I think what it comes down to is contained in the following questions. What is the department saying in their action plan? How detailed is it? Can you as a committee member understand each of the steps they are saying they are going to do? What could they present as evidence that they have completed? I think the process would be to get a detailed understanding of their action plan and how they can come back and demonstrate that they've met the milestones along the way.
On December 4th, 2013. See this statement in context.