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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” - PowerPoint PPT Presentation
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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 [email protected]
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