April 17, 2012 Guest Speaker: Heather Kapp shares her take on the public health professional.

1. Public Health Leadership in
Healthcare: The Good, The Bad
and 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.r.kapp@medstar.net
Phone: 202.877.2089

2. Presentation Overview
Personal/Professional Development
Illustrating Gaps in Services and Advocating to Fill
them
Support Services at Washington Cancer Institute
(WCI)
Advocating for Social Work/Patient Navigation
Services
Sustainability

3. Graduation in 2004
Director in 2005??
Challenges and Strategies
Staff morale
Youth
No management experience
No guidance from supervisor
“Just” a social worker

4. The Power of Language
Explaining the impact of psychosocial services in their
language
Administration: patient satisfaction (Reiki project)
In later years: cost savings (ROI project)
Now: revenue generating (Billing)
Future: American College of Surgeons new standards,
heath care reform
Medical Director: patient outcomes, IOM report, evidence
based interventions, stress that these are clinical
interventions
Staff: patient first, whole patient care
Patients: hope, help and support

5. Early Successes
Teamwork: increased 27 statistically significant percentage points
and employee satisfaction index by 7 as measured on employee
satisfaction survey
Advocated for staff: most were underpaid, needed updated JD
Obtained 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 (.5
was 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

6. Illustrating Gaps in Services
In 2008, a needs assessment was completed. This
included patient and caregiver focus groups.
Several participants had never heard of the
support services offered. Those that had some
awareness could only identify nutrition assistance
and printed literature such as pamphlets.
Few patients/caregivers had ever used or
participated in an education or support program
offered through WCI.

7. Advocating to Fill Gaps
Strategic plan written: promotion identified as
number one QI project.
Grant written to add Social Worker to CSS. Focus
was on patient navigation and eliminating barriers
to care (position obtained in 2008).
Grant written to add New Patient Liaison position.
Focus on promotion of CSS to newly diagnosed
patients (position obtained in 2009).

8. 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)

9. Support Services Continued
Ongoing Programs
Look Good…Feel Better in partnership with ACS
Yoga
General Cancer and Head/Neck Cancer Support Group
Living Well With Cancer Educational Seminars
Smoking Cessation
iS Skincare
Art and Music Therapy, provided by Smith Center for the Healing Arts
Shawl Ministry
Annual Programs
National Cancer Survivors Day
Interfaith Service of Remembrance

10. Advocating for Social Work/Patient
Navigation Services
In 2010, in partnership with GWU and D.C. Cancer Consortium
(D.C.C.C.), WCI received an additional 2 positions as part of the
D.C. City-Wide Patient Navigation grant
In 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 funded
1 full-time vacant Clinical Social Worker, grant funded (not
D.C.C.C.)
3 social work interns

11. Challenges
Advocating for a non-revenue generating department
In 2010, three positions were eliminated due to RIF
Had to redefine roles, strategic plan no longer
relevant
Constantly changing organizational prorities
Finding grants to sustain program

12. Role Refinement:
New Patient Liaison
• Began in 2009, grant funded position
• All WCI patients are mailed information on
support services, including Hope, Help and
Support brochure, newsletter and offered a
personal new patient orientation
• Administers screening tool
• Leads volunteer program, in 2011 partnered with
American Cancer Society (ACS)
• All WCI patients are offered a treatment binder
and tailored educational materials

13. Role Refinement:
The Volunteers
Rounding in the waiting rooms
Inviting patients to programs
Completing New Patient Orientations
Administering New Patient Screening Tool
Referring patients to programs and services at WCI
and ACS
Escorting lost patients to appointments

14. Role Refinement:
Clinical Social Worker
Psychotherapy/Counseling
Helps reduce anxiety and depression
Helps patients communicate their diagnosis to family and friends
Teaches ways to reduce stress (Reiki, Healing Touch, relaxation
skills training, mind/body therapy)
Helps patients develop and enhance coping skills
Assists patients in adjusting to a life-altering transition
Case Management
Assess and remove barriers to treatment: transportation, home
health care, medical equipment, insurance concerns, financial
issues related to medical care, etc. Stewart Trust grant

15. Sustainability: ROI
Measuring the success of the social work program by focusing
on social work interventions that allowed patients to adhere to
their treatment.
Analyzed third party reimbursement associated with patients
who would have been lost to treatment without social work
intervention.
Based on 7 months of data in FY 2012, WCI received $381,615
in net revenue for 25 patients who maintained their treatments
due to social work navigation.
The results provide important information on the positive
financial and health impacts of social work services/patient
navigation. Requested FTE in budget. Denied because not
revenue generating. I chose not to fill vacant grant funded
position.

16. Sustainability: New Standards
American College of Surgeons Accreditation
Standard 3.2: Psychosocial Distress Management
Phase in for 2013
The cancer committee, or other appropriate
leadership body, will develop a process to monitor
and integrate psychosocial distress
screening, referral for the provision of
psychosocial care, and follow-up evaluation as the
standard for cancer patients

17. Sustainability: New Standards
American College of Surgeons Accreditation
Standard 3.1: Patient Navigation
Phase in for 2015
A patient navigation process, driven by a community
needs assessment, is established to address health
care disparities and barriers to care for patients.
Resources to address identified barriers may be
provided either on-site or by referral to outside
agencies. This process is evaluated, documented
and reported to the cancer committee annually. The
process is modified or enhanced each year to
address additional barriers.

18. Sustainability
Use new accreditation standards to our advantage
Define patient navigation roles among Clinical Social
Work and Nursing staff
Contract with behavioral health?
Heath Care Reform: care coordination, patient
engagement, accountable care?
Restructure social work in other ways?