APPLICATION FORM

Information for medical staff to identify and submit initiatives for funding

INTRODUCTION

Increasing support for facility-based physicians is a first of its kind initiative in Canada—resulting from the 2014 and 2019 Physician Master Agreement between Doctors of BC and the Government of BC. A Memorandum of Understanding (MOU) on Regional and Local Engagement, signed by all the Health Authority CEOs, provides support and funding to medical staff associations to facilitate discussions among physicians and departments around issues that affect our patients and work environment.

Funding can be used to pay physicians for their time, hire staff, and support a number of prioritized projects and initiatives, ranging from patient care and system improvements to technology needs, to improving communication and consultation with Health Authority administration.

Please note: If you believe the facility engagement application falls under the Retreat guidelines (click or tap here), there is no need to submit an application or project proposal. Simply email the KGH Physicians Society (click or tap here) and we will be happy to provide further information.

TYPES OF INITIATIVES

Identify challenges that impact physicians and/or patient care, and opportunities to work on solutions. Initiatives do not necessarily have to be large in scope and can range from no-cost proposals to changing how some work is done, to larger issues that have significant impacts.

Consider how opportunities can build relationships and effective communications within and across physician groups, and forge closer communication, trust and shared accountability between physicians and health authority leadership, while championing facility and system improvements.

Facility Engagement funding cannot be used for the following: Advertising with the exception of physician recruitment ads; compensation for clinical services; purchase of real estate and vehicles; purchase of clinical equipment; donations to charities or political parties; meeting attendance that is presently required as part of maintaining privileges. For a synopsis of what facility engagement covers, and what it does not, click or tap here.

You also need to be a member in good standing of the Medical Staff Society for your application to be eligible.

HOW TO MAKE A SUBMISSION

Please review (click or tap here) Guideline 002: Facility Engagement Funding for additional information. Complete the attached form, or the electronic version below, and submit it with any relevant supporting documents to your Departmental Lead on the KGHPS Working Group. A confirmation of your submission will be sent to you. Please submit the application no later than the last day of each month so that we can get it to the KGHPS Working Group who will review and rank all submitted proposals and make decisions on funding allocations. The applicant may be asked to present or provide additional information.

The applicant will receive notification of the status of the application within 4 to 6 weeks from date of submission. The Working Group will keep a list of ongoing proposals and encourage medical staff to review existing proposals so as not to duplicate efforts.

If you would like to download a fillable PDF, click or tap here.

FACILITY ENGAGEMENT FUNDING APPLICATION

Project Identification

Project Title:

Expected Timeframe:

Total Funding Amount Requested:

Submitting Department(s) / Division / Group:

Name of Principal Physician Applicant:

Names of other participating physicians and/or medical staff (separate by coma):

Project Manager:

Main Contact Name(s):

Phone:

E-mail:

Application completed by (name):

Statement of the Problem or Need

Concisely summarize the issue and relevant background information, i.e. what led up to the issue? How has it evolved? Describe the current situation. What problem / need is the project designed to address?

How will the funds be used? Project Deliverables and Beneficiaries

Describe the objective of the project; how funds will be used and potential outcomes. What is the project designed to achieve, create or deliver? Please identify who will derive benefit from the expected outcome.

Strategic Context

Explain how the project relates to the vision/mission of the KGH Physicians Society as well as the strategic goals of hospital / Interior Health.

Time Factors

How long is the intended project to last? Are there any deadlines to consider? Please note funding for FE Projects is annualize and does not carry over automatically into next fiscal year.

Special Provisions

Are there any environmental factors, such as regulatory requirements, ethical considerations or legal ramifications to be considered?

Related Projects

Identify any other projects that may be related to this one or that may be affected by this initiative.

Project Assumptions and Constraints

Identify any assumptions or constraints that have been identified, i.e. any factors that are considered to be true and will be assumed to be true during the duration of this project or anything that will restrict the ability to successfully achieve the project objectives.

Health Authority (HA) Engagement

Note: Any proposed activities involving patient care, flow, environment, data analytics, allied health, resources for sustainability would benefit from early consultation with HA.

Indicate how/if the HA has been/will be informed of the activity, consulted with, involved, and/or a collaborative partner, as applicable.
This project would benefit from HA involvement as it required input, data, implementation, financial or inkind resources, etc.I need help finding the appropriate HA contacts.I am aware of the appropriate HA contacts and have included them below:

Name	Title	Department	Contribution

Evaluation Plan

Indicate how you will assess whether the activity’s objective are being met. Consider how and when data
(i.e., indicators) will be collected and analyzed. Please advise if you require assistance developing an
evaluation plan.

Project Expenses

(Sessional fees are $171.05 per hour. Maximum meal expenses: $40 per person (including taxes, gratuities and service fees – alcohol cannot be funded). Funding cannot be provided for retroactive project work except for up to 3 hours for Project Lead for working on application.
NOTE: The Director, Facility Engagement can assist you in developing the Project Budget within the guidelines.

Please Note: Sessional Fees must be submitted within 90 days of the meeting or activity taking place; otherwise, they will not be approved.)

Implementation Expenses: (For larger, more complex projects expenses can be divided into planning, implementation, evaluation
or dissemination phases – please work with the Facility Engagement Director to assist you in developing
the budget.)

Post-Implementation Operational Expenses:

Submission

Enter name to sign as the applicant