Interview by Aisha Taylor, PhD
As a pioneer in the credentialing community, Denise Fandel has made important strides for the athletic training industry, as well as for the Institute for Credentialing Excellence. Since 1997, she has served as the executive director of the Board of Certification Inc. for the Athletic Trainer (BOC), building it from a group of volunteers to a well-respected professional organization with a full-time staff of 19 and a national headquarters based in Omaha, Nebraska. Starting as a volunteer for the ICE (then National Organization for Competency Assurance (NOCA)) program committee, Fandel has served as chair of the National Commission for Certifying Agencies (NCCA) and as chair of the ICE Board, contributing to the rebranding of the NOCA to the current ICE. Her active participation provided a strong network for the work she does, and also gave her, as she calls it, the “certification bug.”
ICE Digest asked Fandel to share her experiences and perspectives on the challenges and opportunities facing her industry, as well as her advice for credentialing professionals.
How did you become involved in the credentialing community?
I went to graduate school at the University of Nebraska at Omaha, where I continued my career in athletic training. I was certified as an athletic trainer, and a few of my mentors and bosses were involved with the National Athletic Trainers’ Association (NATA) certification exam. My boss at the time volunteered me to help administer the practical exam, which was quite labor intensive. As a result of that activity, I became an active member of the NATA certification committee. Before 1989, the BOC was the certification arm of the NATA, and in 1989, the BOC became an independent nonprofit organization. After the split, I served on the board of the BOC. After a number of years, my colleagues on the board honored me by recommending that I take a stronger leadership role. In 1997, I became the first paid BOC staff member, as executive director. My charge was to develop a strategic plan that would lead to the development of a full-time staff. In the years that followed, there was gradual growth, and we now have 19 full-time employees. Within three years of becoming executive director, we brought the exam administration in-house. We have since brought the administration of continuing education in-house, as well.
Along the way, mentors were important for my education in certification, and one of these mentors was Paul Grace. As a founder of NOCA, he was serving as chair at the time that I was on the board, and he instilled in my mind the importance of certification. His influence, as well as becoming engaged in the NOCA/ICE community, was what gave me the certification bug and got me engaged in the standards that guide how to run a quality certification program.
What do you believe are the most pressing challenges certifying organizations face today?
I see three main challenges. The first is always the challenge of helping the general public understand the value of certification. This is even more relevant now with deregulatory trends in government and the potential implications for occupational licensing and certification. There are also many changes occurring with the increase in certificate programs and digital badging. Our challenge is to educate the public regarding the value of credentialing and to know to look for certification program or organization accreditation from an external organization (e.g., NCCA, ISO). Anyone can have a certification program, but it makes a major difference if the program or organization is accredited by a respected national or international third-party agency. The third-party agency provides standards that programs can use to benchmark certain aspects of their program and stand out from the crowd. Our challenge is to demonstrate the value of the credential by showing that the quality of work is higher when performed by a certified individual than by one who is not.
The second challenge facing many programs is the issue of governance and making sure the board stays at the level of strategic thinking and planning versus doing the work of the program itself. I call this “noses in, fingers out.” The board provides oversight and direction (noses in), but does not take part in the management of the program (fingers out). This type of governance was developed by John and Miriam Mayhew Carver, who names it Policy Governance. The Policy Governance model allows the executive director to manage the day-to-day business of the program and make appropriate decisions, while the board is able to strategize for the future and focus on its fiduciary responsibilities.
The final challenge I see is handling disciplinary issues. If a certification program or organization is accredited, the certification organization needs to be diligent and provide strong oversight regarding discipline. This is tied to governance in that the organization’s disciplinary policy and procedures must be nimble enough to take action as swiftly as necessary, but it must also be thought out well in advance. This is where Policy Governance becomes necessary and shows its value. It empowers the executive director to make more decisions regarding discipline (and other) issues because she or he knows the boundaries and parameters the board has set. The board has had discussions ahead of time regarding the type of actions that could be taken in different situations, and this strategic planning helps the executive director make decisions without needing to take every situation to the board for review.
What is your organization doing to tackle these challenges?
The BOC has taken a number of steps to proactively address these three challenges.
First, to help educate the public regarding the value of certification, especially in the midst of deregulation trends, we have made intentional efforts to develop relationships and partnerships with state regulatory boards to help them understand that our program exists and to demonstrate its importance. Our certification is required in 48 of the 50 states, so this is especially relevant for my organization. We created a network for state regulatory employees and their voluntary boards. This model works well when there is trust between the board and executive director, who is the link to the staff. With this network in place, we are educating state regulatory boards about the value of our credential and certification generally. Through the relationships we have developed and the information we provide, we are demonstrating that certified athletic trainers perform the job more competently, thus showing the value of the certification.
Second, to address challenges surrounding governance (including disciplinary issues), we transitioned the BOC board to the Policy Governance model, which provides more continuity and consistency for all involved, from the board room to the staff at the national headquarters. We have also created an infrastructure to gather and analyze data to anticipate upcoming changes, so the board can strategize solutions and ways to maximize opportunities and minimize potential threats. We gather data in myriad ways. We solicit responses from candidates at the exam site when they take the exam, we work with institutions of higher education to keep abreast of the most recent research, and we facilitate an open comment period for certificants before any major change is implemented. In addition, three of the BOC board members are not credential holders, which helps gather information from outside the athletic training industry. I also helped create the strategic alliance, which include four pillar entities: the educational arm, the profession membership association, the charitable foundation and the BOC (the certification entity). This alliance works as a group to ensure we are not duplicating efforts in the athletic training industry, and we share and have access to each other’s data. For example, we use the numbers the educational arm provides to determine roughly how many athletic trainers are in the pipeline to forecast potential growth. We also obtain information from the professional association to determine if there will be attrition due to aging members, etc. To share the information gathered, we publish a great deal on our website, and we make presentations and receive feedback in different forums — ICE being one of them. These channels enable us to monitor and keep up to date with what’s going in the in the health care industry as well as the credentialing community.
What are some of the opportunities certifying agencies should be aware of and preparing for coming down the pipeline?
What immediately comes to mind is the work the BOC has been doing over the past 10 years regarding the best ways to demonstrate maintenance of competence. We, and the public, are wondering how an individual remains competent in the profession after he or she has been certified. The ongoing discussions revolve around the question of how or if any of our current continuing education requirements should be changed to ensure practitioners maintain competence. The opportunity here is to think differently and be proactive about recertification requirements, asking ourselves if they actually serve to maintain the knowledge and skills needed for the profession. To ensure the standards are met, we have to make sure they have meaning to certificants and to the public. To help answer these questions, we gather information, including the results of CE activity audits and discipline cases. We are also asking new graduates who are entering the profession what are the most difficult areas in the transition from student to professional.
A second opportunity for certification organizations is to become more active in helping candidates understand the credentialing process (i.e., to understand the exam). The NCCA standards do not prohibit participation in test preparation, and it would behoove programs to listen to the voice of customers/candidates in providing the necessary information. The appropriate firewalls must be built, but there is no NCCA accreditation standard precluding programs from having an arm that conducts test preparation and another entity that conducts the continuing education. The point is to observe what the candidates need and ask questions as appropriate to further find ways to help the potential certificant and solidify the program as an important part of their professional lives.
Finally, I cannot stress enough the value of ICE. Getting involved enables you to learn what other organizations are working on, what the vendor community is developing, and it’s a great way to benchmark your program in the context of peer organizations.
What advice do you have for credentialing professionals given your experience?
Take advantage of the educational resources of the ICE. The online education programs are excellent and have recently been improved (e.g., certification 101, 201, and the credentialing specialist program). Use these educational pieces to increase your own knowledge and that of your staff. It’s important for staff to have a depth of understanding certification, as it’s such a specific industry.
Get involved. It helps not only with networking, but it will also give you an understanding of what is going on in the industry.
Find a mentor who has been involved in the community. Learn from each other and focus on developing relationships and thinking strategically. Don’t get caught in the weeds and be blindsided by changes that inevitably come. Use your network and data to think ahead strategically.
Finally, I am a strong advocate for ICE, so I recommend that you budget for attendance to the ICE annual meetings. ICE has been a powerful resource throughout my career. By attending the annual conferences and being active in the ICE community, I have learned that credentialing encompasses a great deal more than I thought, especially with more and more non-health care practitioners involved. It provides a window to other industries to see the bigger picture and to learn what potholes others have stepped in and how to get back on track.
The Board of Certification Inc. (BOC) was incorporated in 1989 to provide a certification program for entry-level athletic trainers (ATs). The BOC establishes and regularly reviews both the standards for the practice of athletic training and the continuing education requirements for BOC Certified ATs. The BOC has the only accredited certification program for ATs in the U.S.
The BOC exists so that healthcare professionals worldwide have access to globally recognized standards of competence and exceptional credentialing programs that support them in the protection of the public and the provision of excellent patient care.
To provide exceptional credentialing programs for healthcare professionals to assure protection of the public.