FE 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.  Please note that M&M rounds or any Quality Assurance projects are not covered by FE funds.

If you need further assistance, please email the KGH Medical Staff Association (click or tap here), and we will be happy to provide you with further information. For KGH Recruitment funding requests, please use this form; recruitment guidelines can be viewed here.

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 foster relationships and effective communication within and across medical staff groups, and promote 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 except 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 financial management is, 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 the Facility Engagement Funding Application Guidelines for additional information. Complete the form below, and submit it with any relevant supporting documents to the FE Program Manager. A confirmation of your submission will be sent to you.  Please apply no later than the last day of each month so that we can forward it to the KGH MSA Working Group, which will review and rank all submitted proposals and make funding allocation decisions. The applicant may be asked to present or provide additional information.

The applicant will receive notification of the status of the application within 2 to 4 weeks from the 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.

FACILITY ENGAGEMENT FUNDING APPLICATION

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Project Title: *

Proposed Timeframe: *

Please note funding for FE Projects is annualized and does not automatically carry over into the next fiscal year

Total Funding Amount Requested ($10,000 maximum): *

Submitting Department(s) / Division / Group: *

Name of Principal Physician Applicant(s): *

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

Main Contact Name(s): *

Contact Telephone Phone Number(s): *

Contact E-mail Address(es): *

Application completed by (name): *

Additional Comments (if any):

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? *

AREA(S) OF IMPACT

Identify all areas that resolution to this issue would affect. *

• Patient Care
• Physician Work Environment
• Population Health
• Reduction in Per Capita Cost
• Capacity & Flow
• Physicians Representation / Input Mechanisms
• Patient Safety
• Use of Allied Health Professionals
• Electronic Systems
• Communication with Physicians
• Communication with Health Authority
• Delivery of Program Services
• Passion & Energy

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 annualized 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

Name 1

Name 2

Name 3

Name 4

Title

Title 1

Title 2

Title 3

Title 4

Department

Department 1

Department 2

Department 3

Department 4

Contribution

Contribution 1

Contribution 2

Contribution 3

Contribution 4

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 $176.18 per hour. Maximum meal expenses: up to $40 per person (including taxes, gratuities and service fees – alcohol cannot be funded). Maximum Project Manager rate: $95/hour. 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, it will be rejected by FEMS.

Please be sure to complete the ‘Description’ field in FEMS and enter sessional time as it occurs rather than one lump sum.
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.)

Sessional Fees: Itemize Use: (field must be filled in)

Number of Physicians: *

Number of Hours per Medical Staff *

Medical Staff type *— Select Choice —Medical staff: $176.18Midwives: $70NP & Nurses: $65

Total Sessional Fees *

Meals: up to a maximum of $40 per person (including taxes, gratuities and service fees – alcohol cannot be funded)

Number of Physicians *

Meals Total *

Project Support: Total not to exceed 50% of the overall budget

Itemize Use: (if utlizing field must be filled in) *system calculates the hourly rate by the number of hours

Administrative Support Rate *

Project Manager Rate (maximum $95/hour) *

Number of Hours *

Number of Hours *

Administrative Support Total *

Project Manager Total *

Other Costs:

Itemize Use: (if utilizing field must be filled in)

Other Costs 1:

Other Costs 2

Other Costs 3

Other Costs 4

Description Other Cost 1:

Description Other Cost 2

Description Other Cost 3

Description Other Cost 4

Total Requested ($10,000 maximum):

System calculates all sub-totals

Total Requested: *

*We have a funding limit of $10,000 per project. Please adjust the expenses

SUBMIT APPLICATION