San Francisco Breast Cancer Services Collaboration

Transcription

1 GrantSpace - Collaboration Hub San Francisco Breast Cancer Services Collaboration Participating Organizations Shanti, San Francisco, CA Project Open Hand, San Francisco, CA Primary Contact Name:Susannah Dunlap Title:Director of Development susannah.dunlap@bcef-sf.org Url: Please note that all data below was derived from the collaboration's nomination for the Collaboration Prize. None of the submitted data were independently verified for accuracy. Formation Type of Collaboration: An alliance or similar collaborative structure through which members retain structural autonomy and have defined roles and responsibilities to achieve specific social goals or purposes Geographic Scope: County Collaboration Focus Area: Human Services Population Served: Economically Disadvantaged Other Year Collaboration was Established: 2007 Goals Sought Through Collaboration: Achieve administrative efficiencies Address unmet and/or escalating community need Leverage complementary strengths and/or assets Reasons Prompting Collaboration: Funder initiated / mandated the collaboration Advancement of a shared goal Response to a community need Who Initiated Collaboration: Executive Director(s) / CEO(s) / President(s) Funder Number of Participating Organizations: 3-4 Nature of Funder Involvement: Suggested / encouraged the collaboration Were Partners Added or Dropped?: No

2 For nearly a decade, Shanti s LifeLines Breast Cancer Program (LifeLines), Breast Cancer Emergency Fund (BCEF) and Project Open Hand (POH) have held separate MOUs to improve collaborative services for low-income people battling breast cancer. LifeLines and BCEF developed an MOU in 2003; POH developed MOUs with LifeLines and BCEF in These initial MOUs established cross-referral relationships and confidentiality procedures regarding shared client information. In 2007, all three agencies, LifeLines, BCEF and POH ( Partners ) developed a formal collaboration at the suggestion of a common major funder, the San Francisco Bay Area Affiliate of the Susan G. Komen for the Cure. The goal was to create a collaboration that would simplify a low-income patient s path to accessing breast cancer services, eliminate duplication of services, maintain accurate multi-agency breast cancer data and leverage funding resources. The Partners were chosen based on their existing referral relationship and ability to build a comprehensive continuum of care for breast cancer support services. Each of the Partners is a breast cancer agency founded by established HIV/AIDS organizations that already had a shared legacy of MOUs. Our access to over three decades of experience providing care to a disease-focused, undeserved community has been invaluable. This common denominator unites the Partners in a collaboration that is committed to a long-term service model and sustainability. Breast Cancer Emergency Fund (BCEF) responds quickly and compassionately to provide emergency financial assistance to low-income women and men of San Francisco and San Mateo County who are in active treatment for breast cancer, in order to cover basic human needs, lessen financial burdens, and improve quality of life. Project Open Hand (POH) meeting community nutrition needs through programs for people living with HIV/AIDS, breast cancer, the homebound/critically ill, and seniors. Shanti s LifeLines Breast Cancer Program (LifeLines) provides culturally competent human services, transportation and emotional support to San Franciscans diagnosed with breast cancer, to ensure that each individual has access to medical care, can maintain treatment regimens and enjoy an improved quality of life with better health outcomes. Over the last couple of years, our collaborative efforts have continued to deepen, leading to additional projects between the Partners. In 2009, the Partners furthered collaboration efforts by developing and implementing a shared Universal Letter of Diagnosis (ULD). This new protocol streamlined eligibility guidelines and expedited patient applications to each program by at least 25%. Subsequently, the Partners have successfully leveraged each other s complementary strengths, reduced barriers to support services, and improved health outcomes for low-income breast cancer patients. Each Partner agency tracks detailed patient data for approximately 350 unduplicated clients annually. On average, the Partners share 75% of their respective client populations. If one agency is missing critical information for a patient or needs additional assistance in order to make services available to a client, the likelihood is high that one of the other two agencies can step in to help bridge the gap immediately. It also represents a checks-and-balances mechanism wherein each agency can review their respective data against the other two agencies to monitor for any major data variances. The administrative efficiencies that this collaboration has brought about have allowed each program to serve more clients in a timely manner, ultimately leading to improved programmatic outcomes. Less time is spent by the Partners staff and clients in intake and renewal processing. The Partner agencies benefit daily from leveraging each other s complementary strengths. The result is a comprehensive safety net that keeps a client in the continuum of care. Management Management Structure: Management team / oversight committee with representatives from each partner Each agency maintains its own separate and distinct management structure. The collaboration is based on an equally shared committee process with program managers from each agency overseeing collaborative project development and implementation. Direct service staffs maintain weekly communication and have the dynamic ability to adjust to one another s program criteria for the benefit of shared patients. Challenges Challenges to Making the Collaboration Work: Addressing lack of staff or allocation of staff resources Clarifying partner roles Coordination / integration of programs & services Our biggest challenge has been maintaining our support services during California s economic crisis. Traditional private funding sources have been redirected to help fill the gap of public health funding. The strength in our partnership is that each of us maintains steady funding. Should one of us reduce or close services, our ability to provide a comprehensive continuum would be negatively affected. Our solution is to begin to pursue collaborative grants in addition to individual program grants so that we can maintain our network. Impact

3 Internal Efficiencies and Effectiveness: Greater ability to allocate resources to areas of need - Greater ability for each partner to focus on core competency Greater ability for each partner to focus on core competency - Greater ability to allocate resources to areas of need Enhanced ability to manage reporting, documentation, billing - Enhanced ability to manage reporting, documentation, billing Community Impact: Increase in number of clients / individuals / organizations served Greater coordination of services (less overlap, duplication, fragmentation) One best measurement for our outcomes has been our ability to absorb a tremendous growth in the client requests for services without denying a qualified applicant or creating a wait list. Over the past two years, LifeLines has absorbed a 55% increase in unduplicated clients while BCEF has absorbed a 70% increase and added a second county service area. POH has maintained their client population but has done so while absorbing a 40% reduction in the Breast Cancer Services Coordinator position, while not reducing the quality and quantity of services. The collaboration has also enhanced relationships across Partner staffs and led to greater fluency in each program s services resulting in increased in community awareness. Model Our breast cancer support service continuum of care is a model which can be replicated and would benefit many communities. Breast cancer services are often disjointed and disconnected from one another. The time between initial diagnosis and the beginning of intense medical care is often a matter of days, especially for patients diagnosed with later stage breast cancer. Being able to respond quickly and efficiently to the individual needs of our clients is crucial. The individual services of each agency are immediately enhanced by the groundwork of our collaboration. Patients, medical providers and social workers know that when a referral is made to one Partner, at minimum, that patient will be given comprehensive support by all three. This collaboration model is ideal for small community agencies that share a common client population. Often times, more formal mergers of institutions/programs lead to a dominant culture and mission prevailing over the other and most importantly, a falling off of community support. Instead, our collaboration allows each agency to maintain their own distinct identities with the added flexibility of leveraging our Partners strengths and resources to achieve a greater outcome. Our model is uncomplicated, sustainable and easily replicated in any community. Efficiencies Achieved Our three-way collaboration has two distinct types of economic and operating efficiencies: (1) those inherent in each partner-program s relationship to its parent agency, and (2) those resulting from the combined service delivery of the partners. 1) All three partners were launched from and continue to be housed within separately well-established HIV/AIDS service providers. Independently, each partner program has significantly benefited from systemic economic and operating efficiencies inherited by the exemplary legacies and existing organizational structures of their partner agencies. In addition, a long history of collaboration between the parent-agencies (focused on HIV/AIDS) has served to expedite, encourage and support partner collaboration between our breast cancer programs. Without these shared common bonds, the collaboration might not have formed as early as it did and might not be as efficient and impactful as it is today. a. There is a history of trust and collaboration among HIV/AIDS community-based service agencies in the Bay Area. Our partner collaboration is an example of this disease-specific community-based collaborative model successfully tailored to the breast cancer community. i. The Community-based model of service delivery for people with HIV/AIDS in San Francisco is unique in public health history world-wide. Prior to HIV/AIDS, no other community has ever rallied its resources to produce a network of inter-related disease-specific agencies that met the medical, social, financial, emotional, spiritual and practical needs of an afflicted population. Our collaboration is replicating that acclaimed and revolutionary public health model to the most common cancer and second leading cause of cancer death in women: breast cancer. Our collaborative mantra is every door is the right door, meaning that a client in need can enter service at any one agency and be instantly referred to all other necessary services. This may seem remarkably simple, but it is unique. Other disease-specific agencies operating in the same geographic area nearly always see each other as competing for funds, visibility and clients. A positive

4 example of this trust: the three collaborating partners share one intake form, a simple process that reduces the time and resources needed for clients to access services, reduces the client s stress and confusion and reduces the need for duplicative intake workers. Most importantly, sick clients do not have to travel to multiple service locations. b. Equally key to the successful outcomes that our collaboration has achieved has been the access to economies of scale of our respective parent agencies financial strength, operational size and specialized knowledge base. i. It would not be a sustainably viable option for the three agencies to break away from their respective parent to form a newly merged entity nor would it work if the partners broke away to form three smaller stand-alone entities. The breast cancer collaboration is only cost effective because the unique resources that each partner is able to secure from its parent entity. Delivery of nutritional meals and groceries from Project Open Hand (POH) to women with breast cancer is only cost effective because of POH s massive investment in kitchen facilities and delivery vehicles for its larger meals program for people with HIV/AIDs. Likewise, AIDS Emergency Fund (AEF) processes 9,500 financial assistance payments to third parties annually, and maintains sophisticated anti-fraud procedures with the unique ability to verify doctors signatures and rightful landlords - -processes that the BCEF could never afford on its own. Shanti s award-winning practical and emotional support training gives the LifeLines program access to 36 years of client expertise, training that the staff of the LifeLines could not obtain without the unique relationship to the larger Shanti organization. ii. Each new entity would need the financial resources to compensate an executive director, disease-specific development staffs and financial management services. Even if each of the three new smaller agencies had the resources to provide for the full cost of these overhead services, its administrative costs would dwarf its program costs making it unlikely to garner continued funding from sophisticated foundations and corporations that would find its proportion of revenue used on fundraising and administration costs to be unacceptable. c. In addition, our current collaborative structure allows each partner access to the wider variety of donors attracted to and cultivated by the parent agency along with the natural diversity of fundraising events that provide additional revenue. i. To illustrate this point, POH positions itself as a safety-net service and appeals to donors who value direct services such as homeless shelters. These donors, who may also be attracted to POH s breast cancer program, are different from AEF and BCEF s donor base who respond to their message of social justice and economic empowerment, and also different from the donors that support Shanti s model of compassionate peer support and patient advocacy. ii. The three partners also have several major donors in common. The Komen Foundation and Avon, for example, fund at least two of the three partners, often with funding awarded at their most generous level. If the partners were to merge, the new entity would be eligible for only one grant, which would be smaller than the current combined totals. Likewise, if the partners were independent of their larger agencies and applying to these same foundations as smaller entities, their smaller budget sizes may preclude large gifts. 2) As mentioned above, there are also additional economic and operating efficiencies that stem from the actual day-to-day workings of the collaboration. a. With the current collaborative structure, BCEF and POH are able to rely on LifeLines to process and enroll new client applications affording both BCEF and POH the savings to maintain smaller client-intake staffs. Likewise, clients do not need to travel to BCEF or POH to be enrolled in their programs affording clients saved energy and time while battling a disabling illness. b. Additional efficiencies are also achieved when the partners rely on each other to be the experts in their respective areas of core competency, often reducing the need of any partner to contract out for specific services or develop costly in-house expertise. c. Lastly, there is a strategic advantage over other breast cancer agencies when competing for charitable funds. The wrap-around nature of the service delivery is extraordinarily appealing to some funders, who are often exasperated by competition and lack of collaboration among their grantees. Evolution

5 We believe that we addressed the first portion of this question in our initial application and in Question 1. Why should this collaboration win The Collaboration Prize? We believe that our collaboration should win the Collaboration Prize because we have successfully developed and nurtured a sustainable community-based collaborative model that is responsive to our community s needs and does not require complicated or capital intensive organizational mergers. Together, as partners we truly have created a viable safety net for our clients, some of San Francisco s most vulnerable, to lessen barriers to care, cover basic human needs and improve quality of life. In fact, our collaboration was featured in The San Francisco Examiner s October 2010 Special Breast Cancer insert as a ground-breaking service model. Underserved individuals diagnosed with breast cancer living anywhere in the country could greatly benefit from our comprehensive and efficient service model. These funds would enable us to continue our collaboration and also codify our model for replication, a powerful legacy initiated by this Collaboration Prize. Our model is the best intersection of the key variables to success: each player has retained the independence and core competency needed to expertly deliver its particular service, while eliminating overlapping expenses, allowing others in the partnership to take on only those tasks for which they are best suited. The winners in our collaboration are our clients who are newly diagnosed with breast cancer: they are seamlessly provided with expert case management, practical and emotional support, fast and responsive emergency financial assistance, and nutritionally appropriate meals and groceries -- all with one initial appointment. Our collaboration also represents the successful transference to the breast cancer community of 30 years of HIV/AIDS experience in building a successful community response to illness. Cooperation and collaboration among community-based HIV/AIDS organizations was the hallmark of the San Francisco AIDS model in the late 1980s and the 1990s. Its client-centered service delivery system revolutionized care for the terminally ill, and, over time, helped lift the death sentence for people with HIV. We can do the same for breast cancer! Copyright 2016 Foundation Center. All Rights Reserved.