Public Health Leadership inHealthcare: The Good, The Badand the Ugly Heather R. Kapp, MPH, LICSW Director, Cancer Support Services MedStar Washington Hospital Center Washington Cancer Institute 110 Irving Street, NW, C1205 Washington, DC 20010 Heather.firstname.lastname@example.org Phone: 202.877.2089
Presentation OverviewPersonal/Professional DevelopmentIllustrating Gaps in Services and Advocating to FillthemSupport Services at Washington Cancer Institute(WCI)Advocating for Social Work/Patient NavigationServicesSustainability
Graduation in 2004 Director in 2005??Challenges and StrategiesStaff moraleYouthNo management experienceNo guidance from supervisor“Just” a social worker
The Power of LanguageExplaining the impact of psychosocial services in theirlanguageAdministration: patient satisfaction (Reiki project)In later years: cost savings (ROI project)Now: revenue generating (Billing)Future: American College of Surgeons new standards,heath care reformMedical Director: patient outcomes, IOM report, evidencebased interventions, stress that these are clinicalinterventionsStaff: patient first, whole patient carePatients: hope, help and support
Early SuccessesTeamwork: increased 27 statistically significant percentage pointsand employee satisfaction index by 7 as measured on employeesatisfaction surveyAdvocated for staff: most were underpaid, needed updated JDObtained chaplain position in operational budget for outpatient(WCI)Obtained psychosocial counselor position in operational budget(originally paid out of donated funds)Obtained .5 dietitian in operational budget to bring total to 1.5 (.5was a contractor)Initiated development of social work and patient navigation services(4 new grant funded positions)Developed mind/body program, including reiki, healing touch,reflexology, yoga
Illustrating Gaps in ServicesIn 2008, a needs assessment was completed. Thisincluded patient and caregiver focus groups.Several participants had never heard of thesupport services offered. Those that had someawareness could only identify nutrition assistanceand printed literature such as pamphlets.Few patients/caregivers had ever used orparticipated in an education or support programoffered through WCI.
Advocating to Fill GapsStrategic plan written: promotion identified asnumber one QI project.Grant written to add Social Worker to CSS. Focuswas on patient navigation and eliminating barriersto care (position obtained in 2008).Grant written to add New Patient Liaison position.Focus on promotion of CSS to newly diagnosedpatients (position obtained in 2009).
Support Services• Psychotherapy/Counseling & Support Groups• Reiki, Healing Touch & Reflexology• Spiritual Care• Nutrition Counseling & Yoga Class• Genetic Counseling• Patient Education & Smoking Cessation• Community Outreach, Screening and Education• Salon Services(Wigs, Hats, Turbans, Skin Care, Bra Fittings)
Support Services ContinuedOngoing ProgramsLook Good…Feel Better in partnership with ACSYogaGeneral Cancer and Head/Neck Cancer Support GroupLiving Well With Cancer Educational SeminarsSmoking CessationiS SkincareArt and Music Therapy, provided by Smith Center for the Healing ArtsShawl MinistryAnnual ProgramsNational Cancer Survivors DayInterfaith Service of Remembrance
Advocating for Social Work/PatientNavigation ServicesIn 2010, in partnership with GWU and D.C. Cancer Consortium(D.C.C.C.), WCI received an additional 2 positions as part of theD.C. City-Wide Patient Navigation grantIn total:1 full-time New Patient Liaison, grant funded (not D.C.C.C.)1 full-time LICSW Clinical Social Work Supervisor, grant funded(half funded through D.C.C.C.)1 full-time LICSW Clinical Social Worker, grant funded.8 LICSW Clinical Social Worker, WCI funded1 full-time vacant Clinical Social Worker, grant funded (notD.C.C.C.)3 social work interns
ChallengesAdvocating for a non-revenue generating departmentIn 2010, three positions were eliminated due to RIFHad to redefine roles, strategic plan no longerrelevantConstantly changing organizational proritiesFinding grants to sustain program
Role Refinement: New Patient Liaison• Began in 2009, grant funded position• All WCI patients are mailed information onsupport services, including Hope, Help andSupport brochure, newsletter and offered apersonal new patient orientation• Administers screening tool• Leads volunteer program, in 2011 partnered withAmerican Cancer Society (ACS)• All WCI patients are offered a treatment binderand tailored educational materials
Role Refinement: The VolunteersRounding in the waiting roomsInviting patients to programsCompleting New Patient OrientationsAdministering New Patient Screening ToolReferring patients to programs and services at WCIand ACSEscorting lost patients to appointments
Role Refinement: Clinical Social WorkerPsychotherapy/CounselingHelps reduce anxiety and depressionHelps patients communicate their diagnosis to family and friendsTeaches ways to reduce stress (Reiki, Healing Touch, relaxationskills training, mind/body therapy)Helps patients develop and enhance coping skillsAssists patients in adjusting to a life-altering transitionCase ManagementAssess and remove barriers to treatment: transportation, homehealth care, medical equipment, insurance concerns, financialissues related to medical care, etc. Stewart Trust grant
Sustainability: ROIMeasuring the success of the social work program by focusingon social work interventions that allowed patients to adhere totheir treatment.Analyzed third party reimbursement associated with patientswho would have been lost to treatment without social workintervention.Based on 7 months of data in FY 2012, WCI received $381,615in net revenue for 25 patients who maintained their treatmentsdue to social work navigation.The results provide important information on the positivefinancial and health impacts of social work services/patientnavigation. Requested FTE in budget. Denied because notrevenue generating. I chose not to fill vacant grant fundedposition.
Sustainability: New StandardsAmerican College of Surgeons AccreditationStandard 3.2: Psychosocial Distress ManagementPhase in for 2013The cancer committee, or other appropriateleadership body, will develop a process to monitorand integrate psychosocial distressscreening, referral for the provision ofpsychosocial care, and follow-up evaluation as thestandard for cancer patients
Sustainability: New StandardsAmerican College of Surgeons AccreditationStandard 3.1: Patient NavigationPhase in for 2015A patient navigation process, driven by a communityneeds assessment, is established to address healthcare disparities and barriers to care for patients.Resources to address identified barriers may beprovided either on-site or by referral to outsideagencies. This process is evaluated, documentedand reported to the cancer committee annually. Theprocess is modified or enhanced each year toaddress additional barriers.
SustainabilityUse new accreditation standards to our advantageDefine patient navigation roles among Clinical SocialWork and Nursing staffContract with behavioral health?Heath Care Reform: care coordination, patientengagement, accountable care?Restructure social work in other ways?