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Week 11 Discussion Board

“Smoke-Free SFMC” Project, St. Francis Medical Center, Lynwood, CA (Chapter 12 #1)

Established in 1945, St. Francis Medical Center (SFMC) is the only comprehensive, nonprofit health care institution serving Southeast Los Angeles. The medical center operates a 384-bed acute care hospital, one of the busiest private emergency and Level II Trauma Centers, a Family Life Center with state-of-the-art Neonatal Intensive Care, a Health Benefits Resource Center, and a Children’s Counseling Center. Additionally, SFMC sponsors a Behavioral Health Service Line with a 40-bed locked acute Behavioral Health Unit (BHU), Outpatient Psych Services (OPS) and a Psychiatric Evaluation Team (PET) for psychiatric crises. Over $10,000 per year was spent by the medical center to purchase cigarettes for psychiatric inpatients.

SFMC provides quality medical care, educational programs, school-linked health services, and support services to the 1,000,000 residents of communities in Southeast Los Angeles County including Lynwood, South Gate, Downey, Huntington Park, Bell, Cudahy, Bell Gardens, Maywood Compton, and the Watts and Florence-Firestone sections of Los Angeles. Within Service Planning Areas (SPAs) 6, 7, and 8, which encompass the major communities within SFMC’s service area; Hispanics are the largest [growing] ethnic group at 56.8%, followed by Whites at 16.3% and African-Americans at 13.0%. This is according to US Census Bureau and American Community Survey 2010 statistics.

Based on the most recent data from the LA County Department of Public Health, from 2000 to 2009, the leading causes of mortality in LA County were coronary heart disease, stroke, lung cancer, emphysema, and Alzheimer’s. In SPAs 6, 7, and 8, coronary heart disease was also the leading cause of death. Compared to the other SPAs and the county, SPA 6 has the highest percentages of adults living with one or more chronic health conditions. Overall, Southeast Los Angeles residents suffer from significant risk factors associated with cardiovascular disease, such as hypertension, diabetes, high cholesterol, and smoking.

Smoking is a controllable risk factor, and evidence-based practice (EBP) shows that smoking cessation is effective in lowering risk, reducing complications of chronic illness, and improving quality of life. According to the Cigarette Smoking in Los Angeles County: Local Data to Inform Tobacco Policy (Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, 2010) report produced by the Office of Health Assessment and Epidemiology at the County of Los Angeles Public Health Department, all the communities served by SFMC are at the third or fourth quartile for prevalence of smokers (Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, 2009). This equates to nearly 115,000 estimated smokers in the communities located in SFMC’s primary service area. According to the Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology (2015), 13% of adults smoke cigarettes. Tobacco use in the County is lower than the national average of 19%, but remains slightly above the Healthy People 2020 target of 12% or fewer adults using tobacco.

• Approximately 8,600 lives and $4.3 billion are lost due to medical care and lost productivity costs associated with smoking and smoking-related diseases in Los Angeles County each year.
• The leading causes of smoking-related death are lung cancer, coronary heart disease, and chronic obstructive airway disease (COPD).
• 17% of households with children report tobacco smoke exposure in their homes (Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, 2015).

A decision was made to have the medical center, situated on a 121-acre campus, including the medical office building, progressive care unit (housing the behavioral health service line), and children’s counseling center (two sites), completely smoke-free for patients, visitors, employees, medical staff, and volunteers within 6 months of starting a health and wellness journey. This was an unbudgeted initiative to improve the health outcomes of the community requiring massive culture and systems change. A grant was available from Los Angeles County for $5000 per site to implement smoke-free policies and practices. The deliverables specified by the grantor were:

• Develop a smoke-free policy and achieve a smoke-free campus
• Develop and implement smoking cessation protocols
• Purchase signage
• Participate in educational webinars and monthly conference calls (two people per site)
• Consent to technical site visits by government officials

The SFMC Foundation did not have a grant writer available for a small grant; however, a doctor of nursing practice (DNP) student working at the medical center needed to write a grant project for class. The grant application was due 30 days from the time the DNP student became aware of its existence.

Questions for Discussion: 

1. What steps does the DNP student need to take to leverage this grant opportunity in a short submission time frame?

1. What grant components should be included in the grant framework?
2. What resources may exist from the grantor, medical center, community, state, and/or nation to maximize the economics for the unbudgeted “Smoke-Free SFMC” initiative?
3. How can the numerous departments and service lines on the campus be leveraged to increase the grant award?
4. Who (if anyone) does the DNP student need on the grant planning, writing, and executing team?
5. How will outcomes be measured for the various populations impacted (patients, visitors, associates, medical staff, and community) by the grant tactics?

Week 11 Discussion Board

What steps does the DNP student need to take to leverage this grant opportunity in a short submission time frame?

Grant writers are important people in an organization. Their responsibility is to research, draft, and submit proposals that help organizations or individuals receive grant funding. In the case of St. Francis Medical Center (SFMC), the first step to grant writing is to take a good hard look at the organization to determine if it meets the grantor’s requirements (Delaney & Gibson, 2021). Step two is to set a reasonable mission and goals for the grant proposal. Step three is to prepare all the documents needed. Step four involves writing the grant proposal and step five is the submission of the grant proposal.

What grant components should be included in the grant framework?

The components that would be included in the grant framework include the title page and cover letter, introduction, institutional background, and problem statement/needs assessment. Others include program goals, mission, objectives/outcomes, methods/implementation of the smoke-free activities, and evaluation plan (C.P.B., n.d.). Additional issues include future funding/sustainability, budget, and other components such as financial statements, letters to support, and others.

What resources may exist from the grantor, medical center, community, state, and/or nation to maximize the economics for the unbudgeted “Smoke-Free SFMC” initiative?

Both the grantor and the medical center may provide a budget so that they can compare and harmonize. While the grantor provides funds, the medical center provides skilled personnel to avoid the extra budget of hiring experts (Serrano-Velarde, 2018). The community may provide skilled and unskilled volunteers to help throughout the process. State or government agencies may support by providing additional grants. Since technology (such as computers) will be used, the medical center may offer computers to aid monthly webinars instead of buying new computers for the project (Serrano-Velarde, 2018). With such collaborative effort, the costs of the unbudgeted project may be minimized.

How can the numerous departments and service lines on the campus be leveraged to increase the grant award?

The medical center has several departments and service lines, including emergency and Level II Trauma Centers, a Family Life Center with state-of-the-art Neonatal Intensive Care, a Health Benefits Resource Center, and a Children’s Counseling Center (Serrano-Velarde, 2018). Additionally, SFMC sponsors a Behavioral Health Service Line with a 40-bed locked acute Behavioral Health Unit (BHU), Outpatient Psych Services (OPS), and a Psychiatric Evaluation Team (PET) for psychiatric crises. All these departments may have lone projects that can be used to apply for more grants (Rothstein, 2019). Having departmental projects rather than just one at the organizational level will ensure more grant awards.

Who (if anyone) does the DNP student need on the grant planning, writing, and executing team?

Grant writing is not a one-man job, hence, the grant writer will need various individuals around to help with various kinds of information and ideas. The DNP student will need the project team, which may include the institutional project manager, the head nurse, and some physician representatives. Additionally, a representative of psychiatrist groups should be included. Furthermore, the school accountant or any financial officer must be present to ensure proper budgeting. The medical staff will provide important inputs since they are the implementers.

How will outcomes be measured for the various populations impacted (patients, visitors, associates, medical staff, and community) by the grant tactics?

Smoking is a major problem in the community leading to increased cases of coronary heart disease, hypertension, and other cardiovascular diseases. The program is meant to develop a smoke-free policy, implement efficient smoking cessation programs, and others. The outcomes will be measured by gauging the knowledge of healthcare providers before and after the implementation (Rothstein, 2019). The Smoking rate in the community will be measured. The number of patients admitted with smoking-associated cardiovascular diseases will be measured (Rothstein, 2019). Positive results associated with the parameters will indicate the effectiveness of the program.

References

Delaney, M., & Gibson, S. (2021). Why grant writing and research matters in counselor education: Advancing our discipline. https://westcollections.wcsu.edu/handle/20.500.12945/1896

CPB. (n.d.). Basic Elements of Grant Writing. https://arisc.org/wp-content/uploads/2019/10/cpb-grant-writing.pdf

Rothstein, A. L. (2019). Creating winning grant proposals: A step-by-step guide. The Guilford Press.

Serrano Velarde, K. (2018). The way we ask for money… The emergence and institutionalization of grant writing practices in academia. Minerva, 56(1), 85-107. https://doi.org/10.1007/s11024-018-9346-4.