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 [email protected]
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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.
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