In recent years, performing medical ultrasounds has become easier. And that’s made Dale Cyr’s job harder.

In 2010, Cyr, CEO and executive director of the American Registry for Diagnostic Medical Sonography (ARDMS), began losing sleep over the growing use of handheld ultrasound devices by medical professionals who weren’t trained as sonographers and sonologists. “These folks are out of the realm of our traditional credentialing and certification,” he says. “And these machines were being sold at a rapid rate.”

You can’t have real strong biases toward the work, because this requires thinking outside the box.

Critics say the proliferation of so-called point-of-care ultrasound carries the risk of misdiagnoses.

The potential erosion of ARDMS’s standing was no small concern, either. “At that point the organization had to evolve in terms of how we test and who we test,” Cyr says. “It would require significant operational and governance changes.”

Cyr began making those changes in earnest in March 2011. With a strategic planning facilitator, he convened a two-day meeting of approximately 60 of ARDMS’s top volunteers—sonography experts who oversee the association’s testing.

Taking an urgent conversation to volunteers first—instead of the board—accomplished two things. First, because consensus was thin before the meeting, the retreat allowed the association’s stakeholders to get on the same page about the problem before asking the board to take action. Second, starting with a volunteer discussion removed the pressure of making strategic decisions on the spot. “We told them that this is strictly to take a step back, hear the information, talk amongst yourselves about the information, and then talk about how the organization has to evolve,” Cyr says.

Still, the association moved fast. Two months later, the ARDMS board convened to respond to the volunteer discussion. There, it launched a three-year strategic plan and an innovation task force “to begin developing new types of exams that would be meaningful to new practitioners,” Cyr says. That means making the tests more tablet- and smartphone-friendly and doing better outreach to candidates for the testing.

ARDMS recently piloted a new exam, using iPads and tablets for delivery, to a point-of-care group in Spain. ARDMS will revisit its plan again in 2014 and intends to roll out its examinations more broadly. In the meantime, the association has placed a stronger emphasis on innovation among its staff and hired two dedicated test-development experts with experience in educational strategy—but, Cyr says, without preconceived notions about what ARDMS should do. “You can’t have real strong biases toward the work, because this requires thinking outside the box.”

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