Tailoring A Grant Application To A Grantor’s Vision… While Avoiding Mission Drift

Tailoring A Grant Application To A

Grantor’s Vision… While Avoiding

Mission Drift

Mary Jean Houlahan, RN, BSN, BA, CCM President and CEO COMMAND PRESENCE : “ Speaking Authentically” Oncology Patient Navigation

President Elect Florida Coalition of Oncology Nurse

Navigators

(561) 302-7559 mjhoulahan@comcast.net

USED MY OWN FREQUENT FLYER MILES

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OUR HOSPITALS

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ADMINISTRATION

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ADMINISTRATION

CHAIRMAN OF THE VERY BORED

THE BREAST CENTER

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Patient Registration “You don’t wait for us, we wait for you!”

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MAMMOGRAPHY WAITING AREA

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UNDISCIPLINARY TEAM

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TUMOR REGISCZAR

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LACK OF QUALITY IMPROVEMENT DIRECTOR

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BREAST CANCER NAVIGATOR

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BREAST RADIOLOGIST

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BREAST PRE-TREATMENT CONFERENCE DISCUSSION

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CANCER COMMITTEE MEETING-CANCELED

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MARKETING AND COMMUNITY OUTRAGE DEPARTMENT

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IT line is busy-send in a ticket

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HOW I GET TO WORK

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HOW THE BREAST SURGEON GETS TO WORK

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THE PATHOLOGISTS ARE AT WORK

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THE ONCOLOGISTS JUST TEXT.

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NAPBC Standard 2.2

Intradisciplinary Care

Input=Output

Why now more than ever?

Patient Navigation: More than “The Standard of Care”

Foundation mission statements define ideals through which they support patient care and well being.

Embracing their goals in a way that increases your value and reduces their risk will give your grant team the edge.

Initiating Factors in Implementing a Patient Navigator Program

IN BREAST CANCER NAVIGATION AS IN THE SUPERBOWL, SAVING LIVES AND CHANGING THE SCORE IS A LABOR INTENSIVE, EXPENSIVE, AND SERIOUS CHALLENGE. SO…

1. BE READY 2. KNOW THE PLAYBOOK and…

PLAY LIKE A CHAMPION TODAY !

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When ball teams play and swim teams have meets, they know their competition!

Know: How Foundations think Who funds them How they perceive risk How they implement Study: The Foundation’s Community

Profile is their play book

Execute the play convincingly!

THINK LIKE A CHAMPION TODAY!

HEALTH?

EDUCATION?

SOCIAL ISSUES?

WHAT IS THEIR ENDPOINT?

WHERE DOES THEIR MONEY COME FROM AND HOW DO THEY SUSTAIN IT?

WHAT RISKS ARE THEY WILLING TO ASSUME?

WHAT ARE THEIR DISBURSEMENTS?

WHAT MAKES YOUR GRANT RFP A GOOD RISK?

WHO FUNDS THE FOUNDATIONS?

Proactive financial investments made to (1) further a foundation’s mission and (2) recover principal invested or earn financial return.

Q: What does this mean to you as you apply for a grant?

A: An opportunity to exponentiate their investment returns.

MISSION INVESTING

1700’s Tradesmen

1970’s Community Investing

2007 Financial markets in question

2010 Health focused mission investing

Who invested when?

When leveraging, or supplementing the incentives of the capital markets foundations can alleviate suffering.

They do this by making grants and using their endowments to craft market-based solutions to social problems.

Lisa Richter, GPS Capital

Partners

Leverage- How do Foundations use it?

Foundation: Impact, levels of support, how flexible they are to fund FP and NFP, Alignment, Leverage, etc.

Grantee: Capacity, sustainability, management, credibility of concept, partnership

Society and Market: Innovation Catalyst, efficiency in use of resources, accountability, changes in policy

Foundations invest by “strategic benefit”

Needs Resources

Pressure to grant when markets are good problematic sustainability for the long term.

Access to commercial funds for NFP

Alignment with foundation and grantee

Foundation Investment Challenges

SHOW ME THE MONEY !

Over 40 years, 92 foundations realized 2.3 billion in Program Related Investing

There is $350-400 million invested annually .

Growth in volume was 16.2% from 2001-2005

2010: Smaller foundations provide 44% of grants

The Record Speaks for Itself

To grant or not to grant??? Repayment capacity is not necessarily the issue.

Is there a revenue stream for this project that will sustain it?

Is this project well managed and does it have resources to carry out its objectives?

Perceiving Risk

INVESTING IN THE MARKETS

Could cause direct harm

May neither benefit nor harm

Not aligned with the foundation mission

INVESTING IN YOU

Reputational risk

Lackluster performance and synergy

Reports to their investors/donors show low return on investment

What is their appetite for risk?

Implementation puts science into service.

IMPLEMENTATION 101

LT. Col. Patrick “ Hot Lips” Houlahan, USMCAfterburner Seminars

IIMPLEMENT BY THE BIG PICTURE-NOT THE LITTLE RED BUTTON

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Evidence based proposals: Research findings+needs to be addressed=better

outcomes

Q: Why is that important to your RFP? A: $200 billion-Yearly government and foundation

expenditures on treatment research $2 trillion on support services

Patients only benefit from interventions they receive. Dean L. Fixsen and Karen A. Blase,

2010

IMPLEMENTATION 101

Mark Lipsey( 2007)

Quality+ implementation = strong outcome predictor

For the grantee this means implement well to build capacity that will sustain your program through outcomes that really make a difference.

IMPLEMENTATION 101

Paul Nutt (2002) Why Decisions Fail

Do not rely on laws and regulations, following the money, keeping supporting roles and functions the same, giving out information and training alone to successfully implement a program.

Intervention and implementation result in positive outcomes.

IMPLEMENTATION 101

Tucker, Edmonson, and Nembhard (2005)

Intervention is knowing WHAT.

Implementation is knowing HOW.

IMPLEMENTATION 101

Fixen and Blase (2007) developed the theory of “Implementation Drivers and Team.”

A well selected, trained and coached staff + Technical and Adaptive Leadership + Data, Administration and systems support

= Innovation to produce benefit

IMPLEMENTATION 101

The Implementation Team

Prepares departments and staff Prepares the institution and community Prepares the systems Prepares the stakeholders

They are now ready to assure that implementation will produce the benefits that you want-

a sustainable grant program.

IMPLEMENTATION 101

Why do good concepts die?

“Numbers Don’t Lie”

Fixen, Blasé, Timbers and Wolf in 2001 and Balas and Boren in 2000 determined that :

If you have effective implementation of an intervention, it will be 80% effective in 3 years.

If you just let it happen it will only be 14% effective in 17 years!

IMPLEMENTAION 101

The better the implementation the lower the budget costs along the continuum.

Micro and macro-organizations must change and adapt for innovation to seed successfully.

If you always do what you always did you’ll always get what you always got. Value each other in new ways. Shaking things up does not mean shaking people down.

IMPLEMENTATION 101

Anhinga-snake bird

ESSENTIAL COMPONENTS OF AN RFP

In your statement of need, identify factors that make your proposal dovetail with the Foundation’s mission.

Component #1

“STATEMENT OF NEED”

“PROVIDE INNOVATIVE BREAST HEALTH, BREAST CANCER EDUCATION AND OUTREACH. “

SUSAN G. KOMEN FOR THE CURE

FY 2010

$1,150,000 total grant donations to local NFP for patient oriented programs

$170,005 in Navigator grants among 4 hospitals

Remainder – screening, biopsy, treatment and education grants

Community wide impact on Navigator programs

Breast Cancer NavigatorBreast Health Program for Seniors

“Genetics” Mammograms, Ultrasounds, Biopsies and MRI’s for the uninsured and underinsured.

Breast Cancer Resource Package

Breast Cancer Specialist Training

APPROVED GRANT S

“ Our Mission is to provide access to breast healthcare for those in need and to find a cure and learn how to prevent breast cancer.”

AVON FOUNDATION FOR WOMEN

Grants for up to $150,000 for one year

Avon Foundation Safety Net Program-enables hospitals to provide post-screening diagnostics and care to underserved women.

The emphasis in 2010 is for patient navigation projects or partial equipment support in facilities with a history of successfully navigating patients.

*** A small subset of applications will be invited to submit a full proposal based on their Letters of Intent.***

FY 2010

$140,000 Avon grant divided over 2 years

To navigate medically underserved women of all ages, living below 200% of the Federal Poverty Level, who received an abnormal mammogram.

Broward Health Breast Cancer Patient Navigator Program

The RN facilitated navigation program was established in 2006. Broward is a 6 facility public hospital system in South Florida.

The Avon assistance allowed for a bi-lingual social worker who is a LMHC.

The AFBCF disburses $7,000,000 to 145 NFP to navigate 150,000 women into screening and educate 500,000 on breast health and early detection.

Grantors look for evidence of applicant support of fund raising activities.

“The American Cancer Society is the nationwide, community based, voluntary health organization

dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer through research, education, advocacy, and service.”

AMERICAN CANCER SOCIETY

2005- NCI tackled unequal access to standard cancer care as a cause of health disparities.

Nine Academic research institutions established the Patient Navigator Research Program to develop navigator interventions and test efficacy and cost-effectiveness.

#1 Navigator role: Timely diagnosis and treatment through access to services and enhanced communications between patients, families, physicians and the system.

ACS Public Funding

The Coleman Foundation provided funding to ACS for the Patient Navigator System in Chicago to include case management and patient tracking as well as traditional support programs.

ACS Private Funding

There are eight Chicago area Nurse Navigators employed by ACS.

3 - funded by Foundations

3- funded by Astra Zeneca and other pharma

2-ACS paid employees

“LIVESTRONG”

“We fight to improve the lives of people affected by cancer.”

Lance Armstrong Foundation

2008- 3 year Survivorship Navigation Program

Breast Cancer survivors at Hartford (CT) Hospital

Treatment Summary/Care Plan/Care coordination/education

Sounds like it supports NAPBC standards for surveillance?

Lance Armstrong Foundation

The Breast Cancer Navigator RFP Resonating with the Decision Makers

• Dovetail your activities to their mission.

• Address each of the grant components.

• Focus on the spirit as well as the language of the grant RFP.

• Delight the grantors with exponential benefits of partnership.

• Know your customer- the donors as well as the Foundation. Let them know that you anticipate an RFP.

• Demonstrate NAPBC accreditation or accreditation intention to the grantor.

How can patients find their way through the system?

With all the options and medical advances how can they make treatment decisions?

How will they cope with psychosocial and financial demands at the same time?

How will they be followed? Are they group identified? (Don’t lose

yourself in this.)

The Statement of Need is essentially the problem to be addressed:

Immediate and delayed impact of diagnosis Inability to navigate a complex medical

system Confusion with insurance issues ,approval

delays, lack of coverage Frustrating referral and scheduling delays

and conflicts Lack of information upon which to make

treatment decisions Delay from diagnosis to treatment Effect upon family and work Psychosocial, spiritual, nutritional concerns

Define the Typical Experiences of theNewly Diagnosed Patient:

Demographic information

Acuity

Special populations

Increase in quality standards

Community concerns

Relate the expounded Statement of Need to specific patient population characteristics

Why do you want to establish a program? In what other settings has it been used?

What is the impact of a navigator?

Why will your innovations make a difference and how?

ESSENTIAL COMPONENT #2 Project Explanation

Evaluate both positive and negative letters received in the past from patients. Use them to focus on common threads of issues to be addressed by the grant.

Patient satisfaction surveys

QI studies and trends

Community impression of your facility imparted by the media

Components of the Project Explanation Itself

Use NAPBC Standards for accreditation

What components of the standards can be impacted and actively supported by the grant ?

What other community issues will be positively impacted by a Navigator grant?

Define the role and responsibilities of the Navigator in your institution

Rapid work-up Provider selection Treatment decisions Education Psychosocial intervention Symptom management Involvement of intradisciplinary team Management of benign breast disease Pre-treatment conferences Long term surveillance Genetics Survivorship

How many patients do you see a year?

How many are in special circumstances?

Will the navigator see them all?

Who is your constituency?

What percentage of patients will the Navigator see?

Will other cancer patients be seen as well?

Is your service area a factor?

What percentages of patients will be presented at pre-treatment conferences?

How will time from diagnosis to treatment be lessened?

What guidelines will be incorporated?

COMPONENT #3Goals and Measurable Objectives

Standards

Research

Partnerships- internal and external

When will the position be filled?

How will the program be marketed?

How will the public be educated?

Component #4

Activities That Will Accomplish the Goal!

FTE’s Volunteers IS and the appropriate technology Software needed

Administrative commitment can make or break your program and staff enthusiasm

Remember this! You are making a statement about your attitude regarding delivery of care when you address or ignore these components

Component #5 Identify Support Components

When and how will evaluations be accomplished?

Six month reports to the Foundation

Yearly site visits

Component #6 Timetable for Accomplishing Goals

Tumor Registry: Standards and Certifications

Lab: CAP Guidelines, assays

Admissions: Timeliness, service, referrals

Palliative Care: Symptom management

Staff Education: Awareness, on demand navigation

Component #7 What other departments and organizations will be involved?

Component #8 Partnering Organizations

Community Based

Faith Based

Schools

Health Initiatives

Financial and Treatment Support

Other Foundations

Offset of program cost

FTE attrition shift

Donations

Endowments

Component #9 Long-term Funding Strategies

Component #10

A review of comparable programs in your area or service line. Differentiate the unique features of your grantprogram.

Know your colleagues and competition

How are they addressing problems that your intended grantor funds?

Who or what has fallen between the cracks?

Avoid redundancy

QI and Surveys:

Show improved patient outcomes and long term survival.

Surveillance leading to decrease in disease, new primary or recurrence, time to progression of disease, improved quality of survivorship.

Reinforce the symbiotic synergy of grantor/grantee goals.

Component #11 How Will Success Be Measured?

Improving the patient experience and clinical outcome

Benefit your institution

Develop a symbiotic relationship with your grantor Foundation, in- house Foundation, medical community, individual donors

Share the wealth-NCOON, ONS

Component #12 Outcomes

Patient and physician satisfaction surveys

Enhancement of relationship with the tumor registry to show better outcomes through accurate statistics

Increases in outpatient, imaging and surgery volumes

Shorter LOS from fewer complications clinically and psychosocially

Use and disseminate results to support expansion, new initiatives, new equipment

Why We Do What We Do

Words from the folks who really matter……..

MY GRATEFUL HEART REMEMBERS....

T.L.

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K.H.

“You ask how it is possible to have so much joy with all of this,

but it is.”

http://www.cancer.gov/newscenter/pressreleases/PatientNavigatorGrants

www.cancer.org

www.komen.org/grants/default.asp?nodeid=302 grants.com

www.avonbreastcare.org

Resources

www.gih.org (Grant Makers in Health)

(National Implementation Research Network

http://www.fpg.unc.edu/~nirn/resources/detail.

cfm?resourceID=31)

www.patientnavigation.com

www.nconn.org

www.foundationcenter.org

Livestrong.org

In SEARCH box, type :”grants”

Five sites will appear which clearly spell out the steps of a successful grant process through any Foundation.

1. Create Grants that Will Get Funded

2. Manage Your Grants Successfully

3. Locate Potential Grantors

4. Community Awards

5. Internships