I am writing to express my interest in serving our profession as the Secretary-Treasurer of AAPA, 2018-2020, and to highlight my selected qualifications. I hope to convey to you my longstanding commitment to best practices of board oversight and governance that began in 2001 when I was new to board service.
You may recall 2001 was the year when the failures of Enron’s Board of Directors to provide adequate oversight became public. Witnessing that scandal unfold shaped my perception of what it means to accept the responsibilities associated with serving as a board member. Drawing from my PA experience, I employed the same lifelong learning approach we take with clinical knowledge. I actively sought the knowledge, skills, and abilities to provide effective fiscal oversight while concurrently adding value to the organization’s performance and governance. As a result, I am making better, more risk-informed, strategic decisions.
In 2003 I was recruited to work at Goldman Sachs. The firm was highly supportive of charitable board service, and I regularly attended events with guests from Deloitte, EY, KPMG and PwC where I was introduced to the nuances of board fiscal oversight. I found myself with unlimited access to resources like the Harvard Business Review. One day a month I left the office to attend organizational development training on managing conflict, leading more efficient change, and improving effective interpersonal communication on multiple levels. I continued this training through 2013.
Since then I have intentionally sought and served in board director and officer roles with increasing complexity and operating budgets. Incidentally, I continue to receive invitations to serve on finance and audit committees after my board affiliation with an organization has concluded.
More recently, during my tenure as an AAPA director at large (2014-2017), I served as an active member of the Board finance committee. I am grateful to the three consecutive AAPA presidents who expressed their confidence in my contributions to the Finance Committee by appointing me for an unprecedented three years to a committee that was otherwise composed of board officers. In this role, I was jointly responsible for oversight and review of:
- AAPA’s financial matters on a regular basis to include AAPA’s financial position, quarterly and annual fiscal year financial statements, capital budgets, investment policy and performance, reserve funds, our form 990 and other tax forms before being received by the BOD and filed with the IRS;
- Accounting and financial policies and procedures;
- Long-term financial planning;
- Evaluating the proposed fiscal year budgets and performance against the approved budget;
- Monitoring Audit Committee activities;
- Presenting the proposed annual budget to the full BOD for their consideration;
- Responsibility for hiring, compensation, retention, and termination of the investment advisor.
In 2017, I was elected to fill the seat vacated by the Secretary-Treasurer and serve the remainder of the 2016-18 term. As Secretary-Treasurer, I have assumed the added responsibility of chairing the finance committee as well as serving on the audit committee, where I continue to ensure diligence in the fiscal oversight of our organization.
I am also prepared to enthusiastically address the other responsibilities of the office of the Secretary-Treasurer as delineated within the bylaws, including ensuring proper corporate and statutory documentation, recordkeeping, and reporting. I have had experience with these tasks in former board officer and staff positions.
Serving on the Executive Compensation Committee is another responsibility of the Secretary-Treasurer. My board colleagues have heard me repeatedly say that recruiting, supervising, evaluating, and compensating the CEO is probably the most important task of a board member. I have experience serving on executive search and compensation committees for various boards.
As a PA who continues to practice clinically, my participation on the Executive Committee (EC) is complementary to the other committee members – all of whom are employed in academia or hospital administration. Further, my board experience and training have focused on board oversight and governance, which would also complement experience from other EC members.
To summarize, I am committed to fiscal responsiveness and experienced with best practices of board oversight and governance. I believe the optimal decision‐making process requires effectively applying an appropriate level of professional deliberation to judgment processes, explicitly considering alternative perspectives, and engaging management in frank and open discussions. I am prepared to promote vision and direction while safeguarding values and reputation. I have been and always will be a guardian of the organization’s mission. More than 15 years of training and experience in board-level fiscal oversight has prepared me for the multiple facets of the Secretary-Treasurer role: from oversight of the organization’s financial matters to corporate and statutory documentation, recordkeeping, and reporting, as well as matters handled by the EC and the Executive Compensation Committee. Finally, I am aware of the time commitment necessary to fulfill these duties, and I am prepared to give them the attention they deserve.
Thank you for your consideration of my interest. I would be honored to serve if elected.
Diane Bruessow, PA-C, MPAS, DFAAPA
- How would you explain what Optimal Team Practice is, and its implications for the PA profession and for patients?
I always make an effort to understand each issue from the perspective of the person I’m speaking with – whether that person is a PA or PA student, a PA educator, a constituent organization leader, a physician, a hospital administrator, or anyone else. Because each of their roles and goals, and the context of their relationship to healthcare, varies, so does my explanation.
Speaking with a PA, I might talk about how AAPA’s 2017 House of Delegates revised the policy on Guidelines for State Regulation of PAs, to further optimize PA practice. The revision represents four areas where clinically practicing PAs are finding themselves at a competitive disadvantage within the healthcare workforce. These four tenets are being referred to as optimal team practice (OTP).
Influence on patient care may not be obvious. To share a few examples:
- Barriers that prevent direct reimbursement to PAs may result in a segment of PAs’ work being excluded and ultimately invisible from the data used for public health and healthcare workforce planning.
- Physician collaboration requirements may maintain rather than mitigate the existing problem of inadequate healthcare workforce distribution by restricting PA practice to areas where physicians are already practicing. An exception is rural health where PAs already practice in a slightly more relaxed regulatory environment and provides us with valuable insights into what some aspects of OTP may look like in practice.
- The legal requirement for PAs to have a specific relationship with a physician may contribute to the inefficient application of healthcare workforce resources. After 50 years, the PA profession is capable of mobilizing experienced PAs to assume responsibility for education and practice support for less experienced PAs.
- What is your position on Optimal Team Practice (OTP)? What do you view as the most challenging hurdle(s) to overcome in the implementation of OTP? As a Board member, what strategies would you offer as a means of overcoming these challenges?
I support the four tenets of OTP.
Because PA practice is regulated predominantly at the state level, and because state chapter resources vary, the most challenging hurdle is lack of adequate resources among state chapters as well as their PACs, which are consistently underfunded in contrast to other healthcare professionals. I voted for the FY2018 budget line item to provide support to our state chapters who are ready, willing, and otherwise able to advocate for implementation of OTP’s four tenets. I support the current AAPA strategy for OTP rollout at a pace determined by those state chapters who are ready to do so.
It is through an organization’s budget (how we distribute the organization’s resources) that a board prioritizes some goals over others. If re-elected to serve as the Secretary-Treasurer, I would continue to work toward ensuring OTP receives the financial support necessary for its progress in those states that are ready and willing but are financially unable to move forward.
- What is your primary motivation for wanting to become a Board member? As a member of the Board, what initiatives would you bring to the Board’s work and how do these initiatives support the critical role PAs play in today’s healthcare marketplace?
Philanthropy – giving time and money for the good of others – is both a personal and a family value. Board service is one such opportunity.
I am also motivated by a personal interest in organizational development and have taken classes for over a decade that emphasize managing conflict, leading more efficient change, and improving effective communication on multiple levels – all of which I believe are essential to optimal decision-making. Above all else, making better, more risk-informed, strategic decisions is the primary role of any board director or officer. Consistently making sound professional judgments in a dynamic environment has never been more important or challenging.
The PA profession has established a solid reputation from decades of being responsive to the health of the public. AAPA must ensure the profession’s reputation and values are safeguarded for future generations of PAs, while promoting vision and direction. AAPA must continue to maintain this priority across all activities and programs along with preparing the profession for new models of healthcare delivery not only in today’s healthcare marketplace as this question suggests, but also in tomorrow’s healthcare marketplace.
An organization’s culture can play an important role in encouraging innovation and supporting many of AAPA’s strategic principles. In 2007, I co-authored AAPA’s Business Rationale for Diversity as a Strategic Management Imperative [http://bit.ly/2ljVA9z]. The relevance of how diversity initiatives respond to this question exists within the documents rationale.
AAPA has yet to find limits to the responsibility our best people are able to assume. To be successful, it is essential that our PA leaders reflect the diversity of the communities and cultures in which we operate. This requires us to attract, retain, and motivate PAs from many different experiences and perspectives to engage in AAPA’s volunteer leadership roles. Being diverse is not optional; it is what we need to be in order to succeed in today and tomorrow’s healthcare marketplace.
- We all have connections through our professional networks. Can you explain how, as a Board member, you would proactively engage your network to further the work of AAPA and the PA profession?
First and foremost, I would be vigilant to ensure that I wasn’t inadvertently engaging in a conflict of interest, and I would continue to monitor the circumstances over the course of the engagement. If the circumstances weren’t clear, I would seek the counsel of our Internal Affairs Committee and/or Judicial Affairs Commission.
Most often, proactive engagement with my network involves making introductions between people in my network and the appropriate AAPA staff member, then removing myself from the engagement.
This topic is something that all board officers and directors should always be thinking about.
- What non-PA organizations are critical partners to moving the PA profession into the future, and why? What are the “4 Orgs” and how should these organizations interact in the best interest of the profession?
While there is much to be gained from differentiating PAs from advanced practice registered nurses (APRNs) in terms of education and training, AAPA should continue to partner with the American Association of Nurse Practitioners – and other non-PA orgs – wherever there are mutual advocacy interests.
The “4 orgs” refers to AAPA, PAEA, NCCPA, ARC-PA. Each organization has a different cohort of stakeholders, and each mission has a variation on the theme of the PA lifecycle and the health of the public. As a result of these differences, we have inherent conflicts between the various missions and stakeholders, thus the PA profession’s success is dependent upon the 4 orgs’ success with conflict resolution and employing functional ways to work through the change process.
In other words, the 4 orgs’ ability to move the profession into the future depends upon the capacity of their leaders to effectively communicate about differences big and small. To serve stakeholders effectively, 4 org leaders must be fully capable of engaging the depth and breadth of the profession in an informed and nuanced manner that reflects the significant level of responsibility that PAs take on every day; beginning with the language we use to describe our profession, our practice, and our relationship with physicians. Without this, PAs will continue to lose out on opportunities, we risk losing a unified voice for the profession, and we also put our ability to lead efficient change externally at risk.
- How do you define and implement leadership in your work environment? What leadership skills do you call upon when challenged on a deeply held belief?
I used to believe the saying that if you don’t like something, rise to a position of authority and make change. Now I believe this only to be partially true. From 2001-2013 I participated in training with the Systems Centered® Training and Research Institute that emphasized the ability to manage conflict, lead more efficient change, and improve effective communication on multiple levels. I’m also a fan of the Harvard Negotiation Project/Project on Negotiation, which works toward improving the theory and practice of conflict resolution and negotiation by being “soft on people and tough on issues.”
As a result, I’ve developed skills that are applicable to all interpersonal communications, regardless of whether I am working in a boardroom, exam room, classroom, or other work environment. I have utilized these skills in all of my work environments whether or not I am in a position of authority. Over time, I’ve developed greater clarity on the nuances between authority and leadership.
I also subscribe to a leadership theory that leaders are responsible for creating the environment in which the work is done. With this in mind, my definition of leadership as it relates to the AAPA Board emphasizes the importance of an optimal environment for clinically practicing PAs, as well as an optimal environment for the work conducted by AAPA’s volunteer PA leaders and AAPA staff.
The leadership skills I call upon when challenged on a deeply held belief include:
- Listen to learn
- Nothing inhibits communication and resolution more than someone who is focused on presenting the perfect rebuttal to prove how right or smart they are. Instead, active listening must be combined with a strong work ethic (see below). Adequate preparation for every board meeting allows me to listen differently than if I’m absorbing information for the first time. Preparation frees up some of my focus which can then be directed to the communication itself, including clues to other’s interests.
- Strong work ethic
- By setting aside adequate time and familiarizing myself with all pre-meeting board material as well as doing supplemental research into the systems and the environment surrounding the issues, I can communicate more effectively, manage conflict, and serve as a driving force for more efficient change in the boardroom, and in associated discussions.
- Caring empathy
- Sometimes this just means employing the strategy of leading with validation rather than with no. The capacity to imagine what it’s like in another person’s shoes isn’t a tagline; it’s vital to effective interpersonal communication.
- Being able to communicate efficiently depends on my ability to recognize the earliest sign of stubbornness or agitation and modify my mindset.
- I define integrity as the alignment of words and actions. In an organizational context, it’s also the practice of aligning action with the organization’s mission, vision, and values.