Danielle Grant · Chief Product Officer · United States
What a nurse-trained product leader would add to a quality committee
My contribution to a board
I would bring a view of healthcare products from three places most directors have not stood: the bedside, the hospital informatics office and the product team that decides what a clinician sees. I spent eight years as a cardiac nurse and have spent more than twenty in clinical software, the last ten on connected products that carry patients' data to clinicians. I know what it takes to bring software through the FDA as a device, what design controls and complaint handling demand of a product team, and how HIPAA shapes what a vendor may do with the data it holds for its customers. I would bring the habit of asking what a product asks of the people who use it, counted in steps and minutes, before asking what it earns.
American listing standards require a majority of independent directors and independent oversight of audit, compensation and nominations, and many medical technology and healthcare boards add a committee for quality, compliance or technology. That last committee is where I would be most useful. I have reported to one at Ardenwick twice a year since 2022, and I can tell a quality report that describes activity from one that shows whether risk is rising or falling.
I would also bring a record of turning down revenue on the record. I recommended declining a manufacturer's funding, delaying a product line our investors had modelled and taking a feature down the slower regulatory route. Each time I put the cost in the paper before anyone asked for it. A director needs the same discipline with less information and more distance, and I have practised that on a community health centre's board since 2019.
Judgement in practice
01
Declining a manufacturer-funded messaging programme
In 2023 a pharmaceutical manufacturer offered Ardenwick about US$2.4 million a year to fund medication reminders and educational messages for our heart-failure patients who had been prescribed one of its products. Our commercial team saw welcome revenue and a service some patients might value. I recommended that we decline. Under HIPAA, communications about a product that a third party pays for generally require the patient's written authorisation, and our business associate agreements did not permit our customers' patient data to be used that way in any case. Even with authorisations collected, patients had enrolled to be monitored by their own clinicians, not to receive a manufacturer's messages through a device their doctor had prescribed. The board debated it for most of a meeting; one director thought I was being too cautious, and the offer was declined. As a director I would ask the same of any revenue that rests on patient data: who agreed to this use, and would they recognise it if we described it to them?
02
Reporting a silent alert failure before its cause was known
In June 2024 a firmware update from one of our scale suppliers changed the format of a field our software used to validate readings. For eleven days some weight readings were stored but did not reach the alert rules. One heart-failure patient whose weight had risen was admitted to hospital without an alert reaching her nurse. I took the event to the Quality and Regulatory Committee within a week, before the engineering investigation had finished, setting out what we knew, what we did not and which customers we had already told. Lydia Habersham's team handled the complaint and assessed our reporting obligations. We added a check that stops any alert rule from running silently on malformed data, and supplier firmware now has to pass our own tests before release. On a board I would want to hear about events like this early and incompletely rather than late and tidily, and I would tell management so at my first meeting.
03
Funding interpreters before a patient portal
In 2023 the management team at Marlowe Avenue Community Health Center proposed a US$310,000 patient portal and app, financed partly from a grant, to reduce telephone volume. As the board's product person I was expected to welcome it. I first asked for two facts the proposal lacked: the languages our patients speak at home, and the ages of the patients who telephoned most. About 29 per cent preferred a language other than English, and the heaviest callers were over 65. I argued that a portal would mainly serve patients who were already getting through, and that the queue would shrink faster with interpreter lines and two more call-centre staff, at about US$140,000 a year. The board agreed in one meeting to fund the telephone changes first and to revisit the portal a year later with translated content and a caregiver option. Average telephone waits fell from eleven minutes to four. I would bring the same question to any board considering a new system: who will not be able to use it?
My first year on a board
Before forming views I would try to answer three questions about the company. How does it find out that a product has harmed or failed someone? How does a concern travel from a field engineer, a nurse or a customer to the board? And how much of the evidence behind its products' claims does the board actually see? To answer them I would read two years of quality committee minutes or their equivalent, the complaint and recall history the company has disclosed, its most recent cybersecurity assessments and any public inspection findings. I would ask to spend a day where the products are used, whether that is a clinic, a laboratory or a patient's home, and to meet the heads of quality, regulatory affairs and clinical affairs, each on their own.
For the first six months I would offer questions rather than proposals. In the second half of the year I would test whether the committee's papers let directors see trends rather than single events, and suggest changes only where they would help the whole board. At the end of the year I would ask the committee chair for a candid view of whether my questions had been useful, and re-read my notes from the first month to find what I had misjudged.
Conflicts and their management
Four kinds of relationship could compromise my judgement, and I would rule each out before accepting a seat. The first is Ardenwick's customers: I would not join the board of a health system or medical group that buys remote monitoring from us or is negotiating to do so. The second is our competitors in remote monitoring and digital care management, and any company preparing to enter that market. The third is our suppliers, including the makers of the scales, cuffs and meters in our kits and the cellular carriers that connect them. The fourth is my own finances. I hold share options in Ardenwick, which is privately held, and I would disclose them and any other holdings to the nominating committee in writing.
Marlowe Avenue Community Health Center does not buy from Ardenwick, and I abstain there from any decision about remote monitoring vendors. Before accepting any seat I would ask Thaddeus Brannigan and Ardenwick's board for their consent. If a relationship arose after I joined, for example because the company opened talks with Ardenwick, I would tell the chair that day, leave the discussion and resign if the relationship looked likely to last. Time is a conflict too. Ardenwick comes first, so I would fix the board calendar a year ahead rather than discover a clash in the week of a meeting.
My independence statement
My employer is Ardenwick, where I work full time and hold share options. Before any nomination goes forward I will set out in writing every relationship that Ardenwick, my family or I have with the company, its executives and its major customers and suppliers. Those facts are mine to disclose completely; whether they meet the exchange's independence tests, or a not-for-profit board's own policy, is the board's decision and not mine.
Board and committee exposure
Presented to the Board or a committee
Ardenwick Health, Inc.
Board of directors: product strategy, roadmap investment cases and the decision to take the risk score through the FDA
March 2021–present
Presents the product plan and every major investment case to the board each quarter; not a director of the company and holds no vote.
Reported to a committee
Ardenwick Health, Inc.
Quality and Regulatory Committee of the board: device submissions, complaint trends, missed-alert reviews and product security
January 2022–present
Reports twice a year with the head of regulatory affairs and quality, and attends whenever a product event reaches the committee.
Presented to the Board or a committee
Pellmore Medical Corporation
Board science and technology committee: annual review of connected-care products and product security
2019–2020
Presented the connected-care portfolio and the post-disclosure security programme to the committee in each of those years, alongside the division president.
Served as a director
Marlowe Avenue Community Health Center
Board of directors; member of the Quality Improvement Committee
January 2019–present
Unpaid director of a community health centre in Columbus serving about 19,000 patients; as its federal grant requires, a majority of the board are patients of the centre, and I am one of the non-patient directors.
Governance learning and readiness
IICA Independent Directors’ Databank: Not yet registered
India keeps the IICA databank as a register for its own independent directors, and it has no bearing on the American boards I am approaching, listed or not-for-profit. I have therefore not registered, and the status shown here reflects that rather than any step I have postponed. Should an Indian company ever ask me to join its board, I would first find out what registration there would require.
Quarterly board presentations at Ardenwick since 2021, and twice-yearly reports to its Quality and Regulatory Committee since 2022
Nearly eight years on the Marlowe Avenue board, including its annual review of the chief executive and the oversight calendar attached to its federal grant
A director-education programme on risk, audit and quality oversight for private-company and not-for-profit directors, completed in 2024
Working sessions with Ardenwick's outside counsel on FDA submissions, HIPAA business associate obligations and the board's oversight of both