The Challenge of Leadership

When I accepted the honor and challenge of leading the California Dental Association one year ago, I trusted that I was prepared for anything.

Now, as I offer my thanks to you for allowing me my time as president of this organization, I reflect upon the year that has become another benchmark in the association's history. Clearly, it was a year during which anything could happen, and nearly everything did.

With our desire to consistently bring to the people of this state excellence in dentistry while offering our members an organization steeped in the tradition and spirit of service as catalyst, we, together, won battles, sought and found compromise, made the best of change and continued to thrive, both as an association and as a profession that rightly commands the public's respect.

As I consider the significant achievements of the past 12 months, I am compelled to acknowledge that what has been and continues to be accomplished is the result of effort on CDA's behalf by innumerable individuals who share a belief that our work has meaning and our goals are honorable.

I respectfully emphasize that none of this year's accomplishments would have been possible without gracious help from all corners. Nothing would have been possible were it not for the CDA staff, council members, your Board of Trustees and the Executive Committee. Their planning, commitment, deliberation and advice planted ideas and gave those ideas a chance to take root and flourish.

And I must thank others behind the scenes, the most important people in my life, my family, beginning with my wife and true love, Claire, and my children, Steven, Dr. Kevin and Dr. Jill. They are the foundation upon which all else is built.

Our most-visible and far-reaching successes came in the halls of government this year, where CDA's legislative agenda gained support and our new way of doing business found favor that translated into new laws that buttress the profession of dentistry. As a member of the Council on Legislation in 1996, I seeded the notion that our association become an active rather than reactive participant in the legislative process and saw that the Government Relations Office is the best machine to work with the "new" rules and legislative tenures.

Bill Emmerson, as chairman of the Council, has provided leadership this year to make that vision reality, and Liz Snow has shown through her direction of Government Relations how effective we can be in shaping debate and building consensus while keeping our ultimate goals in plain sight.

Our posture helped harness the efforts on our behalf of Sen. Jim Brulte and Assemblyman Fred Keeley. Brulte, a Republican, authored Senate Bill 1014, which makes it unprofessional conduct for a patient to be treated before having been examined, diagnosed and having a treatment plan completed by a dentist. Keeley, a Democrat, was author of Assembly Bill 1116, establishing uniform educational standards for dentists seeking licensure in California and eventually eliminating the restorative techniques exam. Much credit for this bill must go to members of the forum -- a roundtable of leadership from the ethnic dental societies who formed the coalition to move this bill. The signing of these bills into law in October by Gov. Pete Wilson was a testament to our new effectiveness as a political force.

Before becoming CDA president, I made a commitment to attend all meetings of the Board of Dental Examiners, and to encourage more association members to attend and participate, especially volunteer leadership. This presence established, I believe, our desire and ability to be engaged and provide strong, good-faith input to the board. This attention led to the thawing of what had been chilled relationships between CDA and the BDE, which allowed us to become a trusted party that now works well with the Board. The bonus of our improved relations brings added luster to accomplishments in that arena, which include elimination of the definition of surgical procedures in infection control regulations. Our efforts to bring together prominent scientists and research experts on the matter of dental unit waterlines gave the board information necessary for reaching a sound decision. We have encouraged the Board to use science-based information to make decisions rather than rely on anecdotal information and emotion. Dental Affairs Director Judith Babcock and Assistant Director Terry Fong have been a significant presence and force in our successes with the BDE.

I speak with pride of another concept that has broadened the table upon which ideas are laid and helped us look into dentistry's future -- the dental think tank. The think tank sessions have brought together deans of California's five dental schools with leaders from our association and the Board of Dental Examiners. The enthusiasm for establishing and supporting more rewarding relationships among the participants and organizations represented has been notable. Also significant is the building of better understanding among all parties sharing common goals and individual insights relative to issues facing dentistry. These are facets of this new enterprise. Support of the think tanks by the Executive Committee is a clear example of that body's desire to open important lines of communications and to think ahead, another example of pro-activity by CDA.

Access to care for the children of our state's "gap" population is being addressed by Gov. Wilson's Healthy Families program. The program creates a government-subsidized funding partnership with the insurance industry to pay a portion of the cost of care. CDA's Special Projects Director Dr. Teran Gall, who boasts a long background in addressing access issues for underserved people, is leading CDA's involvement in the program.

CDA has taken the lead in trying to make the 1996's legislative victory in the fight to bring fluoride to more of the state's people a practical win as well. Passage of AB 733 opened the door for the enlightened supporters of fluoridation, but it provided no funding mechanism, throwing a new challenge at our association. CDA is seeking funding sources in the form of grants to put financial teeth into the law and give all communities the opportunity to fortify their dental health through fluoridation. This is an area in which we must do much more. We must lead the fluoridation effort in each of our own communities.

As we continue to try to address dental health concerns of the state's people, we are likewise moved to bring thoughtful consideration to our members' needs and desires as we together face a changing and sometimes problematic professional landscape. To face head-on the challenge presented by managed care, CDA has made available education modules and courses that offer dentists who choose to practice within that reimbursement system the best chance to provide ethical care. The reality is that the more managed the program, the greater the concern must be that those plans are underfunded to the point that a practice may no longer be able to exist. The Council on Dental Care, chaired by Dr. Robert Gartrell and coordinated by Ann Emery, provided the impetus and expertise to fashion the managed care education program.

An alternative to managed care, at the other end of the spectrum, is direct reimbursement. Debate has clung to it tenaciously throughout the year. Serious consideration by the Board of Trustees, wide-ranging discussion, and extraordinary effort by the Direct Reimbursement Committee and its chairman, Dr. Russell Chang, have resulted in significant adjustments to the program. It is poised now to make further market inroads, utilizing CDA staff and the expertise of people such as Caroline Turner -- who has done tremendous work on DR's behalf as executive director or Santa Barbara-Ventura County Dental Society -- and Teran Gall.

Similar conscientious exertion on behalf of the association by the Committee on Voluntary Continued Competency Assessment has allowed QUIL3 to emerge from a developmental process into a vehicle that provides a systematic approach to continuous quality improvement through self-assessment. The program, under the impetus of committee Chairman Dr. Steven Schonfeld and coordinator/consultant Linda Seifert, will tie into various teaching modules addressing specific areas of dentistry. As presented, QUIL3 is totally voluntary, protects the privacy of those willing to use it, and shows agencies that would try to legislate such assessment evidence of our ability and willingness to determine how the continued professional growth of our members shall be judged.

Who will our membership include? The answer is all qualified dentists, those people who exhibit the skills and knowledge to provide care that is looked upon with admiration; people who acknowledge the association's record of service to its members and concern for the oral health of the state. From all backgrounds and origins, these people will be welcomed. Through education, sensitivity and awareness of the multifaceted issues that are woven into the fabric of California's population, we must enthusiastically embrace diversity, make it a constant, working part of our association and our outlook, and thereby render it a non-issue. I thank the Diversity Steering Committee; its chairman, Dr. Russell Webb; coordinator, Pat Parsell; and consultant, Maridel Moulton, for their consistency in facing this challenge and opportunity on our behalf.

Change has been so much a part of the year within CDA headquarters, too. I have asked the association's staff to engage in the important analytical processes of operational and functional analysis to determine how and why resources are used and whether we are structured optimally to accomplish our tasks. Led by our chief financial officer, Laura Catchot, we have put cost accounting into place and now know more precisely where the money goes. Determining what programs and services best serve our members will be done with the re-initiation of the operational/functional/organizational analysis/study. This study will incorporate input from the association's leadership while staff illuminates realistically and honestly the human, intellectual and financial resources that give life to these programs and services.

Proudly, I point to our advancements in a far-reaching area that is defined by progress. Having emphasized our need to build our information technology into a formidable presence and tool, I am gratified to be part of the modernization of CDA's computer capabilities and the expansion of its possibilities. Val Szyntar's efforts as director of the association's Information Technology Department have galvanized our determination to claim IT as major factor in our future success -- this is our backbone and spinal cord. A subsidy program offered by CDA has given component societies an opportunity to build their computer capabilities and enhance their ability to participate with CDA in the ADA's ambitious Tripartite Association Management System. Thanks to the ad hoc Information Technology Committee for its guidance.

As I gladly welcome the ascendancy of Dr. Ken Lange to CDA's presidency, I continue to work to meet a challenge given to me by your board, that is serving as the association's interim executive director. I offer you my best efforts in this enterprise, even as the search committee I appointed to find a permanent executive director pursues its work. That committee -- Chairman Dr. John Lake and Drs. Matt Campbell, Daryl Lee, Dennis Kalebjian, Kent Farnsworth and Mike Miller -- will attempt to bring a list of candidates to the March meeting of the Board of Trustees. Closely related is the effort to modify how the executive director is reviewed. This new system was developed by the Committee to Review the Executive Director, which is made up of Drs. Mike Miller, Ken Lange, Dennis Kalebjian, Richard Rounsavelle, Rich Durando and myself as chairman.

What a year! The intensity and adjustments that have been almost daily requirements throughout the last year cause me to stand before this honorable body and breathe deeply the air of accomplishment to refresh me for the challenges ahead. Dr. Zakariasen's short tenure brought restructuring, and his departure has engendered yet another opportunity for contemplating what we do and perhaps modifying how we do things. This is another challenge presented to CDA to further enable the association's staff to utilize the palate of direction given by leadership and apply it with individual creativity and assertiveness to canvas a masterpiece.

This marriage of ideas and initiative, leadership and trust, communication and commitment is the synergy I hope to rely upon as your interim executive director, and which will sustain and empower us on our journey to a better CDA.