Business and Operational Plan Examples

Transcription

1 Business and Operational Plan Examples

2 Business and Operational Plan Examples * Guide to Business and Operational Plan Development Page # A. Introduction 3 A1) Introduction and Instructions 3 Page 2 Guide* Reference B. Executive Summary 5 C. Business Plan 7 C1) Governance C2) Vision, Mission and Strategic Objectives C3) Population Characteristics, Health Data and Access to Care C4) General Information and List of Programs and Services C5) Summary of Business Plan Timelines C6) Financial Forecast D. Operational Plan 29 D1) Core, Optional, and Special Services/Programs /5.1.3 D2) Human Resources and Recruitment Plan D3) Collaborative Team Practice D4) Physical Site Preparation D5) Information Technology and Electronic Medical Records D6) Extended Hours/ Telephone Health Advisory Service D7) Other Programs D8) Evaluation D9) Consolidated Timelines D10) Annual Resource Requirements/Budget E. Quick Reference Sheet 54 App. C F. Appendices 55 Appendix A Job Descriptions 55 Appendix B Location details - quotations, estimates for renovations etc. Appendix C Transitional One-Time Cost Details 62 Appendix D Timelines 63 Appendix E Financial Forecast/Budget 68 G. Acknowledgments 77 H. Where to Get More Information 78 61

3 Page 3 A. Introduction A1) Introduction and Instructions Purpose This template accompanies the Guide to Business and Operational Plan Development and is meant to assist you in developing your Business and Operational Plan. It comprises two sections: the Business Plan and the Operational Plan. These examples have been drawn from actual plans that have been submitted to the Ministry for review and are being provided here with the permission of the authors after having been changed to remove identifying information. The Ministry is appreciative for these Teams sharing their plans to assist others in moving forward with their own. Background The Business Plan provides a multi-year overview of Family Health Team planning and resource requirements. It should set out elements such as the governing structure, vision, mission, population characteristics, and an overview of programs and resources. The Operational Plan is completed on an annual basis (by fiscal year) for each of the 5 fiscal years and provides detail on the major activities for implementing each year of the Business Plan. Every Family Health Team's plan will be different and should reflect the population needs, the availability of health human resources and the local availability of other complementary health and social services. The samples have been chosen to try to illustrate how plans will differ based upon governance, size, and community and population needs. These samples are a compilation of a variety of plans for each of the sections of the Business and Operating Plans and should not be read as a whole but rather as examples of good practice for each of the sections. Layout of Template/Instructions Each section provides a reference to the relevant guides available on the ministry website 1 and a summary of requirements. All guides referenced in the Template are hyperlinked 2 to the Guides themselves on the ministry website. The front page of the Business Plan Template is also hyperlinked to the corresponding section in the Template itself. Most sections also include either a sample response, a sample template, or a sample of the type of issues to be addressed in each section. Please note that all examples may not be relevant to your submission. 1 For Family Health Team guides visit 2 A hyperlink or simply a link, is a segment of text that serves as a reference between parts of a document, to another document, or to a website. To follow the link, simply place your cursor on the blue underlined text, hold Ctrl, and left click.

4 Page 4 The Business Plan and Operational Plan Cycle 9. What criteria should we use to evaluate and determine if we have achieved our objectives? 8. What are the major challenges to success and how can they be managed? 1. Where are we now? Operational Plans: 7. What resources are required? 2. What are our goals? Business Plan: Rationale for Proposed Family Health Team Services Transition Period Plan for Implementing Family Health Team Services 6. How long will it take and what are the key milestones in getting there? 3. What is our rationale/justification for them? 4. What are the different avenues to get there? 5. What is the best avenue and what will it involve?

5 Page 5 B. Executive Summary REQUIREMENTS: Please provide an executive summary of your submission. SAMPLE RESPONSE Background/Executive Summary The XYZ Family Health Team is a group of 7 family physicians, together with a broad range of interdisciplinary health providers, who will offer comprehensive primary care to the citizens of Appleville and the surrounding area. The group is committed to: patient-centred care; creating a teaching and learning environment for patients and for health care providers; practicing medicine in an economic and ecologically sustainable environment; a focus on wellness, prevention, and effective management of chronic disease/conditions; efficient and effective use of a broad range of allied health professionals and existing community resources; seamless systems for patient access and referral. The Group s Mission Statement is: to provide exemplary interdisciplinary patient care and excellence in clinical teaching in a sustainable healthy environment. This Family Health Team will offer service to approximately 10,000 patients from Appleville and from the townships of O, P, and Q. Over a 5-year period, the patient load will double, providing new access to residents of the region who currently do not have a family physician. Most of the practice associated with this Family Health Team will be located in SITE 1 beginning in June There are plans to secure an additional SITE 2 for an additional five family physicians by 2007/2008. Patients will be persons from all demographic categories. The SITE 1 and 2 offices are urban sites, while the Site 3 office is a rural site. In addition to the provision of primary care, the XYZ Family Health Team will focus on education; a significant focus of the Team will be on providing patient education in a variety of formats, including one-on-one consultations and educational/teaching sessions aimed at illness prevention, wellness, and management of chronic conditions. Targeted programs will focus on Diabetes, Asthma, Osteoporosis, Smoking-related cancer, and Cardio-Vascular illness. The Family Health Team will be results-oriented, and will practice a model of ongoing learning and evidence-based medicine. The physicians and interdisciplinary providers will work together to maximize the effectiveness of the interdisciplinary team. Nurses and nurse practitioners will be the cornerstone of the team. The roles they play and the services they provide will fully utilize their knowledge and skills; their duties will go beyond the duties of the typical practice nurse. The effective use of all of the team members will improve patient satisfaction, improve

6 Page 6 health status, and create capacity for the Team to provide service to residents of Appleville who currently lack access to primary health care. The use of information technology (IT) is paramount to the successful recording of patient encounters and medical records and as a research and communication tool for all of the medical professionals in the Team. Timely access to the patient s medical and demographic information will be another vital component that will contribute to the successful integration of the team. In total, we are proposing a first year budget of $XXX, the allocation of which consists of 80% for medical resources (representing XX FTE positions) and 20% in overhead costs. The first year budget contains over $XXX in capital expenses primarily for the renovations required at Site 1 and for information technology requirements. This Family Health Team will also provide leadership in continuing medical education and teaching opportunities for physicians.

7 Page 7 C. Business Plan The Business Plan provides a multi-year overview of Family Health Team planning and resource requirements. It should set out elements such as the governing structure, vision, mission, population characteristics, and an overview of programs, and human resources. C1) Governance Please refer to the Guide to Business and Operational Plan Development, section and the Guide to Governance & Accountability to help you complete this section. REQUIREMENTS: Please provide: o Your Family Health Team name and contact information. The Ministry requires that the name includes Family Health Team ; o The name of legal entity that will receive and be accountable for funding; o The name of Authorized signing officer; o The Bank Account details for funds: name of bank, bank account number, branch address, account holder name; Briefly describe the governance and accountability mechanisms in your Family Health Team, including: o Current governance model (e.g. FHN, none), and legal arrangement. o The new governance model (e.g. community, provider, mixed) your Family Health Team will espouse and a list of the providers and/or community groups who are joining your Team. o The new legal arrangement (not-for-profit, partnership, etc.). Based on SAMPLE the RESPONSE options in the Guide to Governance and Accountability, describe the legal arrangement of your Team. SAMPLE RESPONSE Name of Family Health Team Contact Information Lead Physician s Name and Mailing Address ABC Family Health Team Tel: Dr. Martha French 123 Street Ave. Fax: City, ON A1A 2B2 name@ .ca Current Governance Structure Proposed Governance Structure Participants Provider-based Mixed XYZ FHN, ABC Hospital Current Legal Arrangement Professional Corporation Proposed Legal Arrangement Partnership

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9 Page 9 SAMPLE RESPONSE 1.1 MODEL OF GOVERNANCE XYZ Family Health Team will be a provider-based Family Health Team. Physicians are sole providers working under an informal non-incorporated group of Association, called the XYZ Family Practice. The XYZ Family Practice receives funding under a RNPGA Contract with the Ministry of Health for six (6) FTE Physicians. There are nine (9) physicians in the group of Association, who share the funding for six (6) physicians. A full-time business administrator reports directly to all the physicians. All Family Health Team healthcare professionals will provide input to the facilitation and administration of programs and services provided by the Family Health Team by participating on committees, which may include physician, administration and community representation. 1.2 SPONSORING ORGANIZATION The name of the sponsoring organization that will receive and is accountable for funding is the XYZ Family Practice. The XYZ Family Practice will receive the funding for the XYZ Family Health Team, and will set up a separate accounts ledger for this funding on their financial books. This will be the same bank account that is being used for RNPGA funding to the group. 1.3 NAME OF ASSOCIATION The name of the organized Association will be XYZ Family Health Team (XYZ FHT). Contact Information: XYZ Family Health Team 14 Street, PO Box # 123 XYZ, Ontario A0B 2B1 P: (123) F: (123) Att: M. Tremblay, Clinic Administrator mtremblay@ .on.ca

10 Page 10 MINISTRY OF HEALTH XYZ FAMILY HEALTH TEAM BOARD Decisions are Consensus Based! Direction & Accountability Implement Business Plan! XYZ FHT PROVIDERS Physicians Social Worker Nurse Practitioner Registered Nurse Registered Dietician Visiting Cardiologist Decisions are Consensus Based! FAMILY HEALTH TEAM ADMINISTRATOR Governance & Administration Finance Human Resource Management I.T. & Communication Structure, Space & Design XYZ FHT Executive Assistant Note: Meeting & Committee Structure XYZ FHT ADMINISTRATIVE AND SUPPORT STAFF Monthly Meetings: Committees for Program Development: Committees for Logistics & Infrastructure: All XYZ FHT Providers Group Meeting Board of Governors & XYZ FHT Administrator Mental Health Program Committee Structure & Space Finance I.T. & Communication

11 Page 11 C2) Vision, Mission and Strategic Objectives Please refer to the Guide to Business and Operational Plan Development, section 4.1.2, and to the Guide to Strategic and Program Planning. It is recommended that you use the Strategic Planning Template for Family Health Teams (Guide to Strategic and Program Planning, p.9) to assist you in completing this section. REQUIREMENTS: In this section, please address the following questions and ensure that information requested in the Guide s Strategic Planning Template for Family Health Teams is provided. Vision Statement: o Describe the long-term goal of your FHT o Develop a vision statement which should reflect your commitment to improving the health of individuals in your community Mission Statement: o Outline the purpose of your organization to reflect your commitment to improving the health of individuals in your community o Highlight the services your FHT will provide to achieve its vision such as accessibility, comprehensive care, health promotion and chronic disease management programs Strategic Objectives o Develop objectives that are measurable and meaningful. These objectives should concentrate on major responsibilities, be patient-centered, and focused on outcomes, such as impact, quality, patient satisfaction, timelines and efficiency Strategies o Develop strategies and will contribute to achieving the objectives your team has set out. A number of strategies may be proposed some may already exist in the community, others may need to be developed to address gaps in health services. Each Family Health Team will need to prioritize and link to existing programs where appropriate, to achieve its objectives, coordinate services, and reduce gaps and duplication of services

12 Page 12 SAMPLE RESPONSE Vision, Mission & Values The following vision, mission and value statements have been developed to guide the work of the ABC & Area Family Health Team: VISION A patient centered primary health care system, which provides model collaborative health care, successful in improving the health of our community MISSION Maintain and improve the health of the people it serves, by providing increased and timely access to primary health care VALUES As an organization: We value and are committed to delivering Patient-Centred Health Care We are committed to ensuring Quality Care for all patients We will strive to provide patients with Timely Access to care We value and respect the Rights and Needs of each Patient We are committed to ensuring a Balanced Work/Lifestyle for all participating members of the FHT We value Collaboration amongst all stakeholders within the Family Health Team We value and promote continuous Learning We are committed to individual and organizational Accountability We will maintain and uphold Ethical practices Patient-Centred Practice Model In serving the population of the catchment area the Family Health Team is proposing to implement a patient-centered service delivery model. Within this approach, all services will be planned, coordinated and delivered based on the needs of the patient. The patient/consumer will guide the scope and range of services to be delivered, and service delivery will be flexible to respond to the changing needs of the patient population. Strategic Objectives The Strategic Objectives outlined in the following table provide the framework to guide the future delivery of primary health care services by the ABC & Area Family Health Team. This team will be focused on shifting the emphasis from treatment to prevention of illness, injury and disease, reducing hospital admissions and supporting patients to more effectively manage chronic disease conditions.

13 Page 13 STRATEGIC OBJECTIVES 1. To Develop a Comprehensive Interdisciplinary & Patient- Centred Primary Health Care Team 2. To Provide Patients with Timely Access & Effective Coordination of Services 3. To Provide Quality Health Promotion and Prevention Services to Reduce Injury and Disease. * Primary Prevention (*Preventing disease & injury from developing In the first place ) 4. To provide Enhanced Screening and Early Identification of Disease. *Secondary Prevention (*Screening for possible existing disease processes) 5. To Provide Effective Treatment & Enhance Strategies for Managing Chronic Diseases. *Tertiary Prevention (*Preventing further disease and complications of existing conditions + Treatment of existing disease) Interdisciplinary team of doctors, nurses, nurse practitioners and other healthcare professionals working together with Patient a member of the team Expanded access to care through the Telephone Health Advisory Service (THAS) and 24/7 availability of MDs Knowledge dissemination as keystone of improved health status Evidence-based programs and practices, CQI, Risk Management & Accountability practices in use in all programs & services Enabling patients to have timely access services such as acute care, longterm care, public health, mental health and addictions programs and professionals, and increased access to new and existing community programs and services Organized efficient patient-friendly approach to case management Essential Components of Programming & Service Delivery Prevention of disease and injury integrated and emphasized in all FHT strategies Health Promotion programs designed to enable patients to prevent illness, disease and injury, Provide health education & support programs not currently available in the system, empowering the patient & positively impacting individual, family and population health Target Diseases/ Injuries/High risk conditions: Smoking-related Cancers, heart & respiratory disease Injuries: Falls & other accidents/mvcs/ Poisonings Suicide Drowning Substance abuse Infection Teen Pregnancy Hypertension Others based on need Early detection & diagnosis through increased access to diagnostic services such as PACs-accessible X-ray, ultrasound, Bone Density Studies, Cardiac Screening & Peripheral Venous Studies, breast and prostate screening, Laboratory studies Target Diseases: Cardio-vascular Breast /Lung /Prostate/Colon Cancer Diabetes Osteoporosis Others based on need Provide evidence-based program approach to patient s needs re disease management. All health care providers working from common patient-centered goals/common health record/ongoing communication re progress & needed revision to care approach Provide self care & education programs Provide or enable access to minor surgical procedures through ABC FHT professionals or Visiting Specialist program Ensure patients have timely access to major surgery an other services outside community when required Expand & Enhance End Of Life care services and support Target Diseases: Cardio-vascular illness: CHF, MI, Stroke; cancer; Diabetes; Depression; Substance Abuse; Obesity; Others All programs will be developed and offered in collaboration with partner organizations wherever possible

14 By focusing on these strategic objectives, existing health care professionals and organizations will be more closely linked and better able to adapt their services to meet the health needs of the community. Ongoing collaboration and participation at the governance level will facilitate the realization of these Strategic Directions. * It is anticipated that the Family Health Team (once operational) will conduct more detailed planning on an annual basis to identify specific service objectives and targets to be achieved. Annual service delivery data can then be compared to baseline data (available at the time of FHT implementation) to enable on-going monitoring, assessment and evaluation of this new model of primary health care delivery. Page 14

15 Page 15 SAMPLE VISUAL REPRESENTATION OF VISION, MISSION STATEMENT AND STRATEGIC OBJECTIVES Strategic and Program Planning Outline for Family Health Teams Vision Statement Mission Statement Strategic Objective #1 Strategic Objective #2 Strategic Objective #3 Program A Objective #1 Objective #2 Program B Objective #1 Objective #2 Program A Objective #1 Objective #2 Program A Objective #1 Objective #2 Program B Objective #1 Objective #2 Program Strategies Program Strategies Program Strategies Program Strategies Program Strategies Resources Resources Resources Resources Resources

16 C3) Population Characteristics, Health Data and Access to Care Please refer to the Guide to Business and Operational Plan Development and to the Guide to Strategic and Program Planning to help you complete this section. It is recommended that you use the Strategic Planning Template for Family Health Teams (Guide to Strategic and Program Planning, p.9) to assist you in completing this section. REQUIREMENTS: Please provide a description of your Family Health Team s population characteristics, health data and access to care. Please cite the data provided in your response. SAMPLE RESPONSE 3.1 Population Characteristics* Numbers It is estimated that the total population within the proposed ABC FHT is approximately 12,000. At present there are 3295 active patients who are registered with the three existing community physicians and one nurse practitioner. There are also 3881 patients who are registered to physicians who have left the community or who have moved to practice in nearby communities outside of the ABC and area catchment area. Demographics The most notable demographic characteristics of the area s catchment population (impacting health status) include the following: Language The total proportion of residents in the catchment area which report English as their mother tongue is 76.9% which is slightly higher than the provincial rate of 71.6%. However, 17.3% of the ABC and Area population identify that French is their mother tongue which is significantly higher than the provincial rate of 4.4%. Aboriginal Origin 8.2% of ABC & Area s total catchment population is of aboriginal origin while the province s average is 1.67%. This population is underreported through Census data and local officials identify that LMN and PQR populations are significantly higher than reported. Employment Income The average employment income for all census subdivisions in the ABC & Area catchment is slightly lower than the provincial average of $35,185 except for Anywhere District which is more than $4,000 higher than the provincial average. Page 16

17 Page 17 Women in all parts of the catchment area earn significantly less than the provincial average for women $26,894 (ranging from $16,425 in Somewhere River to $20, 576 in Anywhere District) Low-Income Families The total percentage of low-income families in the ABC & Area catchment area is 14.2% which is higher than the provincial rate of 11.7%. Average Household Income The average household income in the catchment area is lower than the provincial average of $66,836 (the lowest income is Somewhere River $42,774, while the highest is Anywhere District $60,362.) Social Assistance The proportion of the ABC & Area catchment area population which receives social assistance or other government transfers is 21.2% which is more than double the provincial rate of 9.8%. Education A slightly higher proportion of the area s year old population does not attend school (38.8%) compared to the province (35.1%). The proportion of the population aged 20 years and over within the catchment area which has a university education is 10.6% which is less than half the provincial rate of 26.3%. Employment Within the ABC & Area catchment the unemployment rate is nearly double the provincial rate for all age groups with the highest rate of unemployment being experienced by males in the year category at 34.9% compared to the provincial rate of 13.2%. Labour Force-Occupations The top 3 occupational groups (which account for nearly 63% of the total occupations in the ABC & Area catchment) are: Sales & Service (26.8%), Trades, Transport & Equipment Operators & Related Occupations (23.8%) and Business, Finance & Administration Occupations (12.0%). Lone-Parent Families There are a total of 420 single parent families within ABC & Area of which more than 75% are headed by a female. Health Status There is significant data which reveals that the overall health status of residents within the ABC & Area catchment is poorer than the rest of the province. The population is one of the oldest in Ontario and has considerably high rates of diabetes, cancer and cardiovascular disease. The prevalence of these diseases is exacerbated by the fact that the region has one of the highest rates of smoking and a population with a higher than average body mass index (BMI) due to a predominantly sedentary lifestyle. The area s population also has higher rates of binge drinking and injuries and is faced with high levels of unemployment and a lower annual income than the provincial average.

18 Health status indicators for this population have been well documented in a variety of public health unit, district health council, hospital and provincial health research organizations and some of these key indicators include the following: Increased levels of morbidity and mortality for a range of chronic conditions such as diabetes, respiratory illnesses and cardiovascular conditions than the rest of the province, which increases the need for long term care (LTC) services. Higher rates than average of morbidity and mortality, with reduced years of life from various cancers, respiratory illnesses, cardiovascular disease, accidents and suicide. Death rates due to injuries, poisoning and suicide are alarmingly higher in the entire district compared to province. Deaths due to circulatory diseases are disproportionately higher. Higher rates of smoking, leading to higher rates of morbidity and mortality for lung cancer and heart disease. 27% of males in the district smoke daily compared to 23% in province. 26% of women smoke daily compared to 18% provincially. Teen birth rates are consistently higher, as much as 39-63% higher than the province. 13.4% of the population in XYZ have a long-term disability, while the provincial average is 9.6% Lower utilization of cervical screening High use of hospital emergency departments by residents in the ABC area, in residents visited hospital ER 84% higher than the provincial experience. Total ER visits in ABC is normally between 14,400 and 15,000 per year 94.28% of all patients presenting to the ER in ABC are either a level 4 or 5, meaning they are not urgent patients. The provincial average is 59.7%. This is significant, reflecting the lack of primary care providers in the community. Patients are forced to access the ER for simple things such as prescription renewals. Higher proportion of Francophones in the region as compared to the province; Francophone population tend to be older than the rest of the population in Ontario as a whole; they tend to have lower levels of education and income; higher rates of bronchitis-emphysema, asthma and hypertension compared to the rest of the province population; there are a higher proportion of Francophones who smoke on a regular basis Aboriginal origin population much higher than rest of Ontario, with significantly higher rates of Diabetes and resulting complications, as well as other health issues related to the determinants of health such as education, income and access to culturally sensitive health services. Mental health and social services are lacking, with substance abuse and suicide at higher levels than the rest of the population Note: Further research is needed in the area of Needs Assessment for the First Nations population within the ABC & Area FHT s catchment area. A partnership may be sought with the Research and Development Institute of the Anywhere & District Health Unit regarding this important issue. Page 18

19 Page The External Environment 4.1 Catchment Area The geographic area to be served by the proposed FHT is extensive and includes a 50 km radius centred out of the Town of ABC. This catchment area includes a number of neighbouring communities (townships) such as: M, N, and T, 2 Native Reserves, and Anywhere District. A map of this proposed catchment area has been provided. 4.2 Population The total number of health consumers to be served by the ABC & Area FHT is approximately 12,000. This includes the total population figures provided for all available census subdivisions in the catchment area (11,193) as well as estimated populations served in the surrounding Native Reserves. In terms of population distribution by age, the largest proportion of the population within ABC and area is the year old group which comprises almost 32% of the total population. The next largest group is the 0-19 year old group at 26% of the total population followed by the year old cohort which comprises 16% of the total population. A breakdown of this catchment population by age is outlined in the table below. Population by Age Groups: Statistics Canada, Census 2001 Ontario Town A and Town B Town A Town C Village D City E Area Population, % Data 10,753,573 11,946 3,535 5, ,929 Population, % Data 11,410,046 11,193 3,245 5, ,910 Population percentage change, Land area in square kilometres, ,656 18, ,327.6 Total population by sex and age 11,410,045 11,190 3,245 5, ,910 groups - 100% Data , , , , , , , , ,670 1, , , , , , , , , , NOTES: ABC and Area has been developed by summing together the Somewhere River, ABC, D, E and F, and 50% of the Anywhere census subdivisions. Totals and percentages may not always add up due to the effect of rounding.

20 Population Distribution by Sex According to the table provided below it appears that the distribution of population by sex is very evenly divided between males and females. Females make up 50.3% of the total population while males account for 49.7% of the total. The most significant difference between males and females is that there are a larger proportion of females (65%) within the 75+ year age groups indicating that the life expectancy of women is longer than their male counterparts. Population by Sex: Statistics Canada, Census 2001 Ontario ABC and Area Somewhere River ABC D E and F Anywhere Male, total 5,577,055 5,570 1,630 2, , , , , , , , , , , , , , , , , , , , Page 20 Female, total 5,832,990 5,628 1,620 2, , , , , , , , , , , , , , , , , , , ,

21 Page Community Resources There are a number of existing primary care providers and community resources which would complement the proposed ABC & Area Family Health Team. These include some of the following: ABC General Hospital ABC Nursing Home CCAC Optometrists Dentists Registered Massage Therapist Chiropractors ABC Family Medical Clinic: currently staffed with 3 physicians (community complement is 6) Everywhere Mental Health Clinic VON Canada Specialists: Pediatrics, Cardiology, ENT, Ophthalmology, Internal Medicine / Infectious Diseases, Minor Surgery, OB/GYN, Audiology, Podiatry, Chiropody ABC and District Association for Community Living XYZ District Social Services Advisory Board Local Area Medical Clinics (including First Nations) 4.4 Environmental Factors The Town of ABC is home to a large pulp and paper mill currently being operated by ZYXW which is the community s largest employer. * Statistics Canada Census.

22 Page 22 C4) General Information and List of Programs and Services: Refer to the following guides as you complete this section: Guide to Business and Operational Plan Development section Guide to Chronic Disease Management and Prevention Guide to Health Promotion and Disease Prevention Guide to Collaborative Team Practice Guide to Community Funding Partnerships and Program/Service Integration Guide to Patient Enrolment REQUIREMENTS: Confirm your intention to provide, or ensure the provision of the full spectrum of core/comprehensive Family Health Team services; Provide details on the current population being served (if applicable) and estimates of additional patients/clients to be served and how this will be achieved; Provide a list of physicians and other primary health care providers required to provide these services clearly differentiate between existing and new providers; Provide anticipated dates for recruitment of new providers; Indicate compensation mechanisms proposed for physicians (current and new); Specify location(s) where services will be provided; Indicate whether any renovations are required to enable provision of services; Indicate where after hours services will be provided; Provide information on current numbers of enrolled patients/clients (if applicable) and anticipated numbers to be enrolled in future (with estimated timelines); For all participating physicians, indicate if any are practicing under other alternative funding agreements and which type of agreements they are currently members of.

23 Page 23 SAMPLE RESPONSE General Information Core/Comprehensive Services The XYZ Family Health Team affirms that it will provide a full spectrum of comprehensive Family Health Team services. Current population to be served There are 8,000 individuals rostered or affiliated with the XYZ Family Health Network. Additional population to be served Until the successful completion of the three to four year operational plan described herein, there will continue to be orphans and individuals that have to obtain their primary care either out of county or from non-fht physicians. Orphans Orphans are defined as individuals in XYZ (determined by postal code) that are not currently under the care of a physician or nurse practitioner. In conjunction with the implementation of Seniors Health, Healthy Kids, Healthy Living, Chronic Disease Management, Healthy Kinetics, End-of-life, Telehealth and Enhanced Mental Health services, the teams will establish care maps or protocols for delivery of selected services to residents of XYZ without a primary care practitioner. In many cases, these services will be delivered in a group format. Other Primary Care Provider Individuals who receive primary care from other primary care providers outside of the FHT will be able to access selected services of Seniors Health, Healthy Kids, Healthy Living, Chronic Disease Management, Healthy Kinetics, End-of-life, Telehealth and Enhanced Mental Health Programs. Again, protocols will be established to guide the movement of the individual through the program and communication with their primary care practitioner. In both circumstances, the FHT will work with the EMR vendor to establish a reliable method to capture non-enrolled/affiliated patient encounters. These encounters will be monitored, and trends in utilization will be identified.

24 Page 24 Physicians and Primary Health Care Providers Provider Type Existing New FHT FHN Family Physician 8 (=6 FTE)*(FHN 12 (=10FTE) funding) Nurse Practitioner 0 4 FTE Registered Nurse Lead 0 5 FTE Practice Nurse 2.0 FTE 2.0 FTE (Clinic RN) (FHN funding) (FHN funding) Clinic Registered Practical 0.5 FTE (FHN 0.5 FTE (FHN funding) Nurse funding) RPN Telehealth Coordinator FTE Social Worker 0 1 FTE Registered Dietitian 0 1 FTE Psychogeriatrician FTE Pharmacist FTE Case Manager / System FTE contract Navigator (Year 3) Cardiologist visits 1 contract / sessional Paediatrician visits 1 contract / sessional Internist visits 1 contract / sessional Orthopaedic Specialist visits 1 contract / sessional Psychiatrist visits 1 contract / sessional General Optometrist sessional Paediatric Ophthalmologist (yr. 3) 0 1 space and support Specialist - Other 0 Unknown - sessional *Physician FTE s based on actual provision of primary care in office setting, either at FHN clinic or in walk-in. Some physicians practice part-time or are otherwise occupied with on-call/emergency duties for the hospital and long-term care, teaching responsibilities, medical director responsibilities at Long-Term Care Facilities and committee work.

25 Page 25 Recruitment Timelines Please refer to Figure 10 for estimated timelines in recruitment of the required Health Human Resources. Compensation mechanisms for Physicians Physicians are partners in a Family Health Network and compensated through a blended capitation model. Any additional physicians selected to join the FHT will be included in this model. Location of Services and Programs At full operation, all Family Health Team services and programs will be offered in both DEF and surrounding villages. A selection of services will be provided on an outreach basis to satellite locations, such as QR.

26 Page 26 Location readiness A Family Health Centre is under construction. The two-storey, 20,000 square foot structure has been determined to accommodate health services only. Physicians will be able to relocate to the new facilities in March In 2004, the municipality of OPQ et al. undertook these plans to construct a new location for the physicians; upon hearing about the planned Family Health Team, they promptly doubled the planned square footage to accommodate additional health services. These additional health services, including Interdisciplinary Health Professionals of the Family Health Team will be offered out of the first floor of the Family Health Centre. The expected timeline for renovations of allied health professionals space is the summer of One-Time, non-recurring capital funding is being requested to contribute towards the securing of the building. One-time funding that is received will be considered in the development of a rental agreement with OPQ et al, realizing operational cost-savings. Floor plans of the 1st and 2nd floors of the XYZ Family Health Centre are appended. Diagnostic Services Laboratory and X-Ray Services are available both City X and City Y. Ultrasound services are available in XYZ. Outreach Locations Given the lack of transportation in the outlying areas, satellite services will be provided to underserviced isolated communities once primary care practitioners are recruited. The Municipality of VU has partnered with the Family Health Team to provide office/clinic space in the village of Somewhere. This space will be able to accommodate primary care practitioners and other Interdisciplinary Health Professionals. Location of after-hours services After-hour physician services will be provided out of the adjacent emergency rooms, where physicians are remunerated through an Alternative Payment Plan. In XYZ, the physicians that staff the emergency room are the group of physicians that make up the XYZ Family Health Network. Once the XYZ Family Health Team is at full capacity, the need for and the feasibility of an after-hours primary care clinic will be assessed in both City X and City Y. This may be staffed by a complement of Nurse Practitioners, in collaboration /consultation with the on-call physician. After-hours allied health services and programming will be offered out of both locations to meet client needs and reduce barriers to accessing these services.

27 Page 27 Information on current numbers of enrolled clients There are 8,000 individuals rostered or affiliated with the XYZ Family Health Network. Anticipated enrolment with estimated timelines The Family Health Team is estimating timelines for two scenarios. In the first scenario, Plan A, the FHT will be successful in all its Recruitment Goals and will have recruited 4 RN (EC) s and 4 family physicians. With this complement of primary care practitioners, 16,000 individuals can be enrolled/affiliated with the FHT for primary care by the beginning of Year 4. Recent dedicated recruitment efforts have not produced one family physician in the past 5 years. With this in mind, the FHT has also proposed a Plan B, in which by the end of the third year of operation, it will become apparent whether or not family physicians will successfully be recruited to the area and to this model. In Plan B, the FHT will recruit 6 additional RN (EC)s during Year 4 to meet the primary care needs of the region. With this alternative complement of primary care practitioners, 16,000 individuals can be enrolled or affiliated with the FHT by the end of Year 4. Please see Figure 11 for a graphic description of timelines for both Plan A and B. Figure 11 Anticipated Primary Care Enrolment / Affiliation Timelines Physician alternative funding agreements The Family Health Network physicians have an alternative payment agreement with XYZ Health Services to staff the Emergency Department.

28 Page 28 C5) Summary of Business Plan Timelines Please refer to the Guide to Business and Operational Plan Development, section 4.2., REQUIREMENTS: Provide a timeline incorporating the key elements identified in your multi-year Business Plan. SAMPLE TEMPLATE Augus t Sept. October November December January February March April May June July Formative Stage Pre-Operational Stage Operational Stage Develop Governance Strategic and Program Planning Recruit Human Resources Develop Community Partnerships/ Local Integration Determine Physical Location (s) & Logistics of Collaboration Service/Program Delivery C6) Financial Forecast Please refer to the Guide to Business and Operational Plan Development, section 4.3 and to Operational Plan Funding Application Template, Schedule 1, to complete this section. REQUIREMENTS: Provide a 5-year financial forecast. SAMPLE TEMPLATE Please see Schedule 1, Appendix E Financial Forecast/Budget for a sample budget.

29 Page 29 C. Operational Plan The Operational Plan provides detail on the major activities, timelines and resource requirements for implementing each fiscal year of the Business Plan. The detailed annual plan allows for more precise planning of items outlined in the business plan and allows you to advise the Ministry of changes/updates in your Business Plan. It sets out detailed funding requirements for the coming Fiscal Year (April 1- March 31) for implementing that year of the Business Plan. D1) Core, Optional, and Special Services/Programs Enrolment Please refer to the Guide to Business and Operational Plan Development, section and 5.1.3; and to the Guide to Patient Enrolment as you complete this section. REQUIREMENTS: Identify total population to be served Identify the number of patients already enrolled Describe plans for enrolling additional patients including the number and estimated timelines Identify whether patients will be enrolled to individual physicians or to a group of physicians Separately identify the number of new patients/clients to whom you anticipate providing services, and the number of new patients who did not previously have regular access to primary health care. SAMPLE TEMPLATE/RESPONSES Provider Or Group Current # patients enrolled Yr 1 Yr 2 Enrolment Yr 3 Yr 4 Yr 5 Previously unattached (orphaned) Dr. A ,000 1,250 1,500 2,000 1,500 Dr. B X X+Y1 X+Y1+Y2 X+Y1+Y2+ Y3 X+Y1+ X + Y1 + Y2 + Y2 + Y3 + Y3 + Y4 + Y5 Y4 # of new patients previously unattached

30 Page 30 SAMPLE 2 Programs and Services Please refer to the following guides to help you complete this section: Guide to Business and Operational Plan Development, section Guide to Chronic Disease Management and Prevention Guide to Health Promotion and Disease Prevention Guide to Collaborative Team Practice Guide to Community Funding Partnerships and Program/Service Integration REQUIREMENTS: List the core/comprehensive care service that your Family Health Team will provide Include the following for each of the proposed core, optional and special services/programs requiring an interdisciplinary team: o The name of the proposed program or service o A brief description of the service/program including objectives and how it will address population needs, service gaps, and the proposed location of the program/service (e.g. Family Health Team practice site, partner organizations, community) o Identification of the provider(s) who will deliver the program/service (type and full-time equivalency). If more than one type of provider is involved, provide a brief description of their respective roles (If roles have already been discussed, refer to the relevant section of your plan). o A brief description of any linkages/partnerships (e.g., service coordination and collaboration initiatives) with other service delivery organizations and the role/services to be delivered by the other service delivery organization o A list of the services to be provided.

31 Page 31 SAMPLE TEMPLATE Identify key milestones and timelines for the roll-out of the services/program including establishing linkages with other service delivery organizations. Core Comprehensive Care Services (Mandatory) Health assessments Diagnosis and treatment Primary reproductive care Primary mental health care (early identification and treatment of emotional and psychiatric illnesses and where appropriate collaborate with psychiatrists or the FHT mental health workers) Primary palliative care (provide palliative care or provide support to the team responsible for providing palliative care) Support for hospital, home, public health and long-term care facilities (through formalized linkages, assist with discharge planning, rehabilitation services, outpatient follow-up and home care services) Service coordination and referral (coordination of services among the FHT and, where appropriate, referrals to other health care providers and agencies) Patient education and preventative care Access to pre-natal, obstetrical, post-natal maternal care and in-hospital newborn care Arrangements for aroundthe-clock care (through extended office hours and the THAS) Chronic disease management programs Organized health promotion and disease prevention programs* Description, Objectives, how program will address needs/gaps Provider Type & FTE. Provider Roles Linkages/ partnerships with other service delivery organizations, service to be delivered Key Milestones and Timelines for Roll-outs

32 Page 32 Optional Programs X-ray, ultrasound, sleep studies, pulmonary function studies, nuclear medicine (IHF-licensed Services) Laboratory services Description, Objectives, how program will address needs/gaps Provider Type & FTE. Provider Roles Linkages/ partnerships with other service delivery organizations, service to be delivered Key Milestones and Timelines for Roll-outs Some minor day surgery Some specialist services (e.g., internal medicine, pediatrics and cardiology) Other special programs/ services* *For example, programs targeted to specific population needs. SAMPLE RESPONSE (Chronic Disease Management) CHRONIC RESPIRATORY DISEASES PROGRAM Rationale: Need to prevent onset of disease by reaching high risk individuals for development of COPD and Asthma as well as those already diagnosed Region identified as having a lower socioeconomic status, and therefore determined to be at high risk for development of chronic disease such as COPD Barriers such as access to specialized services, identified e.g. transportation Goals: Improve access and compliance to specialized respiratory services Improve quality of care Objective(s) Timely and consistent identification and screening and accurate early diagnosis Timely access to primary care services i.e. during acute exacerbations Timely access to consultants Provide evidenced based care Adherence to evidence based guidelines

33 Page 33 Approach: The current COPD program is a satellite of the TRIANGLE/GSK Program at ORS Hospital and provides early identification and screening for COPD through spirometry; patient education such as medication (use and administration), breathing techniques, exercise and diet, and exacerbation management. The current Asthma Education program is a satellite of the ORS Asthma Program and provides identification, screening and assessment for asthma; patient education such as medication use and administration, breathing techniques, exercise and diet and exacerbation management. All patients who attend either of these respiratory clinics will be targeted for smoking cessation programs. Both of these programs provide opportunities for inter-professional and multidisciplinary consultation, shared care and education. These programs provide improved access for patients of all ages to treatment and services to those with COPD and asthma. Program Description: outreach clinics 1 day per month interdisciplinary approach with a core team consisting of: o respiratory therapist o respiratory NP/Asthma Education Nurse o SL FHT Nurse Practitioner and Registered Nurse o Extended Respiratory Team: Respirology consultant; o FHT Family Physician Early Identification, Screening and Assessment The AB FHT NP works with therapists to implement change, and educates providers to become more adherent to the standards of care. All providers, including residents and students rotate in RT clinics. Increased compliance of providers to protocols will be passed on to more compliance/education with patients. A built-in recall system with track patients and notify for re-screening and assessment. Program evaluation: The following outcomes will be monitored and tracked Improved adherence to current COPD and Asthma Consensus Guidelines Decreased prevalence of smoking monitor changes in smoking rates through IT Action Plan of Care in chart for every asthma patient Decrease in lost work days, school days, social activities