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Tailoring A Grant Application To A Grantors Vision While Avoiding Mission Drift

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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

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USED MY OWN FREQUENT FLYER MILES

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OUR HOSPITALS

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ADMINISTRATION ADMINISTRATION

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CHAIRMAN OF THE VERY BORED

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THE BREAST CENTER

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Patient Registration You dont 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?

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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.

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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

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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 Foundations Community Profile is their play book Execute the play convincingly!

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HEALTH? EDUCATION? SOCIAL ISSUES?

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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?

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Proactive financial investments made to (1) further a foundations 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.

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1700s Tradesmen 1970s Community Investing 2007 Financial markets in question 2010 Health focused mission investing

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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

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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

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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

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Foundation assets 550 billion 3 US Budget 3 Trillion Global Capital Markets 96 trillion Foundation giving 46 billion Foundation investing 3 billion

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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

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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?

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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

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Implementation puts science into service.

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LT. Col. Patrick Hot Lips Houlahan, USMC Afterburner 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

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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.

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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.

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Tucker, Edmonson, and Nembhard (2005) Intervention is knowing WHAT. Implementation is knowing HOW.

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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

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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.

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Why do good concepts die? Numbers Dont Lie Fixen, Blas, 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!

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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 youll always get what you always got. Value each other in new ways. Shaking things up does not mean shaking people down.

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Anhinga-snake bird

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

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PROVIDE INNOVATIVE BREAST HEALTH, BREAST CANCER EDUCATION AND OUTREACH.

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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

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Breast Cancer Navigator Breast Health Program for Seniors Genetics Mammograms, Ultrasounds, Biopsies and MRIs for the uninsured and underinsured. Breast Cancer Resource Package Breast Cancer Specialist Training

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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.

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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.***

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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.

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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.

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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.

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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.

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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.

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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.

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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

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

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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?

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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.

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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? (Dont lose yourself in this.)

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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

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Demographic information Acuity Special populations Increase in quality standards Community concerns

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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?

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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

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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?

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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

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How many patients do you see a year? How many are in special circumstances? Will the navigator see them all?

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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?

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Standards Research Partnerships- internal and external When will the position be filled? How will the program be marketed? How will the public be educated?

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FTEs 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

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When and how will evaluations be accomplished? Six month reports to the Foundation Yearly site visits

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Tumor Registry: Standards and Certifications Lab: CAP Guidelines, assays Admissions: Timeliness, service, referrals Palliative Care: Symptom management Staff Education: Awareness, on demand navigation

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Offset of program cost FTE attrition shift Donations Endowments

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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

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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.

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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

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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

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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.

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http://www.cancer.gov/newscenter/pressreleases /PatientNavigatorGrants http://www.cancer.gov/newscenter/pressreleases /PatientNavigatorGrants www.cancer.org www.cancer.org www.komen.org/grants/default.asp?nodeid=302 www.komen.org grants.com www.avonbreastcare.org

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www.gih.org (Grant Makers in Health) www.gih.org (National Implementation Research Network http://www.fpg.unc.edu/~nirn/resources/detail. http://www.fpg.unc.edu/~nirn/resources/detail cfm?resourceID=31) www.patientnavigation.com www.patientnavigation.com www.nconn.org www.nconn.org www.foundationcenter.org

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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.

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1. Create Grants that Will Get Funded 2. Manage Your Grants Successfully 3. Locate Potential Grantors 4. Community Awards 5. Internships

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