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

Public Health Leadership in Healthcare: The Good, The Bad and the Ugly

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

Graduation in 2004 Director in 2005??

Challenges and Strategies

Staff morale

Youth

No management experience

No guidance from supervisor

“Just” a social worker

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

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

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.

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).

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 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

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

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

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

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

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

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.

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

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.

Sustainability: New Standards

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?