We Have a Grant. Now What?

Applying for a grant is a time-consuming, challenging endeavor. So when hospital executives hear that their facility has been awarded a grant, many believe they have cleared the biggest hurdle. But the bulk of the work is just beginning, says Brian Dixon, MPA, health IT manager with the Regenstrief Institute Inc. in Indianapolis. Hospital executives will need to manage the project and monitor the grant, including regular project updates, detailed reports and possibly even site visits from the funding agencies. Having clear expectations of the process and designated staff members to oversee the project can help executives keep the process running smoothly.

Don’t panic

Two years into an electronic health record project, four of the six participating critical-access hospitals were on track to implement the EHR, but things looked grim at the other two facilities, Dixon says. “They called the funding agency in a panic saying, ‘Do we have to give the money back?’” The granting agency didn’t demand the money back; instead, the agency worked out an arrangement to document the reasons the two hospitals couldn’t go live and explain the barriers to implementation. “The biggest message that I would give folks—especially if this is the first time that they have had a grant—is don’t panic,” Dixon says.

Establish accountability

If the chief executive officer or chief financial officer is the lead project director, designating a project manager may help keep things on track. Establishing accountability for specific reporting elements is also important, says Susan Bryant, the senior director of community relations at New London (NH) Hospital, which received a USDA rural utilities loan grant (part of the telecommunication distance-learning program) in 2005 for approximately $2 million.

Plan for stricter reporting

Reporting requirements vary depending on the funding source—federal, state or private—and they often require quarterly, semi-annual or annual progress reports, says Heather Reed, administrator of the rural health section at the Ohio Department of Health. Her advice is to “assume you will need to spend more time than perhaps you think doing grant monitoring.”

Keep detailed records

With its USDA loan/grant, New London plans to convert its entire health information system to a single integrated EHR that includes hospital, outpatient, school-based health clinics, physician practices and nursing home facilities. The 25-bed critical-access hospital established an oversight committee comprised of the CFO, chief clinical officer, senior director of projects and planning, and clinical leadership that meets every two weeks to discuss concerns and report on benchmarks, says Bryant. Her advice: Keep track of the progress on a grid and update it every three months.

Communicate with all stakeholders

Tehachapi (CA) Valley Healthcare District plans to use its $1.5 million health information technology grant from the Agency for Healthcare Research and Quality to create a communitywide EHR to improve quality and chronic disease management in the region, says Jami Young, the hospital’s assistant administrator and AHRQ grant project coordinator. With so many stakeholders involved, the 24-bed critical-access hospital established multiple committees to help manage the project, including a provider leadership team of hospital executives, physicians and nurses that acts as a steering committee.

Plan for delays

For Tehachapi, the most time-consuming part of the grant was assessing the vendors, says Young. Most projects experience delays, says Dixon, which may require the project to extend beyond the original grant period. “This is called a ‘no-cost extension.’ It is very common, and folks can use it to delay the final report—due usually 90 days after the grant officially ends,” he says.

Make resources count

Don’t be afraid of the project officer who is assigned to you by the funding agency, says Dixon. “The PO has a vested interest in helping you through crises and providing advice as you wade through the reports and dissemination.” Bryant agrees. “I am a big proponent of picking up the phone and calling a funder. It doesn’t make sense to worry about it when you can pick up the phone and talk to somebody.”

Don’t forget to ‘market’ your project

Sustainability and replicability are important to funders, so “take the time to market a bit and share your successes with these grant projects,” says Reed. Dissemination is important, agrees Dixon, adding that funders want to see you publish in academic and nonacademic venues. “Often the funding agency has an office of communications to help you market your outcomes and successes. It would be good to have your marketing department interface with this group early on to establish a good working relationship,” he says.

—Carrie Vaughan