Making Change Karin Hohman R.N., MBA Strategic Health Concepts Stick

 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 Overview

“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” The problem… Smedley and Syme, 2000

…forces conspiring against change WorksitesSchoolsMediaHealth Care Restaurants and Shops Communities

Can we change policies, systems, and the environment to support healthy choices? WorksitesSchoolsMediaHealth Care Restaurants and Shops Communities

 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 Policies, systems and the environment around us

 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 Strengths of policy, system and environmental changes

PSE Change Establish a safe community use fishing pond In other words….

PSE simplified PUT UP a BARRIER to make something harder to do REMOVE a BARRIER to make something easier to do OR

 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 PUT UP 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 Ways to REMOVE a barrier

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

 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 Where do PSE change approaches work best?

The most effective approach is a comprehensive approach CommunityWorksitesSchoolsMediaHealth Care Restaurants and Shops Government

CommunityWorksitesSchoolsMediaHealth Care Restaurants and Shops Government Reduce tobacco use = a comprehensive approach

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 CommunityWorksitesSchoolsMediaHealth Care Restaurants and Shops

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 AppropriateAccessibleAvailableAcceptableAffordable

System Change –  Change hours of service, offer screening in other settings, offer transportation and child care, simplify paperwork Make screening more convenient

Policy change  Reduce costs through a variety of approaches: increase awareness of benefits, issue vouchers, increase employee benefits Reduce costs for screening

System Changes  Patient Reminders  Provider Reminders Use reminder systems

System Change  1 on 1 support to help navigate the patient through their cancer treatment process Provide patient navigation

Policy Change  Advocate for insurance coverage for clinical trials Increase access to treatment

Systems change –  Increase the number of physicians and nurses who are board certified in palliative care Assure palliative care services

System and policy changes  Increase the number cancer centers that work with patients to develop survivorship care plans Support cancer survivors

 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 Keys to PSE success

PSE approaches in the Iowa Cancer Plan

Examples of PSE approaches in the Iowa Cancer Plan

 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 Examples of CCC PSE efforts

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

 Convener  Communicator  Guide  Educator  Planner  Supporter Who does what? Partnership Roles

 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? Ask yourself…

 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 Keys to PSE success

Thank you Karin Hohman Strategic Health Concepts