Download (PSE) Change Approaches - Iowa Cancer Consortium

Making Change
Karin Hohman R.N., MBA
Strategic Health Concepts
Overview
 What is Policy, System, and Environmental change
(aka = PSE)
 What works in cancer control PSE approaches
 Ways to work together to make PSE changes stick
The problem…
“It is unreasonable to expect that
people will change their behavior easily
when so many forces in the social,
cultural, and physical environment
conspire against such change”
Smedley and Syme, 2000
…forces conspiring against change
Worksites
Communities
Schools
Restaurants
and Shops
Media
Health Care
Can we change policies, systems, and
the environment to support healthy
choices?
Worksites
Communities
Schools
Restaurants
and Shops
Media
Health Care
Policies, systems and the
environment around us
 Policies - rules that encourage or discourage
certain behavior
 System changes – changes in how things are
done in an organization or setting
 Environmental changes – changes in places
we work, play, shop, go to school
Strengths of policy, system and
environmental changes
 Effort is ongoing – not episodic with a start
and end
 Supports a population behavior change – not
a 1:1 approach
 Usually lower in cost with a high impact
 Change is built to last– it sticks
In other words….
Establish a safe
community use
fishing pond
PSE Change
PSE simplified
PUT UP a BARRIER to
make something harder
to do
OR
REMOVE a BARRIER to
make something easier
to do
Ways to PUT UP a barrier
 Increase the tobacco tax
 Create a policy that pop or candy is not
available for purchase in schools
 Restrict ages that can utilize tanning beds
 Create a system where you must record
cancer screening test history in an electronic
medical record
Ways to REMOVE a barrier
 Employers offer reduced gym memberships
 Establish a community farmers market for
fresh produce
 Institute a patient navigation program
 Set up a physician office reminder system
How is PSE different?
Events
Policy, Systems and
Environmental Change
Display posters during National
Nutrition Month
Add more / different fruits & vegetables to
cafeteria choices
Open the school gym during a
community fair
Develop a shared use agreement with the
school
Promote “Bike to Work” Day
Provide secure bike parking areas and
showers
Provide a healthy lunch at a
work meeting
Adopt a healthy food meeting policy
Sponsor a screening fair at work
Allow time off every year for employees to
get screened
Adapted from ‘Understanding Policy, Systems, and
Environmental Change to Improve Health’.
Presentation by Brooke Ahlquist, MA, MPH
Where do PSE change approaches
work best?
 The full continuum of cancer…Prevention,
Early Detection, Diagnosis and Treatment,
Quality of Life, Survivorship to End of Life
 Pretty much any setting…schools, work,
communities, home, businesses, health care
clinics, hospitals
The most effective approach is
a comprehensive approach
Community
Government
Worksites
Restaurants
and Shops
Schools
Health Care
Media
Reduce tobacco use =
a comprehensive approach
Community
Government
Worksites
Restaurants
and Shops
Schools
Health Care
Media
Reduce tobacco use initiation and
current use
Policy Change –
 Raise the cost
of tobacco by
10% and
adolescent
tobacco use
drops by 3.7 %
Reduce exposure to
second hand smoke
Policy Change
 Restrict by law where
people can smoke and
voluntary restrictions
in places such as cars
and homes
Decrease obesity rates =
a comprehensive approach
Community
Restaurants
and Shops
Worksites
Health Care
Schools
Media
Promote and increase access to
active transportation
Environmental Change
 Encourage and enable
biking/walking to a
destination
Increase access and availability of
healthy foods and beverages
Environmental Change
 Make it easier at
work, school and
events to get healthy
foods and beverages
 And harder to get less
healthy options
Increase use of food from local
farms
Environmental Change
 Support local farmers
by promoting fresh,
local foods
Increase access to physical
activity opportunities
Environmental Change
 Develop, clean up and
promote trails, fitness
centers, community
centers, and playgrounds
Increase cancer screening rates =
a comprehensive approach
Appropriate
Affordable
Acceptable
Accessible
Available
Make screening more convenient
System Change –
 Change hours of
service, offer
screening in other
settings, offer
transportation and
child care, simplify
paperwork
Reduce costs for screening
Policy change
 Reduce costs through a
variety of approaches:
increase awareness of
benefits, issue vouchers,
increase employee
benefits
Use reminder systems
System Changes
 Patient Reminders
 Provider Reminders
Provide patient navigation
System Change
 1 on 1 support to help
navigate the patient
through their cancer
treatment process
Increase access to treatment
Policy Change
 Advocate for insurance coverage for clinical trials
Assure palliative care services
Systems change –
 Increase the number of physicians and nurses
who are board certified in palliative care
Support cancer survivors
System and policy changes
 Increase the number cancer
centers that work with
patients to develop
survivorship care plans
Keys to PSE success




Start with what works and build on that
Make one change, even if it is small
Get the right people at the table
Look for “win-win” opportunities
e
ms
Workforce
The Iowa Cancer Plan addresses cancer workforce needs.
PSE approaches in the
Iowa
Cancer
trained, and there must
be enough
of them inPlan
every area of the state to ensure a
receive access to the quality services and care they need.
Policy and Systems
The Iowa Cancer Plan promotes advocacy for policy and systems change.
According to the Centers for Disease Control and Prevention, “The policies, syste
environments around us, including our communities, worksites, transportation s
schools, faith-based organizations, and health-care settings shape the pattern o
and our health.”8 It is necessary for change and partnerships to occur at these fo
levels to make optimal cancer prevention, screening, treatment, and quality-of-l
nities accessible to all Iowans.
Examples of PSE approaches in the
Iowa Cancer Plan
Examples of CCC PSE efforts
 Illinois- working with FQHC’s and colorectal cancer
to assure systematic screening
 Michigan – policy scan; what services health care
systems are providing cancer patients have
available to them. Looking for gaps
 Montana – working with worksites to increase
cancer screening – starting with finding the win-win
opportunity
Partnerships are key to success
in PSE efforts
Partnerships…finding the ‘Sweet Spot’
The “Sweet Spot”…
the Iowa Cancer Consortium
 No one organization can do this alone
 Multiple organizations provide credibility and
importance to the cancer plan
 Increases likelihood of success due to widespread
support
 Leverages partner strengths and relationships
 Brings together a range of expertise and resources
 If one partner goes away, the effort doesn’t stop
Who does what?
Partnership Roles






Convener
Communicator
Guide
Educator
Planner
Supporter
Ask yourself…
 What role do you see your organization (or
you) playing in the following scenarios?
 An effort to increase Iowa’s tobacco tax?
 Establishing a patient reminder system?
 A policy to assure survivorship care plans?
Keys to PSE success




Start with what works and build on that
Make one change, even if it is small
Get the right people at the table
Look for “win-win” opportunities
Thank you
Karin Hohman
Strategic Health Concepts
303-906-9336
[email protected]