Legacy of Excellence Digital Flipbook

Chapter 2: 2002 – 2006

However, also he knew that at the same time he would have to meet the new challenge while maintaining management of the traditional services of education, research, Annual Meeting planning, advocacy, and health policy activities. “New staffing for areas that previously did not exist would be required. And budgeting would be hugely problematic, especially since previous leaders had made great political gains out of promoting the idea of never raising dues,” he recalled. “Changing the culture of an organization, even when there is great support, can take years and persistent effort by elected leaders, staff, committees, and grassroots membership. Such change is usually not linear and requires repeated efforts, promotion, and dogged determination.” Like most change, he felt his vision to be unpopular to some, but he recounted that the many members, who in isolation had already been moving in this direction, supported him. And in time, he said, “I relied heavily upon these published researchers, committee leaders, and visionaries who saw the same need that I did and worked tirelessly to implement needed change.” The Path AAO-HNS/F leadership began to take seriously, then embrace and discuss openly, and pledge the necessary resources to responding vigorously to the public demand for defining, identifying, demonstrating, and championing quality in otolaryngologic healthcare. “While every good doctor believes she or he is providing the best care, until the last 15 years or so there was no systematic, scientific, defensible methodology for proving to what degree physicians practice at the highest level,” he said in 2019. “Following the pattern, I had witnessed within primary care where physician payment was now being linked to quality measures and performance, the AAO-HNS/F convened for several years in a row a series of quality conferences to address these topics.” These quality conferences were facilitated by non otolaryngologists, physicians, and methodologists alike, to assess the current state as a specialty and come to some agreement on next steps. They were the beginning of the recognition and acceptance by leadership that the specialty’s long-range planning needed to not just include, but perhaps be led and guided by an integrated, specialty-owned and operated, approach to quality improvement and practice management and all its ramifications for physician payment, training, licensing, board certification, continuing education (now called professional development), research, and more.

“Other significant events that followed included the modification of committee structure to specifically address quality improvement (QI) and performance measurement (PM), assigning accountable Board Directors and Coordinators to these topics, and coordinating with senior and subspecialty societies willing to engage in addressing QI and PM.” The Takeaway: Successes and Challenges “Unity was and always will be a challenge. It was very difficult as a specialty leader to navigate the sometimes polar opposite expectations, directions, and advice that was proffered, and it was very difficult to have any type of collaborative projects. While about half of our membership relies most heavily on the AAO HNS/F for all of its educational, practice management, advocacy, publications, and professional support needs, the other half divides its loyalties between the Academy/Foundation and specialty or senior societies, or other supporting entities (major clinics, health plans, hospitals, journals, employers, etc.). The future effectiveness of our specialty will depend on overcoming differences and working together.” Leadership Development One notable change Dr. Nielsen envisioned was the need for the leadership to work more effectively. In the early meetings, expectations for the EVP’s role varied widely with some supporting an outward face of the specialty to the outside world and to the greater house of medicine and the organization playing larger leadership role on the global stage, while others looked more for an internal manager focusing on organization and governance and not seeking resources to try to keep up with specialties that had much larger memberships and budgets. It was specifically in this area that Dr. Nielsen’s business acumen was put to practice and became a key benefit that continues in today’s operations of the AAO HNS/F. “As a result of the recognition of the inexorable pull of these strategic forces, a stronger emphasis was placed early on and continued throughout my tenure on formally training the Boards in better strategic processes, accountability, reporting structures and functions, and continuous assessment of progress in leadership roles,” he said. Early in his tenure, he promoted improved leadership by budgeting for and attending a strategic planning and leadership development training program with each newly elected president, “to ensure that we would begin our service together for the years of his or her presidency

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