Get 'er Funded: A QI Project to Increase Grant Monies

State: KY Type: Promising Practice Year: 2014

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The goal of this practice was to improve our process of seeking, selecting and applying for grants. Ultimately the objective was to increase the total number of grants and the total amount of grant monies received.

To achieve this goal a Plan-Do-Check (Study)-Act (PDCA) Quality Improvement (QI) cycle was utilized. After identifying this as an opportunity for improvement a team was assembled. The team then examined our current grant application process and the root causes for low grant funding. An improvement theory was then developed and tested. The results were then analyzed and standardized within FCHD.

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Franklin County Health Department
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Get 'er Funded: A QI Project to Increase Grant Monies
The Franklin County Health Department (FCHD) is located in Kentucky’s capital city of Frankfort. The Franklin County community covers 210.46 square miles and has a population of 49,285 that surges with a daily influx of Commonwealth of Kentucky employees.The public health issue addressed by this practice is that of decreasing Local Health Department (LHD) funding and staffing. FCHD, like many LHDs, has experienced budget cuts as well as staff reduction through attrition and lay-offs. This has occurred during a time when there has been an increase in demand for services. These issues have increased the importance of grant funding even when no grant writing position exists. The goal of this practice was to improve our process of seeking, selecting and applying for grants. Ultimately the objective was to increase the total number of grants and the total amount of grant monies received. To achieve this goal a Plan-Do-Check (Study)-Act (PDCA) Quality Improvement (QI) cycle was utilized. After identifying this as an opportunity for improvement a team was assembled. The team then examined our current grant application process and the root causes for low grant funding. An improvement theory was then developed and tested. The results were then analyzed and standardized within FCHD. The results and outcomes of this project were significant. An improvement theory that included a flowchart of our new grant application process, a decision tree for when to apply for grants and a grant toolkit to assist with the writing of grants was developed. This resulted in a 65.7% increase in grant funding within one fiscal year. The objectives for this practice were met. These included an increase in both the total number of grants and the abovementioned increase in grant monies received. The success of this practice was due to several factors. FCHD team members served as the greatest resource. Following the established PDCA QI cycle was also a great resource for team members along with QI tools, such as flowcharts and fishbone diagrams. This practice has a financial and workforce impact on public health by providing a model for grant selection and application that could be tailored by individual LHDs.
The Franklin County community covers 210.46 square miles including Kentucky’s Capital in the city of Frankfort. Franklin County has a population of 49,285 that surges with a daily influx of Commonwealth of Kentucky employees. This population represents a 3.4% increase since 2000, which is less than the state increase of 7.4% and the national increase of 9.7%. The community’s diversity includes African American, American Indian and Alaska Native, Asian and Hispanic or Latino residents. Spanish is the language spoken at home for 2.8% of the population, other Indo-European languages are spoken by 0.6%, Asian and Pacific Islander languages are spoken by 0.9% and other languages are spoken by 0.1%. 21.7% of residents are under the age of 18 and 13.8% of residents are 65 years of age or older (U.S. Census Bureau, 2010). The problem or public health issue addressed by this practice is one commonly experienced by Local Health Departments (LHDs). The Franklin County Health Department (FCHD) was experiencing numerous budget cuts along with staff reduction due to both attrition and necessary lay-offs. This along with FCHD’s focus on accreditation and quality improvement helped to bring the issue of low grant funding to the forefront. After careful examination it was discovered that numerous staff hours were spent researching and applying for grants that were not necessarily aligned with our Community Health Assessment (CHA), Community Health Improvement Plan (CHIP) or agency Strategic Plan. It was also noticed that several seemingly opportune grants had been overlooked. Although FCHD does not have a grant writing position it was clear that this job responsibility needed to be more clearly defined. The target population size addressed by this practice was ultimately the entire community of Franklin County since the grants received went to benefit all. The grants received during this project created physical activity policies integrating 50 minutes of physical activity each school week; provided diabetes self-management education; created incentives for breast cancer screening; added electrical outlets to elementary schools allowing for dental treatment through the University of Kentucky Mobile Pediatric Dental Unit; provided supplies for elderly home health patients; created a county-wide smoke-free ordinance including a smoke-free park; provided a physical activity resource guide to the community; provided nicotine replacement therapy to community members wishing to quit smoking; and sponsored a physical activity event attended by numerous community members. Some of these issues including physical activity, obesity and tobacco use are included the CDC Winnable Battles. 3a. Franklin County’s demographics include 49,285 citizens. Franklin County’s diversity includes African American, American Indian and Alaska Native, Asian and Hispanic or Latino residents. 3b. At least 90% of the target population was reached through the grants that were received as a result of this practice. This included K-fifth grade elementary school students who benefit from an additional 50 minutes of physical activity each school week; women aged 40 and over that received an incentive or getting their annual mammogram; K-fifth grade elementary school students who received dental services during the school day; elderly home health patients that received needed health care supplies; residents that received Franklin County’s Physical Activity Resource Guide through the local newspaper and free advertisements; community members who attended smoking cessation classes; and community members who attended Franklin County's Longest Day of Play. In the past grant writing workshops have been provided to help LHDs increase grant funding. While grant writing training is necessary this has not helped to ensure that grants applied for are aligned with LHD CHAs, CHIPs or Strategic Plans. This also has not helped to divide the workload involved in grant writing among traditional public health positions or been proven to increase overall grant monies received.5. The current or proposed practice better addresses the need for increased grant monies by instituting a PDCA QI cycle. Through this QI cycle grant opportunities are better evaluated for alignment with agency and community goals and objectives, grant writing responsibilities are better distributed among staff members and ultimately a greater number or grants and a larger amount of grant money was received. This practice is innovative in that QI is still being adopted in the field of public health. In addition this practice applies QI to an area not before seen in public health. A review of the NACCHO Model Practice Database did not reveal any similar projects. 6a. The use of QI to increase grant funding is new to the field of public health as best determined by a literature review. The NACCHO Model Practice Database did address other ways to increase revenue that were not related to grant funding. 6b. N/A. 6b1. N/A. The current practice’s use of QI is definitely evidence based. The Public Health Foundation, National Association of City and County Officials (NACCHO), National Network of Public Health Institutes (NNPHI) and Robert Wood Johnson Foundation (RWJF) all recommend using the PCDA QI cycle to improve public health issues.
Nutrition, Physical Activity, and Obesity|Tobacco
1. The goal for this practice was to improve the overall grant selection and application process. The objectives were to increase both the number of grants and the total grant monies that were received. 2. To achieve this goal and these objectives a PDCA QI cycle was implemented. 2a. The steps taken to implement this practice included: identifying low grant funding as an opportunity for improvement; assembling a team; examining our current grant application process, which included flowcharting the process; determining root causes for low grant funding utilizing the five whys and a fishbone diagram; developing an improvement theory that included a decision tree for when to apply for grants, a flowchart of the grant application process; an internal grant tracking form and a grant toolkit that included community health data, staff resumes, possible evaluation techniques, sample grant applications, sample letters of support, budget and funding information, possible evidence-based interventions and agency strategic plan and CHIP goals; testing the improvement theory; analyzing the results of testing the improvement theory; and standardizing the process within FCHD. 3. Those selected to receive this practice included internal FCHD staff members and external community partners. Internal staff members were identified based on their grant writing experience, interest in pursuing additional funding and available time. Considering all of these criteria resulted in the selection of internal partners that included representatives from Health Education, Environmental Health/Emergency Preparedness, Home Health, Clinic and Administrative staff. External community partners were identified in both the decision tree and grant application flowchart, that were both included in this project’s improvement theory. Including external partners in this practice ensured that eligible community partners were not competing applicants and possible grants were referred to eligible community partners. This made a wide array of local public health system partners key stakeholders in this practice. 4. The time frame for this practice was fiscal year 2010 to fiscal year 2011. 5. Other stakeholders included the above mentioned external community partners. Their role in the planning process was to review the FCHD grant application process and provide input and their role in the implementation process was to evaluate and apply for potential grants that were forwarded by FCHD. These partners included county, city and private school boards; family resource centers; community organizations including the Frankfort YMCA and Franklin County Extension Agency; local childcare centers; and city and county government. 5a. FCHD fosters collaboration with community stakeholders by providing notification of grant opportunities as defined by this practice. Also defined by this practice is offering letters of support and technical assistance for grant applications. In addition FCHD facilitates a large local community coalition that conducts regular Community Health Assessments and develops Community Health Improvement Plans that can be used by all community partners for grant applications. 6. The only start up or in-kind costs associated with this practice were staff time and the staff time of community partners who considered and/or applied for grants that were forwarded as part of this practice.
The overall goal of this practice was to improve the grant selection and application process. Great improvements were made to the provided grant application flowchart and decision tree. The provided grant tracking form also assisted in gathering valuable evaluation data.The specific objectives of this practice were: Increase the total number of six grants received in fiscal year 2010 by 30% by June 30, 2011. Increase fiscal year 2010 grant funding totals of $42,469.84 by 30% by June 30, 2011. The overall goal of improving the grant selection and application process was measured by the improvements to the grant application flowchart and the creation of a decision tree specifying the criteria for grant selection. A grant tracking form was also created to measure the amount of time spent of grants, track the number of grants applied for and identify further areas for quality improvement. The first process objective of increasing the total number of grants received by 30% June 30, 2011 was exceeded. A total number of 10 grants were received in fiscal year 2011, a 66.6% increase in the number of grants received in fiscal year 2010. The outcome evaluation of increasing grant funding totals by 30% was also exceeded. A total of $70,395.42 was received in fiscal year 2011. This represented a 65.7% increase from fiscal year 2010. 2. Per the PDCA QI cycle this practice was evaluated using the above measurable objectives. 2a. The primary data source for the evaluation of this practice was the number of grants applied for and the amount of grant money received. This data was collected by internal FCHD staff members who participated in the grant selection and application process as well as FCHD financial staff who reported the total grant money received. This data was collected using the attached grant tracking form and the baseline data was collected from past financial records. 2b. N/A 2c. The performance used included: Process measure: Improve the grant selection and application process. Process measure: Increase the total number of six grants received in fiscal year 2010 by 30% by June 30, 2011. Outcome measure: Increase fiscal year 2010 grant funding totals of $42,469.84 by 30% by June 30, 2011. 2d. Results were analyzed by comparing the total number of grants received in fiscal year 2010 to the total number of grants received in fiscal year 2011. A percentage change in the number of grants was calculated. The total dollar amount of grant funding received in fiscal year 2010 was also compared to total grant funding received in fiscal year 2011. A percentage change in the total funding amount received was also calculated. 2e. Per the PDCA QI cycle the improvement theory created in this practice was adapted and standardized throughout FCHD.
Lessons learned from this practice include the importance of tracking all aspects of grant application including time spent on grants, number of grants applied for and reason(s), if any, for not applying. Utilizing the PDCA QI cycle for all internal problems was also a lesson learned from this practice. The root cause analyses and grant application flowchart that resulted from this practice showed that a process for seeking grants and deciding when to apply for grants is necessary. In addition, the creation of a grant toolkit with sample grant applications, CHA data, CHIP goals, Strategic Plan goals, budget information, staff resumes, sample letters of support, possible evidence-based interventions and possible evaluation methods was helpful in decreasing the barriers to writing grants. Lessons learned in relation to partner collaboration include the importance of involving staff from all internal department in grants applications and QI projects in general. Having staff from all departments better positioned this QI grant team to assess and apply for all possible grants. Having multiple staff assume responsibility for grant selection and application also more evenly distributed these miscellaneous, but extremely important job duties. Including steps for ensuring collaboration with external local public health system partners on grant applications and/or having formal mechanisms for referring grant application to external partners has the greatest benefit for the community as a whole and fosters relationship building. This practice is better than practices in the past that focus on sending a select one to two staff members to grant writing trainings. While these trainings are immensely beneficial they have not helped to align LHD grant applications with their agency strategic plan goals or their CHA or CHIP. Nor will trainings alone, without a process such as that defined by this practice, result in an increased number of grant applications or an increase in grant funding received. This practice helps to divide the workload involved in grant selection and application among not only LHD staff, but also local public health system partners. The practice also specifies suggested elements of grant toolkit that could easily be tailored in individual LHDs. The cost/benefit analysis conducted for this practice resulted in a 65.7% increase in grant funding within one fiscal year. There is definitely sufficient stakeholder commitment to sustain this practice. FCHD staff members have incorporated the duties in the provided grant application flowchart into their daily job functions. All grant applications and the receipt of grant awards are also reported to the management team and Board of Health. In addition, external community partners have come to rely to FCHD’s notification of grant opportunities and support in subsequent applications. Sustainability plans include continuous quality improvement. While the improvement theories from this practice have been thoroughly incorporated all aspects of the process are still being examined. In addition to the total number of grants received and the total amount of grant money received, the amount of time spent of grants and the ratio of awarded grants is now also being tracked. In addition, the reasons for choosing not to apply for grants is being examined for future QI initiatives.
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