ADA REPORTS

President's Page: 1992-19983 Anual Report

Years from now, programyear 1992-1993 will be recognized asa watershed year in the history of The American DieteticAssociation (ADA). Each major initiative created or fur-

thered during the year focused on helping the dietetics professionachieve competitive advantage.

The most significant event of the year has been the nationaldebate about fundamental, yet dramatic, changes in the way thisnation approaches - and reimburses for- health care services. To fulfill ADA'sstrategy of achieving competitive advan-tage, we must make our voices heard inthe health care reform debate.

By any standard, health care reformpresents the single greatest opportunityfor the dietetics profession in the past 30years. Decisions made in the next 18months will affect the profession for yearsto come. This past year has seen theAssociation spare no effort to influencethe direction of health care reform and Ss""ot C. incto ensure that nutrition services are included as a basic benefit inthe new health care legislative package. Although progress hasbeen made, much remains to be done as ADA strives to fulfillits mission.

Beyond health care, 1992-1993 saw the implementation of keyinitiatives created to meet specific challenges within prioritymarket segments and to capitalize on particular opportunities forthe profession. This report addresses significant developmentswithin each initiative and recaps the rationale behind the Strate-gic Thinking Initiative.

Of course, many other activities helped make 1992-1993 amemorable year. A strong focus on education, research, andpractice issues continued to add value to ADA membership.

BUILDING THE FOUNDATIONFOR A SUCCESSFUL YEARADA's Board of Directors established priority objectives for 1992-1993. These goals - which were developed to be consistent withthe Strategic Thinking Initiative -- formed the foundation onwhich the year's program was built.

Program Objectives* This year we have focused our efforts on ensuring inmpleirment;a-tion and periodic evaluation of priority strategic initiatives, inparticular those related to health care reform and food labeling.These efforts will continue into next year and beyond.* Throughout the year, we have continued to support the reirn-bursement plan through becoming knowledgeable about codingprojects and deciding on the advisability of long-term investment.* We met our objective of completing implementation plans fordesignated strategic initiatives, operating plans for business andorganization units, and support plans for service units withaccompanying fiscal year 1993-1994 budgets by February 15,1993.

This President's Page excerpts information presented in AchieoiogCompetitive Advantage: The American Dietetic Association 1992-1993 Annual Report, with an emphasis on activities related to theStrategic Thinking Initiative. To obtain a copy of the full report, contactKaren Lechowich at ADA Headquarters, 216 W Jackson Blvd, Suite 800,Chicago. IL 60606-6995.

* The cost-benefit of restructuring the organization was assessed,and an appropriate course of action was recommended. Prelini-nary plans for internal reorganization have been announced, andplans are close to fruition for external reorganization.* We have determined and have been responsive to the key issuesfacing the profession and its members. We mobilized the appropri-ate resources and addressed issues in the following areas: prac-

tice, including networking, hunger, andthe environment; research, ie, targetingan appropriate focus for the professionand corresponding resource allocation; andeducation, including identifying educationchanges needed to help members be com-petitive in the marketplace

Operating ObjectivesThe following operating objectives havebeen a guiding force behind decisions thatwere made and actions that were taken

BleolerJ Bayjus throughout the year.* Create a climate that facilitates open conununication and fulldiscussion of issues.* Provide enthusiastic support and leadership to the organiza-tion.* Make decisions and take action according to ADA's mission,vision, philosophy, values, and financial capacity.* Foster partnerships between headquarters staff and memberleadership, and between internal organization units and externalaudiences.

COMPETITIVE ADVANTAGE THROUGHSTRATEGIC POSITIONINGCreating opportunities, rather than waiting for opportunities topresent themselves, is the essence of achieving competitive ad-vantage. The challenge, then, is identifying markets and trendswhere the greatest opportunity lies.

Today, with the overwhelming support of membership, theStrategic Thinking Initiative - as demonstrated by measurableprogress in each of the initiatives -- is pushing the Associationrapidly toward the 21st century. Many challenges have alreadybeen identified and met, and potential problems have been antici-pated and planned for. Real, measurable progress has been made.

Following is a closer look at the six initiatives, from the thinkingbehind each program to major accomplishments and the futureoutlook in each area.

Health Care ReformTwo years ago, the Association identified health care reform as itshighest priority. What followed was development of a platform."The Economic Benefits of Nutrition Services," that; provided afinancial rationale for including nutrition services in the healthcare reform package.

Today, the health care reform debate dominates the nationalagenda, providing an unprecedented opportunity for the dieteticsprofession. Armed with hard facts about how medical nutritiontherapy can save millions of dollars in treatment costs, ADA isaggressively taking its message to the Clinton Administration antiCapitol Hill. The Wexler Group, a leading Washington, DC, publicpolicy firm, was hired to strengthen our effort.

When President Clinton introduced his health care reformpackage to Congress and the nation on September 22, 1993 he

1448 / DECEMBER 1993 VOLUME 93 NUMBER 12

recognized that prevention is an important part of health care. (Seethe January 1994 Jo nCal for an analysis of nutrition componentsof the plan.) The President's proposal calls for health educationand training and increased funding for disease prevention, both ofwhich include a focus on nutrition. ADA's efforts will continue tostress the benefits of including medical nutrition therapies as abasic benefit in the final health care legislative package.

In addition to efforts influencing legislators on Capitol Hill, theAssociation has mobilized an extensive grassroots network amongthe membership. In August, the Division of Government, Affairsand the Wexler Group conducted an intensive training session tohelp Legislative Network Coordinators refine their skills and focuson key messages.

Raising the awareness of key legislators, policy makers, and thepublic is an essential health care reform strategy. The ADAAmbassadors and State Media Representatives are engaging in anintensive camnai.n to explain to the media theneed for medical nutrition therapies in the newbenefits package. Meetings have been held withkey members of Congress and their staffs toemphasize the benefits of nutrition services.Testimony has been provided before Congres-sional committees involved in the health carereform debate.

The Nutrition Screening Initiative has beenhelpful in ADA's health care reform efforts.Surveys demonstrating the cost-effectivenessof nutrition care and the $9 million allocatedfrom the National Institute of Aging to study thebenefits of nutrition screening and interventionshould provide the information needed to en-sure inclusion of medical nutrition therapies inhealth care reform legislation.

Nutrition & Health Campaign for WomenA well-documented link exists between nut ri-tion and three major diseases that affect women:coronary heart disease, breast cancer, andosteoporosis. For that reason, ADA created theNutrition & Health Campaign for Women withthe support, of Weight Watchers International,Inc, and the National Dairy Council.

The multiyear campaign, which emphasizesresearch andl education, is perfectly timed tocoincide with the health care reform debate.Thi vnr nlnn rnmillinns of lnlars will hp npnt

t reating approximately 50.00.00( wornen for car-

Mission -Dietetic Asscadvocate ofprofession,

public thpromotionnutrition,

well-

Vision -.The AmerirAssociation

thefood cimpact thestatus of l

Philosophyof The A

Dietetic Aserve thebest by s(

publi,

dciovascular disease, more than 180,000 women for breast cancer,and the one third of postmenopausal women who haveosteoporosis.

The campaign's launch at a New York City press conference in.une received considerable nationwide coverage from print andbroadcast media, including a July segment in which ADA's effortswere featured on NBC's "Weekend Today" show.

In September, literature reviews by four leading dietitian scien-tist s who are experts on breast cancer, heart disease, osteoporosis,anti healthy body weight were published i the Joncunal of TheAunericma Dietetic Associatiov. These papers provided a scien-tific direction for the campaign and recommended future re-search and educational strategies on each subject. The findingswere also presented to national leaders in the women's healthmovement in Septenmber. ADA has used the findings of thesescientific review papers to call for studies that explore the role ofnutrition in preventing these diseases and to educate womenabout how a healthful diet can help them reduce their risk ofchronic disease. Synopses of these reports were also presented by

U

Th)c

tt

s.

hb

IL

hi

£th

.7)

.s.p

Crc

the researchers at the newly created members' meeting duringthe 1993 Annual Meeting.

A panel of national advisers has been assembled to support,guide, and promote the campaign and to review materials devel-oped for consumers and professionals. Opportunities may alsoexist to collaborate with the food industry on assessing how theiractivities affect women's health.

Physician InitiativeA 1985 National Academy of Sciences report found that nutritioneducation in US medical schools was inadequate -- a disturbingdiscovery given that 8 of the 10 leading diseases in the UnitedStates are linked to nutrition. Filling in some of the gaps inphysicians' nutrition knowledge is essential to the success of thePhysician Initiative.

In addition to providing educational materials for physicians, akey strategy for the program will be enhancingthe skills, knowledge, and attitudes of dietitians

de American to help them become more effective research-iation is the ers, clinicians, communicators, and educators.he dietetics A Physician Nutrition Education Project,

sponsored by Nestle USA, Inc, was launched toserving the help physicians better understand the role ofough the nutrition in health promotion and to evaluatef optimal patients' nutrition information needs more ef-ealth, and fectively. An advisory council of physicians in

family and general internal medicine and dieti-tians experienced in medical education is guid-ing the project. Focus groups with physicians

members of have been conducted to help determine thean Dietetic scope of the project.will shape The first educational effort of the Physicianvoices and Nutrition Education Project wil address physi-

cians on a personal level. A self-assessmentjut rational survey--"How does your pyramid stack up?"-l.e public. will encourage physicians to compare their own

nutritional habits with established dietary guide-- Members lines. Later mailings will provide models to,zerican evaluate patients' food consumption practices.

In October 1993, AD)A sponsored an exhibit;sociation at the American Academy of Family Physicians'profession Scientific Assembly in Orlando, Fla. A question-wving the naire for attendees was available at the booth.first. and the results will be evaluated along with the

focus group findings. The American Medicalb inA IAtr A A ;nthr -fk tr

lion education projects, including developmentof a CD-ROM program on nutrition.

In the planning stages are educational programs for ADAmembers on communication and leadership skills to enhanceinteraction with physicians and administrators who influencehealth care decisions. In addition, a 1993 Annual Meeting presen-tation, "Positioning Yourself for Effective Interaction: TeamingUp for Success," highlighted a variety of success st ories of dieti-tians working effectively with physicians, chief financial officers,and hospital administrators. In addition, the session outlinedfuture initiative activities.

Leadership InitiativeLeadership, always an essential attribute, becomes even morecritical during periods of rapid change. On t he brink of the 21stcentury, change abounds in all areas of the dietetics profession-education, research, and practice.

ADA is in the business of developing tomorrow's leaders. TheLeadership Initiative (formerly known as the Institute for Profes-sional Enhiancement) was created to further enhance the skills of

.JOUtRNAL OF THE AMERICAN DIETETIC ASSO :IATION / 1449

~IJ. "'"". '""''" CLLU"". Illl'JL"J t`l~t; ~llL>;- =" .<;r"~rtL"\"' 1u0 111ati I~itu VIII.I rwlJAII tlblk 1I II1111--

.................................................................. ..................................................................REPRTSADA REORTS

OPIRATIN IG UGTS

The following is just a taste of the many achievements and accom-plishments in other areas of the Association. A more detailed descrip-tion may be found in the full Annual Report.

Education The Dietetics Education Task Force recommendation thatsupervised practice programs be recognized exclusively by theaccreditation process will be implemented in the future.

Research The Council on Research published the proceedings ofthe 1992 dietetics research conference and identified high-prioritynutrition research issues for future investigation

Practice Operational guidelines were developed for networkinggroups. Two new practice groups - Hunger and Malnutrition andOncology Nutrition - were founded this year.

Quality Management Through the efforts of the ADA Joint Commis-sion Standards Review Task Force, the 1995 JCAHO standards willshow the need to include an RD in developing nutrition care plans.

Alliance Program New strategic alliances were formed with theInstitute of Food Technologists, the American Society of ClinicalNutrition, and the American Institute of Nutrition. The resulting group,called the Food and Nutrition Science Alliance, will translate scientificinformation into practical advice for consumers.

Marketing and Communications Aggressive media relations ef-forts were launched in conjunction with health care reform, the 1993Men's Nutrition Campaign, the Nutrition & Health Campaign forWomen, and the ADA Survey of American Dietary Habits.

an emerging generation of leaders, leaders who are willing tomake changes rather than waiting for things to change aroundthem. The Leadership Initiative subscribes to the philosophy thatleadership is not exclusively a function of position; a premium isbeing placed on leadership abilities at all organizational levelstoday. Another tenet is that leadership is not a special gift for aselect few. With the right training and support, all ADA memberscan become leaders.

Through potential collaboration with outside organizations,such as the Center for Creative Leadership and The PennsylvaniaState University, a core curriculum of educational programs inleadership will be developed. The initiative's core programs willprovide intensive experience in the theory and practice of dietet-ics leadership.

In July, a task force analyzed ADA's most recent: role delinea-tion study against 86 critical leadership skills. This has resulted ina prioritized list of skills that will be tested for use as a guide inprogram development.

The initiative's planning team met in August to develop aconcept paper that was presented to the House of Delegates atAnnual Meeting. Their discussion centered on establishing priori-ties for leadership development programs; for example, givenlimited resources, what target audiences and what developmentapproaches should be emphasized in the start-up phase. Alsodiscussed were ways to market programs to members and em-ployers and evaluation strategies to determine the effect of suchprograms on participants, the workplace, and the profession.

Although the final form of the Leadership Initiative is still beingevaluated, it will definitely offer something of benefit to everymember. The initiative will provide opportunities for members toimprove skills such as negotiation, entrepreneurship, and strate-gic thinking. Many programs will be available to the full member-ship, others may focus on developing qualified individuals forhighly visible leadership roles.

Meetings Attendance at the 75th Annual Meeting, in Washington,DC, was 11,000, an 8% increase over 1991.

Membership As of May 1993, membership was just over 63,500, a1% increase overthe previous year. The "Set Your Sights" recruitmentprogram continues to build contacts with prospective students.

PolicyAdministration/House of Delegates Positions were adoptedin support of ADA's major initiatives, including the first joint positionwith the Canadian Dietetic Association.

Publications The Journal of The American Dietetic Association andCouriercontinued to reach members monthly. More than 30 profes-sional and client education publications were released this past year.

National Center for Nutrition and Dietetics The Consumer Nutri-tion Hot Line continues to field about 18,000 telephone calls eachmonth. The Nationwide Nutrition Network referral system was suc-cessfully launched. Media coverage of National Nutrition Month®,which featured the Food Guide Pyramid, was strong.

ADA Foundation ADAF granted 165 dietetics scholarships totaling$157,000-a 10% increase over lastyear. Contributions totheAnnualFund Campaign exceeded $149,000, and the Corporate Campaignraised nearly $700,000.

Commission on Dietetic Registration The first Specialty BoardExaminations in pediatrics, metabolic, and renal nutrition were ad-ministered. The award-winning "Self-Assessment Series for DieteticsProfessionals" was launched.

Consumer EducationPublic awareness of the relationship between diet an(l health is onthe rise, but alarge gap remains between knowledge and behavior.As the largest group of food and nutrition professionals in theworld, ADA and its members have an important opportunity toshape food choices and affect the nutritional status of the public.

The Consumer Education Initiative, with its emphasis onstrengthening linkages with the media and with the food, health,and pharmaceutical industries, is one of ADA's most. visibleprograms. Critical to its success are identifying and developingnutrition-oriented messages that meet the needs of diverse groupsof people. Through a wide array of programs, many with the strongsupport of industry partners, ADA is beconuing recognized as acredible, valued source of food and:l health information t to thepublic.

Food labeling education is the initiative's top priority. Helpingconsumers understand how to use the new labels to achieve ahealthful diet is a key objective. With the support of Kraft GeneralFoods, a campaign to educate the media about the new labels isalso being implemented.

This past summer ADA, in cooperation with the Food Processors Institute, cosponsored the first of a series of 16 regionalworkshops for members entitled, "Food Labels: Learning the NewLanguage." The workshops, which began in July and will continuethrough the end of this month, are funded in part by a grant fromthe Campbell Soup Company and are designed to teach diet eticsprofessionals how to help consumers interpret and apply the newfood label.

A new publication, Label Facts fir HealnttiJl ttinzqj, createdby an alliance of ADA, the Food and Drug Administration, the ITSDepartment of Agriculture, and nearly 40 food, nutrition, andhealth associations, supports the Association's far-reaching labeleducation efforts. Through ongoing programs sucnl as NationalNutrition Month® and active involvement in timely issues such as

1450 / DECEMBER 1993 VOLUME 93 NUMBER 12

food labeling education, the Consumer Education Initiative ismoving strongly ahead.

Foodservice InitiativeAmericans currently spend 43 cents of every food dollar eatingout, and by the year 2000 that figure is expected to rise to nearly50 cents. As a result, ADA recognized that the comnercial/retailfoodservice market presents notable new opportunities for di-etetics professionals.

Currently, dietetic(s professionals are an underutilized resourcein this market. Several trends illustrate the benefits ADA mem-bers can offer: consumers are demanding healthier foods awayfroM home, environmental concerns have increased awarenessabout food safety, ad advances in food science are makingnut ritious products easier and more cost-effective to produce.

Forming strong alliances with key groups in this market seg-inment is an essential strategy. In addition, this initiative will focuson enhancing educational opportunities for members in commer-c ial/retail foodservice and foodservice management as well as oilimplementing product s and programs that increase the profile ofdietetics professionals serving this market.

An importall; alliance with the National Restaurant Associationiresulted in AI)A's first-time exhibit at the National RestaurantAssociation show in May 1993. Hundreds of inquiries flooded thebooth and more than 60 requests for dietitian assistance with

menu planning and nutrition information were referred to theI)ietitians in Pusiness and (Communications dietetic practicegroup. Now the Association is studying the new Food and DrugAdministration rules concerning nutrition claims on restaurantmenus annd labeling requirements.

Secondary research has been conducted to assess the areasexperiencing growth within the foodservice market. The resultingrecommendations are being evaluated and form te basis of aneeds-assessment study of conunercial foodservice operators.()nce c( omplet(ed, the research conclusions will be used to identifyactivities that c an develop the potential of this market segment.

The initiative's efforts already are bearing fruit. Culinary TeamI TSA has requested dietitian representation on its board of direc-tors. Through this group, the ADA can influence other key groupssu(hl as The At erican Culiuarv Federationl and the (lub Manage-nerlt Associaiotl.

FISCAL PERFORMANCEFiscal year 9!92-19953 elldedl with a surp:llls of revenue over

expenses of $1.030,182. The excess exceeded expectations be-cause of a larger than expected increase in investment income, adelay from May o June in Annual Meeting marketing and promo-tion, a deferral of health care reform consulting services andgrassroots training, and an increase in 1992 Annual Meetingincome. The Figure on this page shows reventie and expendituresfor fiscal year 1992-1993.

Total ADA assets, including those from dietetic practice groupsand the Commission on Dietetic Registrationr have increased by$1,861,127 from the previous year. The fill increase was addedto our investment accounts.

The annual audit of the Association's financial statements forthe year that ended May 31, 1993, was conducted by Ernst &Young, an independent audit firm, which found the statements tobe in conformity with generally accepted accounting principles.

From a financial perspective, ADA is gaining momentum to-ward its vision of achieving competitive advantage. A solid finan-cial base and prudent fiscal planning and manaclagement are sup-porting the Association's goals.

Operating plans have become the basis for budget preparationand for Imakirig decisions on redistributing funds through thequarterly project monitoring process. This year ADA took animportant step by translating the Strategic Trhiriking Initiativeplans into anullal operat ing plans and linking t hose plans xith thebudget process.

Ext ernal funding, which has significantly expanded, is having apositive effect on the current fiscal year. In August 1993, theComndssioni on Dietetic Registration approved a $200,000 grantto support t he Association's comnmuIicat ion effort s on health carereform.

Other major external commintmenlts included $439,000 fromWeight Watchers International, Inc, and $92,000 from the Na-tional Dairv Council to support the Nutrition & Health Campaignfor Wonmen; $356,000 from the Nestle USA Foundation to supportthe Physician Initiative; and $59,000 from the estate of E. NeigeTodhunter to support the Leadership Initiative.

The ongoing commitment and involvement of each mnenlber areessential in accomplishing ADA's far-reaching mission and vision.Members' individual contributions have been critical to our suc-cess this year. We must continue to work as a team in serving thepublic through the promotion of optimal nutrition hIl.alth and well-beilng and in helping our profession and our Association achievecompetitive advantage. - SI'AN C(.ALVEh'T FIAN, PhD, RD,(Ia l EVEhLY B.' . if S

iOURtINAI. (iF THE AMERICAN DIETETIC ASS(CIATION / 1451

1992-1993 Revenue and ex:pen.ses. " The 70% for Total Member Prograims comprised thefollo uing: Publications,29%; Meetings, 11%; Membership, 6%; Dietetics Practice, 5%; Marketing and Communications, 6%; Education,4%; Legislation and Public Policy, 4%; Research, 2%; Reimnbursenent, 2%; Alliance Relationships, 1%.