Editor’s Note: The following report was approved for publication by the Board of Directors at its April 11,1992, meeting. Certain editorial changes were made by the Board in the statements below that will be printed on Society journal covers and letterhead. Participants in this strategic plan are listed at the end of this report.

Introduction In January 1991, the Board of Directors of A.S.P.E.N. established the Future Directions Committee and charged the Committee to develop a strategic plan to guide the Society into the 21st century. The Board determined this to be the appropriate time to undertake the strategic planning process both because the field of nutrition support is changing so rapidly and because of new findings in fields outside nutrition that affect nutrition support. The key leaders of A.S.P.E.N. felt a commitment to focus on the changing environment and assess its impact on A.S.P.E.N.’s members; to step back from the organization and consider the external and future factors that will shape the field in the next decade. It is also the appropriate time to undertake this effort because the Society is strong, functioning effectively, and is experiencing dramatic growth. This current strength offers an excellent opportunity to adjust the dynamics of the organization to maintain its stability and assure its continued success.


Strategic Planning Process

At the outset, the Committee was made


of the strategic planning process and how it differs from

long-range planning. ~

Strategic planning is the framework that determines the nature and direction of the organization. asks the question &dquo;What does the organization want to be?&dquo;


Long-range planning is the process that allows an organization to extend what it is doing now into the future and is the next step after the strategic planning process. It asks the question &dquo;How do we get there?&dquo;


Strategic planning and long-range planning are two facets critical to the well-being of all organizations, and they are related but separate dimensions. Strategic planning is directional in scope; it is vision directed at what the organization should be. Long-range planning is operational in scope; it is directed at how to get there.

The Work of the Committee The Committee’s work ~ ~ ~ ~ ~ ~


Quality patient care Multidisciplinary approach

shaped by the to


quality patient

values of A.S.P.E.N.


Education and communications within the professions committed to nutrition support Research as an essential element of A.S.P.E.N. Guidelines and standards to improve quality of care Commitment to promote the proper use of nutrition support.

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The work of this Committee moved beyond the traditional questions about organizational mission to ask set of questions about the organization’s paradigms-the basic models used to operate day-to-day. The Committee attempted to look at organizational issues from a new perspective, to test the traditional models, and to see the emergence or existence of other models. The work of the Committee was to think beyond the existing organization, and beyond the next decade, to anticipate changes and create an organization capable of meeting them. A.S.P.E.N.’s President, C. Richard Fleming, MD, selected John R. Wesley, MD, to chair the Future Directions Committee and appointed a cross-section of A.S.P.E.N. members to serve with him on the Committee. The Committee members covered the range of perspectives in the field of nutrition support and represented varied experience with the inner workings of A.S.P.E.N. The Committee members worked diligently from the spring of 1991 through the 1992 annual Clinical Congress in Orlando. The Committee used the following methodology to develop this strategic plan:

a new


Identified the


Listed the


Conducted outreach efforts to ensure feedback from all disciplines, grassroots members, A.S.P.E.N. leaders, a variety of leaders in the field of nutrition support, both researchers and clinicians, and nutrition business representatives.

key strategic


facing A.S.P.E.N.

opportunities and challenges facing A.S.P.E.N. from both the clinical and association perspectives

The Committee discussed and debated the principal strategic issues that resulted in the mission statement and supporting rationale for the Board’s review and discussion.


The Future Directions Committee Has Developed and Recommends the Following Mission Statement for A.S.P.E.N.: -o

A.S.P.E.N. is

multidisciplinary, professional, and scientific organization committed to promoting quality patient care, education, and research in the field of nutrition and metabolic support in all health care settings.

Key Points


in the Mission Statement

Multidisciplinary: A.S.P.E.N.’s founders began an organization committed to providing nutrition support to patients via a multidisciplinary approach, holding that nutrition support is delivered more safely and cost effectively by a multidisciplinary team of physicians, dietitians, pharmacists, and nurses. This is an essential characteristic that makes A.S.P.E.N. an unusual professional model in the health care field. Professional: A.S.P.E.N. remains an organization of individuals with recognized health care or research expertise committed to the ethical practice of nutrition and metabolic support. This commitment to professionalism is a value that binds the groups together within A.S.P.E.N. ’ Scientific: Basic science research is necessary to understand the fundamentals of nutrition and metabolism from which applied science research leads to direct improvement of patient care. The field of nutrition support draws upon the expertise of multiple disciplines such as biochemistry, physiology, cell biology, pharmacology, immunology, and others. Nutrition science involves studies ranging from molecules to populations. The level of effectiveness of parenteral and enteral nutrition support is a direct result of the practical application of nutrition science. Quality Patient Care, Education, and Research: This phrase addresses the full range ofA.S.P.E.N.’s work. Quality patient care is positioned first because it is the principal consideration that forms the basis of A.S.P.E.N.’s work. Quality patient care derives from good research, properly communicated by sound professional education. The majority of A.S.P.E.N. members are in clinical practice and focus their daily attention on the needs of patients. A.S.P.E.N. members who conduct or participate in research provide the new developments essential to the practitioner in providing for the needs of patients. *

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Today, the full range of A.S.P.E.N.’s work encompasses all aspects of research and practice in nutrition and metabolic support from development of standards to information networking, seminars, publishing important research findings, research recognition and support, public policy initiatives, and certification programs. A.S.P.E.N. remains committed to providing forums for the communication, education and research necessary to continue its work. Field of Nutrition and Metabolic Support: In response to the Committee’s outreach efforts, members and leaders in the field strongly advocate that A.S.P.E.N. stay with its historic strength-nutrition support -and address the ramifications of nutrition support when overlapped with other intravenous therapies, such as hemotherapy, chemotherapy, hydration fluid, pain management, or antibiotics. A.S.P.E.N. wants to signal clearly that the expanding field of nutrition support extends into other aspects of metabolism, such as response to trauma and other forms of stress, relationship of cytokines to nutrient utilization, and microbial symbiosis with digestive system. These expanded areas are important frontiers for A.S.P.E.N. In All Health Care Settings: This phrase reflects the importance of nutrition and metabolic support in the hospital, but also in the home and other settings such as outpatient clinics, nursing homes, and other environments. To

Implement Its Mission, A.S.P.E.N.

Promote communication among in

Will Undertake Four Major

professionals through


chapters/professional interest committees/publications/meetings




collaboration with peers cooperation with other organizations in the U.S. and abroad interaction with providers of goods/services.

~ ~

Foster research and

incorporation of the findings


evaluation of patient clinical standards clinical care educational offerings


public policy.

. ~ ~


professional effectiveness through

continuing education publication of journals and educational


peer review




self-assessment certification discussion of ethical issues schools and school curricula feedback from patients and concerned

. . ~ ~




~ ~








family members.

by influencing public policy

research accreditation health care regulations standards of practice











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Rationale for A.S.P.E.N.’s Decision to Commit Its Future to the Field of Nutrition and Metabolic Support The Committee’s outreach efforts found a significant consensus supporting A.S.P.E.N.’s continued focus in the field of nutrition support, expanded to embrace the broader area of metabolism as it affects nutrition. ~

There ~




for this view:

A.S.P.E.N. chooses to be

primarily a

nutrition support

organization-staying focused in this



However, A.S.P.E.N. holds that the field of nutrition support extends into related areas of metabolism and, therefore, chooses to expand its commitment to the practice and science of nutrition to include related areas of metabolic support.


At the same time, many of A.S.P.E.N.’s leaders and members are experts in intravenous access and intravenous delivery systems. It is appropriate to offer A.S.P.E.N.’s skills and knowledge where it affects intravenous infusion that overlaps with intravenous nutrition. For example, A.S.P.E.N. is ready to play a role in the development of infusion techniques and technology when a patient with osteomyelitis, HIV infection, or any other condition that has an impact on the nutritional status of the patient, requires long-term antibiotic or other intravenous therapy.

Recommendations The Committee considered and solicited comments on a proposal to change the name of the Society as reflection of its broadened mission. This proposal did not receive sufficient support at this time to warrant a recommendation in its favor. However, the Committee did receive suggestions that steps be taken to reflect positively on the broadened mission and to more accurately reflect changes already being made in education and publishing programs offered by the Society. To that end the Committee recommends the Board consider statements to appear on various publications and letterhead of the organization: a

On Letterhead: &dquo;A society of health metabolic support&dquo;


professionals dedicated

to the science

and practice of nutrition and

On the cover and/or inside cover of JPEN: &dquo;A peer-reviewed international journal of nutrition and metabolic On the


and/or inside


of NCP:

&dquo;A clinical journal of nutrition and metabolic -

Rationale for A.S.P.E.N.’s



Approach to the Practitioner/Researcher

Relationship Premise Research


provides practitioners with new scientific and technological developments to enhance quality


The Clinical Practice Perspective Delivery of quality patient care is an essential commitment of A.S.P.E.N. effectively, A.S.P.E.N. must: 0

In order to achieve this most

Continue to educate practitioners and students in the delivery of quality nutrition and metabolic support through national and local programs. This includes the provision of some form of certification in the four disciplines.

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champion the multidisciplinary approach to nutrition and metabolic support.


Continue to


Provide forums for the exchange of ideas concerning new ideas generated in the academic and business sectors.


effective treatment of patients through involvement in reimbursement initiatives, thirdinsurance party coverage, and health care delivery programs in the public and private sectors. This includes attention to the balance of cost effectiveness and treatment effectiveness in the delivery of

services. This includes

Support the patient


technology and


Continue to be

to the medical community and government agencies to develop clinical and establish standards of practice in the delivery of nutrition support.

a resource

practice guidelines ~

Foster the continual assessment of clinical evolution of nutrition therapies.


Encourage members to support continual quality improvement through action plans and evaluation.

The Research

efficacy and outcomes

to test the



and support the

gathering, analysis,


In order to achieve the stated mission of quality patient care, A.S.P.E.N. must support the continued growth and vitality of research, both basic and clinical. To that end, A.S.P.E.N. must: ~

Foster and maintain


Assure the


cadre of members who conduct


collaborate in research.

application of research findings in clinical practice by promoting the practitioners.


exchange of

ideas between researchers and ~



variety of settings for the presentation of excellent research, either original presentations or secondary presentations in a review forum.

(first time) ~

Foster research


Develop education programs based on the


Encourage joint meetings with other nutrition organizations.


Promote publication of scientific articles and potential clinical applications.

by encouraging entry-level investigators through mentorships, grants, fellowships, competitive awards and other forms of support and recognition. current &dquo;best&dquo; research in the field.

journal editorials on basic science findings that emphasize

rationale for A.S.P.E.N.’s Continued Involvement in Public

Policy Activities


policy has a major influence on A.S.P.E.N.’s work in this era because it cuts across both health delivery and research concerns. Because the public arena is volatile and unpredictable, A.S.P.E.N. must assure that nutrition research, services, and support are represented and, therefore, continue to take a position in the following areas: Public



Influencing government regulatory issues to assure rational policies that safeguard patients.


Increasing funding for nutrition research.

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and coverage for


Expanding reimbursement


Maintaining a reputation as a reliable advisor in the public policy arena.


Assisting in the formulation of policies established by public and private sector accrediting and standard-setting bodies that affect delivery of nutrition and metabolic support.


Addressing the legal and ethical issues that can arise in the delivery of nutrition and metabolic support. These may include, but are not necessarily limited to, withholding or withdrawing support, professional conflict of interest, and other issues that accompany the economics, science, and technology of nutrition therapies.

professional nutrition


« The Future Directions Committee Recommends That A.S.P.E.N. Focus on the Strategic Organizational Issues That Influence the Vitality, Growth and Effectiveness of the Association

Guiding principles and

at the local and national level.




Support the evolution of new mechanisms whereby individual members can have a greater voice in decision-making at the national level; consider the relevance of chapters to this principle.


Assure that changes in governance and structure maintain achieve its mission effectively.


Assure the


The Committee recommends the Society review a variety of governance issues that have the potential for expanding participation in the organization at all levels, while maintaining the organization’s high level of effectiveness. The review conducted should be consistent with the guidance statement above.


multidisciplinary perspective



expand the organization’s capacity to

continuity of high quality leadership at the national level by providing future leaders with opportunities for experience and training within the national organization.

The issues to review should include, but not

necessarily be limited to, the following:


Provision of full membership privileges for all current nutrition practitioners and researchers regardless of their employer. This would not include sales and marketing professionals, and should be accompanied by the development of enforceable policies through peer review to assure professional ethical behavior and avoid even the appearance of conflict of interest.


Wider education of the membership concerning the process to nominate and elect leaders at the local and national levels. Retain the current Nominations Committee role as a quality control mechanism, but consider proposing slates with two or more candidates for each position.


Elimination of formal barriers


Expansion of the Executive Committee to include the three chairpersons of the dietetics, nursing, and pharmacy discipline committees.

(presently, by professional credential) on who may serve as president. Replace the credential requirement with a set of qualifications or desirable leadership qualities to be used as a guide for the selection of nominees for each national position, including Board positions, committee chairpersons, etc. The most rigorous qualities would be articulated for the president.

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Although the issue of governance does not appear to be a high priority for the average member, it is a subject of importance for a number of current and former committee members, chapter presidents, directors and officers in the Society. Some in that leadership group argue that the current system of governance is not sufficiently democratic and should be changed to make it so. The argument is that more open governing processes will increase the pool of talent from which the leadership is derived, and enable a wider group of professionals to contribute to, and improve, the effectiveness of the organization. Since discipline committee chairpersons are elected by their peers and are involved in the month-to-month activities of their disciplines, to include the discipline chairpersons on the Executive Committee would assure each discipline’s representation at the Executive Committee level. Establishing this multidisciplinary core at the Executive Committee level will reinforce and make evidentA.S.P.E.N.’s commitmentto the value ofthe multidisciplinary approach. The Committee concludes this rationale is a serious and plausible critique of the current structure of the organization. It also concludes that change should be made with great care to assure that the effectiveness of the Society in reaching its goals be maintained. Recommendations The Committee recommends that Professional Interest Committees be maintained in their current role informal peer networks, discussing common interests and enjoying collegiality, but not becoming part of the governance structure of the organization. The Committee recommends that an Ad Hoc Committee on Governance Issues be appointed to review the issues of governance, membership and participation in A.S.P.E.N. and to submit recommendations to the Board of Directors for its approval. The Committee recommends that more specific qualifications be established for the presidency of A.S.P.E.N. which will include, but not necessarily be limited to, the following qualities: as

~ ~ ~ ~ .


Proven exemplary, professional record validated by national reputation, publishing, etc Demonstrated ethical behavior A specified number of years as an A.S.P.E.N member Proven ability in A.S.P.E.N. leadership roles; A good sense of organization realities Proven contribution to A.S.P.E.N. in governance and committee roles A specified number of years on the Board of Directors.

Future Directions Committee John R. Wesley, MD; Kathleen S. Crocker, MSN, RN, CNA, CNSN; John P. Grant, MD; William Heizer, MD; Kathryn A. Hennessy, MS, RN, CNSN; Lyn J. Howard, MD; Nabil Khalidi, PharmD; Stephanie Phelps, PharmD; Denise Schwartz, RD, MS, CNSD; W. Frederick Schwenk, MD; Barney Sellers; Harry Sitren, PhD; Annalynn Skipper, MS, RD, CNSD; Wiley W. Souba, MD, ScD; Bruce M. Wolfe, MD A.S.P.E.N. Staff Support Susan

Eisenberg, Deputy Director; Donna Manili, Administrative Assistant

Independent Consultant Denise Cavanaugh, Cavanaugh, Hagan


Pierson, Inc.

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Strategic plan for the American Society for Parenteral and Enteral Nutrition. 1992.

138 STRATEGIC PLAN FOR THE AMERICAN SOCIETY FOR PARENTERAL AND ENTERAL NUTRITION 1992 Editor’s Note: The following report was approved for publicati...
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