associations that are anything else. It helps because people can donate to a nonprofit and it’s tax deductible. It also helps with our poker tournament. When we called the state, we said we’re a nonprofit and we’re doing this for a fund-raiser, and we got less questions from the state when we did that.

What do you charge for membership, and how did you arrive at that figure? Our membership is $15 a year. It was $10 for a long, long time, and I think we upped it to $15 a few years back. At the time, that was mostly the cost to do our newsletter annually. Now when we do our symposium, we sell ads for our newsletter, so we try to fund our newsletter through that.

How can new organizations start something like your popular CBET study group? Partner with us! We actually partner with quite a few biomed associations, like Indiana, the North Central Biomed Association, Arizona Medical Instrumentation Association (AZMIA), and also with CMIA. By partnering with them, we offer them discounts for all their members to join our group. So they do it as if it’s from their biomed association, but they’re calling into our line and listening to our presenters and doing a Web cast with us. That’s the easiest way.

If you do that once or twice and you can say, “Hey, I think we could have one these locally, and just copy what they’ve done,” you’ll have all the resources from being in our group.

Are the presenters paid? We pay them now, but originally we didn’t have enough money to pay anyone. Now our study group pretty much pays for itself. This is our sixth year running our study group, and we do it by Web and by telephone. We broadcast it nationally and now internationally.

What’s the secret to the study group’s success? Staying up to date on the test. We take notes on the test every time we take it, because it changes every time. But if you’re studying ECG, if you know the details about it then no matter how they ask the question, you’re going to know the answer. We also have practice tests, some that I’ve made up, and some that I’ve had help on, based on our notes and study topics, and based on the CBET handbook. Our practice tests are more to see if students are studying hard enough, if they really know as much as they should know, or as well as they think they might know it. We pass out notes we take off old tests, and we have really good presenters.

Board member and former president of the Virginia Biomedical Association (VBA), Al Strickler, also took time to share ideas for success.

What was the motivation to start the VBA? There had been a number of smaller local attempts by clinical engineering groups to start an educational association in the eastern part of the state and in the northern part. A group of folks got together from the entire state and decided that bigger was better and we could achieve economies of scale with membership, with finances, and ultimately with education, which was pretty much our primary goal.

What were your early areas of focus? Our early area of focus was education, education, education. Early on we identified manufacturers and pieces of equipment that multiple members were either using or that were standardized across most hospitals, and we approached those companies and said, “Hey, how about putting on a tech class for us with your particular instrument, and providing us with training?” Then we evolved into an annual symposium where we invited vendors to display products and also had educational sessions by manufacturers and other educational consultants.

How many members took part in those early educational sessions? In the early days, we may have had 40 or 50 members. There was a certain social component as well, which allowed members to get together and network and share ideas and talk about common problems or issues they might be having in their hospitals or in their shops.

How has the VBA changed over the years? All associations move in cycles, and momentum ebbs and flows. To keep things simple, let’s say we’ve been around for 15 years. The first 5 were really exciting, and we were growing quite a bit. Then we went through a period of a couple years where participation was relatively slack and there was a bit of apathy in the organization, so we ramped up by creating the MBA in a Day program. Our focus groups advised that if we were to get the high participation, we had to get the buy-in of managers and department directors. The goal was to have a program that was so desirable that department managers would come and then they would buy into the VBA and have their techs come and attend the meetings, so we created MBA in a Day, and we ran that for 2 years through a teaching institution, Virginia Commonwealth University. We approached their business department, and we held an all-day class only for managers. It started at 9 am and had a presentation for about 2 hours in the morning, then we had another 2- or 3-hour presentation in the afternoon. We provided the managers with skills they could turn around and use the next day in their shop. One class was on budgeting and finance and justifying purchases, there was another class on development and goal setting and growth as a manager, and a third was a marketing class. The goal was to have the manager go back into their shop and say, “Hey, I can do this differently based on the educational component I just saw.” We did it 2 years in a row, and we saw direct correlations between symposium attendance and those programs.

What are your annual membership fee and dues? The dues/membership fee is a relatively nominal amount. It’s about $40, and if you attend the annual meeting it is included as part of the admission price for the meeting—if you attend the meeting, you’ve paid your annual dues for the year.

How did you develop the bylaws and framework? The bylaws were cobbled together by two or three key people—Mary Coker, James Anderson, Virgil Smoot—they were involved in putting the bylaws together, and as a framework we used the NCBA’s.

How is VBA leadership structured? If you’re a member, you’re allowed to vote in the annual elections to elect board members. The board members then elect the officers to run the organization, and officers do not necessarily have to be on the board. We had limits on board member participation, and so there were talented people out there that were willing to serve and contribute but maybe they had just rotated off the board, so we decided that doesn’t necessarily mean the leadership of the organization needs to be on the board. From the early days we’ve been able to have folks in leadership positions and not on the board.

Typically, if a leadership position is filled by someone off the board, that person has been involved in the VBA for a number of years and knows the organization and knows the people. We’re not just reaching out, tapping someone that doesn’t have any experience. That decision is made in a very transparent fashion for the best of the association.

How did you get the word out about the VBA? We had some ambassadors that were out in the biomed community moving from hospital to hospital. These were vendors, even people like myself that are moving around from hospital to hospital. We had an early newsletter that the ambassadors would take and drop off in the various departments. In those days, e-mail was just coming on the scene and we were really promoting the organization via fax and personal contact.

We had a very focused push about 10 years ago where we assigned everybody in a geographic area certain hospitals for them to contact on a personal level. So a director of biomed, say in Roanoke, Va, was tasked with contacting six or seven hospitals in that area and alerting them about the VBA and letting them know about the educational opportunities and annual meeting, etc. We did that in various geographical areas of the state, so that when people on the board would reach out, we were reaching out to 50 or 60 potential new members that had never participated in the VBA previously.

This was a few years ago, and over the span of 2 years we increased membership from about 100 to 220. We have somewhere in the range of 300 members today.

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Stephen Noonoo is the associate editor of 24×7. Contact him at .