Moving together into the 21st century

Moving together into the 21st century – strategic planning for nutritionists

Kristen McNutt

Strategic planning is in vogue. Corporations have done it for decades. Now, most food and nutrition professional organizations are using similar techniques to decide how member funds and other resources should be allocated. Analogous to the advice of hockey star, Wayne Gretzky, quoted earlier in this editorial column,[1] everyone’s goal is to “skate to where the nutrition puck will be” in the future.

Business world strategic planning[2] generally focuses on existing and predictable factors that will affect a corporation’s product or service (or the entire marketplace), changes in consumer (or a specific market segment) buying patterns, and the competitive environment (from a brand to a global perspective). Professional organizations, health voluntary organizations, universities and government agencies include in their strategic analyses comparable variables.

The trick to good strategic planning is defining the breadth of vision that makes the process most cost-effective. Looking too widely unnecessarily complicates the analysis, thus wasting time and effort. Looking too narrowly misses critical considerations.

THE INTEGRATED FUNCTIONS

MODEL

Figure 1 graphically describes, in one box or another, the functions or responsibilities of most nutritionists. The jobs of some Nutrition Today readers place them in more than one box; a few may actually not fit anywhere in this Integrated Functions Model.

The purpose of this model is to provide a structure for integrating the strategic planning of all food and nutrition groups. Thinking first of various roles in generic, functional terms, rather than cluttering the picture with institution- and job-labels, simplifies the big picture of what nutritionists do to help other people.

The Interdependent Functions Model leads to several conclusions that have strategic implications for everyone:

* Contributions to the bottom line function, deciding WHO FIXES WHAT HOW, is at least part of why most nutritionists do what they do day-in and day-out.

* Changes in priorities for any function group team have an impact on nutritionists who have interdependent responsibilities.

* Improved return-on-resources-investment for each group can be achieved if all function groups use comparable quality-of-output criteria for their strategic planning.

CHANGES COMING FOR

EVERYONE

Several principles will shape all groups’ planning for the 21st century. These new ground rules hold true for public, as well as private, sector nutritionists:

*Nice, but not necessary, uses of resources are being eliminated. Whether a function yields an actionable output largely determines whether member funds or shareholder dollars are used for that purpose.

* When the year 2000 rolls in, what all nutritionists do “at the office” will be somewhat different from what they do in 1993.

* As resources allocation priorities are set, the 80:20 Rule will guide most choices.

The idea crystallized in the 80:20 Rule is, quite often, 20% of the items within a variable group determine 80% of the possible results.

An everyday example of the 80:20 Rule is that 20% of the clothes in a person’s closet account for what is worn 80% of the time. Similarly, 20% of recipes that a food preparer knows are used for 80% of the dishes that person prepares.

The 80:20 Rule applies to many nutrition practices. Probably,

* 20% of knowledge related to diet and health is used to make 80% of professional nutritionists’ decisions.

* 20% of lesson plans are, over time, used for 80% of teaching time.

* 20% of the food composition information in nutrient data bases is utilized in 80% of the program decisions based on dietary analysis.

The strategic planning significance of the 80:20 Rule is that careful attention must be given by each function group to identifying, and then doing very well, the most critical 20% of its responsibilities. Some of the remaining 80% of each group’s responsibilities continue to merit resources allocation consideration, but the cost:actionable-outcome-yield ratio of those functions must withstand greater scrutiny.

WHO’s IN WHICH BOX

Before looking into the future, let’s clarify the responsibilities grouped into each box of the Interdependent Functions Model.

The WHAT’S IN WHAT Team includes people who decide which food components to analyze how; they also do these chemical analyses. Their responsibilities include determining how accurate and how precise results must be in order to be actionable for various WHO FIXES WHAT HOW Team purposes. Furthermore, they set the criteria for deciding when consumption of a food is high enough or important enough to justify the cost of including it in data bases.

Public sector nutritionists here deal primarily with generic foods. Private sector nutritionists with analogous responsibilities collect more in-depth, brand or product category specific information.

The WHO EATS WHAT Team decides what food intake, by whom, is recorded in surveys. These people either collect selected data directly from consumers or hire someone else to do it.

Government-employed nutritionists responsible for this function make decisions about survey design, but they often contract out the actual food consumption data collection. Market research companies perform similar roles for the private sector. These suppliers decide, based on market economics criteria, what information to collect with what degree of statistical confidence, depending on the price food companies will pay for various levels of quantitative and qualitative specificity.

The HOW MUCH OF WHAT IS EATEN BY WHOM Team combines the work products of the top two boxes in the model. They generate population-group and food-component-specific reports related to food consumption.

Again, this function is accomplished in both the public and private sectors. The institutions and companies who employ nutritionists in this function group are similar to or overlap with employers of nutritionists in the top two boxes of the model but, for strategic planning purposes, it is important to keep these functions separate.

The HOW MUCH OF WHAT IS HEALTHY OR UNHEALTHY Team are the people who conduct basic biomedical research as well as implement clinical trials and analyze epidemiologic data. Based on these results, the same and/or other nutritionists set Recommended Dietary Allowances, decide how many of which foods go where in the Pyramid Food Guide, determine what the American Heart Association recommends and provide similar, summary advice to the public and to the WHO FIXES WHAT HOW policy makers.

Some professionals in this function group also work in food safety. For example, their jobs are to set pesticide residue standards and additive tolerance levels.

The WHO HAS A PROBLEM Team combines outputs from the two boxes above them in the model. These people quantify nutrition-and food safety-related problems. They figure out what percentage of the population is eating too much fat or not enough grain products. For example, they also decide which and how many people are eating too much of certain agricultural chemicals, microbiological contaminants or food-processing ingredients. Their role is to provide group-specific, quantitative reports about the incidence of diet-related health problems and potentially dangerous food ingredient or contaminant intakes.

The CAN AND SHOULD THE PROBLEM BE FIXED Team does for the world of nutrition what First Lady Hillary Rodham Clinton is doing in the broader health arena. They are the analysts and planners who decide how to use available resources for programs that compete for the same budget dollars.

Nutritionists in this function group weigh the importance (Should it be done?) and the success expectation (Can it be corrected?) of various problem-solution options.

In the public sector, their expertise is used for tasks such as setting the Health Objectives for the Year 2000. In the private sector, these nutritionists contribute to “healthier alternative” new product development decisions. For example, they do the analyses to predict whether enough people would buy a [beta]-carotene-fortified food to justify investing in the production and marketing of such a product. Nutritionists who work with public health departments and prepaid medical care deliverers have analogous responsibilities which place them in this function group.

The WHO FIXES WHAT HOW Team makes the bottom-line action decisions. These are the nutritionists who implement the School Lunch and Women, Infants and Children (WIC) programs and other publicly funded problem solutions. These and other nutrition professionals do weight-reduction counseling, plan therapeutic diets and teach coaches how to teach nutrition to athletes. Food marketers also go in this box, as do nutritionists who work in the communications industry.

Here, more than in the other function groups, factors beyond the world of foods and nutrition influence decisions. Politics, economics and profitability are real-world considerations that affect WHO FIXES WHAT HOW decisions.

Strategic planning requires facing some hard, cold realities at this stage of charting the future of nutrition. Ignoring what is happening here can be costly and will result in significant wastage of public and private sector resources. Limiting the scope of vision to either only the public sector or only the private sector yields an incomplete picture of what is ahead for nutritionists.

Legislative and executive office employees have a hand in WHO FIXES WHAT HOW decisions at the national level; the same is true for state and local governments. In the business world, nonmanagement members of the Board of Directors and shareholders have a say in what corporations decide to fix, who does it and how.

ELIMINATING NONACTIONABLE

RESPONSIBILITIES

A major advantage of being able to see the collaborative flow of what everyone does is each group’s having a better perspective from which to make its resources allocations decisions.

Strategic planning that includes bottom-line actionability criteria yields decision-making dividends. For example, if the WHO FIXES WHAT HOW people are never going to fix a certain problem anyway, nutritionists who have been spending resources on producing information related to that problem can eliminate some parts of their accountability expectations, thus freeing up time and energies for other more useful activities.

Similarly, if the WHO FIXES WHAT HOW Team is going to fix a certain problem for political or profitability reasons, regardless of what nutritionists’ analyses conclude, then the resources-draining exercise of producing information related to that problem can also be shifted to other priorities.

Seeing each functional set of responsibilities in the context of what others do enlightens decisions at all levels. Knowing the end-result-usage of each groups’ outputs provides direction so that everyone’s resources can be focused on responsibilities where the functions-flow-information is critical for action choices.

INTEGRATING OUR CRYSTAL BALL

A thorough analysis of current trends and projected changes in each component of the Integrated Functions Model is far beyond the scope of this editorial. Furthermore, this part of the integrated strategic planning process should be done by teams with expertise in each set of responsibilities. But – for starters – some examples of changes are pretty obvious.

The WHAT’S IN WHAT Team will not have the resources to keep adding a thousand new products per year to their data bases unless the WHO FIXES WHAT HOW decision makers can justify increased funding for such analyses. The 80:20 Rule will help decide which foods and components to drop or how to “collapse” certain categories.

The WHO EATS WHAT Team will purchase user-friendly programs and then pay consumers to enter into their home computers what they eat; data entrees will go via modern directly into a mainframe. Most teenagers can quickly learn how to do this, even today; many older people are fast becoming sufficiently computer-comfortable to easily master this task.

The 80:20 Rule applies well here. Data from 80% of a survey sample can be collected in a much more cost-efficient manner using home computers. The savings from eliminating interviewer and coder expenses will either reduce total data collection costs or allow reallocation of moneys to improving the quality of information from the other, non-computer-comfortable 20% of the population. The level of resources investment for consumption data for this 20% of the population will depend on how the WHO FIXES WHAT HOW Team plans to use such information.

The HOW MUCH OF WHAT IS EATEN BY WHOM Team faces major changes in the very near future.

* These nutritionists must deliver results faster, even though the information may be less accurate. The WHO FIXES WHAT HOW people are already demanding up-to-date data that reflect actual food usage based on the current marketplace, rather than what was in grocery stores five or ten years ago.

* Since most survey participants will directly enter their food consumption codes into home computers, nutritionists in this function group will be able to spend more time thinking about which analyses provide actionable work products.

* Developing the Thrifty Food Plan will cease to be a purpose of this function group because the Clinton administration is going to give income subsidies for food to whoever needs it, regardless of how that money is used. Once Food Stamps is politically redefined as an income subsidy program instead of a quasi-nutrition program, using nutrition resources to calculate the dollar value of the Thrifty Food Plan becomes a pointless exercise and a waste of government resources.

The HOW MUCH OF WHAT IS HEALTHY OR UNHEALTHY Team will shift its attention away from nutrition and toward food safety. By the year 2000, the 80:20 Rule now governing this function group’s resources allocation will be reversed. Whereas today, 80% of this Team’s assessments relate to nutrition, food safety will get 80% of their attention before the turn of the century.

This change in priorities is an excellent example of the importance of integrating strategic planning. As food safety overtakes nutrition as a priority for the WHO FIXES WHAT HOW decision makers, all the teams that feed data into the system must change their resource allocations accordingly.

The WHO HAS A PROBLEM Team is already seriously dealing with research that suggests some people might reduce the risk of certain diseases by consuming greater amounts of some antioxidant nutrients and certain foods.[3] Even more importantly, the number of consumers consuming nutrient and non-nutrient supplements, herbal remedies and “healing foods” is growing by leaps and bounds.

These changes have ramifications that reverberate throughout the Integrated Functions Model. Those functions graphically above the WHO HAS A PROBLEM box must feed in more information about pharmafood and nutraceutical usage; those graphically below this function group must figure out how to fix problems, if they do exist.

The CAN OR SHOULD THE PROBLEM BE FIXED Team is moving toward having new tools at its disposal. Advances in the biomedical, animal sciences and food technology arenas might make some solutions more feasible and possibly, but not certainly, less expensive. Concurrently, the importance of devoting more resources to fixing certain problems, rather than to others, will shift with political winds, as well as with public health priorities. For example, consumer acceptance or rejection of bioengineered foods and irradiated products will shape available options for nutritionists in this function group.

The future decisions of the WHO FIXES WHAT HOW Team will depend largely on how well the U.S. economy performs, both in an absolute sense and relative to the rest of the world. Another major variable is whether the “fixing gets done” with government resources or by the private sector.

The latter possibility would mean that many nutritionists now employed by government will become part of the business world. Their responsibilities may be quite similar to what they now do, but the signature on their paycheck will change. They will be accountable to shareholders, rather than to taxpayers.

DIAGNOSING REALLOCATION OF

RESOURCES

The Integrated Functions Model provides a conceptual framework for comparing relative amounts of resources allocated to quantifying problems, compared to what is spent on correcting them. This comparison is difficult because many nutritionists have some of both broad category responsibilities. Similarly, many programs currently both collect or analyze information and also deliver health or education services. But, in general, more nutritionists will have fix-the-problem jobs in the future; fewer of our professionals will do food analyses, data massaging and standards setting.

As the 21st century approaches, the balance of priorities will shift between these two broad functions. Soaring health care costs mandate putting relatively more dollars into disease prevention and “problem-fixing.”

But health promotion programs will not look the way they do today:

* Printed booklets and pamphlets will be replaced by computer programs and electronic transmission of information.

* “Fixes” will be targeted to specific groups, depending on their problems and what motivates behavior changes; generic programs for the general public will disappear.

* Payment for health promotions will be based on results. If a program works, the service provider’s income will be proportional to curative costs saved. If it does not work, the provider absorbs the expense.

* Food-health messages will be communicated by people whose skills are 80% communications based and 20% nutrition science based.

DIFFERENT IS INEVITABLE;

BETTER IS POSSIBLE

Whether we plan or not will not alter the fact that changes are coming in the world of nutrition. Things being different is inevitable because the world of nutrition does not exist in a vacuum. Our evolving roles will be determined by shifting societal expectations of us, technologies beyond our own field, and health risk factors over which we have no control.

Nutritionists cannot halt the outside influences that will force us to do things differently. Whether different is better depends on how well the future is charted. But planning for what is coming can help us capture those options that are in the best interests of consumers.

Some nutritionists are capable of being very good strategic planners. This will be fun for them because most people enjoy doing what they do well. On the other hand, many people who now, and in the future will continue to, make major contributions to this discipline are very uncomfortable with tasks which require dealing with abstract concepts. Strategic planning is not for them. Luckily, both types of nutritionists are in all the function groups of the Interdependent Functions Model.

My crystal ball says that the nutritionists who are potentially the best strategic planners will become involved in this process, as the broader discipline acknowledges the benefits it offers us all. Together, we will move into the 21st century with a broader understanding of why we do what we do and a keener appreciation of the contributions of all the players on the Integrated Functions model teams.

Most people today complain about something related to their jobs as they are now. That might also be the norm in the year 2000. But – maybe, things will be better for everybody by then.

REFERENCES

[1.] McNutt K. Reinventing nutrition services. Nutr Today 1993;28(1):40-2. [2.] McNutt K. SWOT before you start. Nutr Today 1991;26(1):48-51. [3.] McNutt K. The individualized prescriptive foods era is here. Nutr Today 1993;28(3):43-7.

COPYRIGHT 1993 Lippincott/Williams & Wilkins

COPYRIGHT 2004 Gale Group