SKILLS-BASED BOARD TOOLKIT

Transcription

1 SKILLS-BASED BOARD TOOLKIT fr FHTs and NPLCs March 2018 Prepared by Cllabrative Slutins

2 SKILLS BASED BOARD TOOLKIT FOR FHTs and NPLCs Table f Cntents A. Intrductin Purpse f this Tlkit Skills-Based Bard Requirements in New FHT Cntract... 4 B. Backgrund/Cntext Why Bard Skills are Increasingly Imprtant Clarifying Terms: Bard Membership versus Bard Cmpsitin Cmmn Cncerns Abut a Skills-Based Bard Other Cnsideratins Related t Bard Cmpsitin... 9 C. Develping an Enhanced Skills Matrix A Fur-Part Apprach t Bard Cmpsitin Develping r Enhancing Yur Bard s Cmpsitin Matrix D. Enhancing the Skills-Based Capacity f the Bard Step 1. Assess and Identify Skills Gaps Step 2. Develp a Plan t Enhance Bard Skills Step 3. Fcus Recruitment t Address Gaps Step 4. Enhance Bard Skills Thrugh Educatin E. Using This Tlkit APPENDIX A MOHLTC-FHT Cntract Schedule A Appendix APPENDIX B Sample Bard Cmpsitin Planning Tl APPENDIX B Sample Bard Cmpsitin Planning Tl (cntinued) APPENDIX C Sample Fur-Part Bard Skills Matrix APPENDIX D Sample Bard Recruitment Letter (External) APPENDIX E Sample Bard Recruitment Letter (Internal)

3 A. Intrductin SKILLS BASED BOARD TOOLKIT FOR FHTs and NPLCs 1. Purpse f this Tlkit In March 2018, Family Health Teams (FHT) in Ontari entered int a new fur-year funding agreement with the Ministry f Health and Lng-Term Care (MOHLTC). The cntract sets specific Gvernance Requirements t be integrated int each FHT s written gvernance structure. One f these requirements identifies a set f specific skills that a FHT must have n the Bard thrugh its Bard membership r have access t thrugh ther means as it perfrms its gvernance rle. As a cnditin f cntinued funding, each FHT must attest annually that this skills requirement is met. The primary purpse f this tlkit is t supprt FHTs in meeting the skills-based Bard requirements in the new cntract. The tlkit prvides an verview f current thinking abut Bard skills and skillsbased Bards as well as practical tls and tips fr enhancing the skills capacity f any Bard. In this way, the tlkit is intended als t be f use by thse FHTs that already meet the Bard skills requirements f the new cntract and by Nurse Practitiner-Led Clinics (NPLC) in cnsidering the skills and cmpsitin f their Bards. In creating the tlkit, it was understd that Ontari s FHTs have ne f three gvernance mdels - prvider-based, cmmunity-based, r mixed cmmunity/prvider-based - while all NPLCs have a mixed prvider-cmmunity mdel. A prvider-based gvernance mdel has a Bard cmprised nly f prviders (likely physicians within the FHT) whereas a cmmunity-based gvernance mdel has a Bard cmprised f individuals frm the brader cmmunity. A mixed cmmunity/prvider-based gvernance mdel has a Bard cmprised f bth prviders and members f the brader cmmunity. It is imprtant t nte that these three terms refer directly t the membership f the Bard and nt t the brader membership f the FHT r NPLC crpratin as defined in its Bylaw. Regardless f gvernance mdel, every FHT and NPLC Bard has the same accuntability fr effective gvernance and relies n a high level f skill, knwledge and experience amngst its Bard members t meet that requirement. This tlkit is designed therefre t be infrmative fr and adaptable by all FHT and NPLC Bards regardless f yur gvernance mdel. Where there are specific cnsideratins r tips fr ne particular mdel mentined in the tlkit, they are clearly identified in the text. Finally, this tlkit is intended t align with and enhance the gvernance resurces already available t AFHTO members, including the AFHTO Fundamentals f Gvernance handbk and its accmpanying dcument Fundamentals f Gvernance: Tls, Examples and Templates. 3

4 2. Skills-Based Bard Requirements in New FHT Cntract Schedule A Appendix 1 f the new FHT cntract utlines certain Gvernance Requirements t be integrated int each FHT s written gvernance structure. One f these is a set f skills that a Bard must have access t, either amngst its Bard members r thrugh ther mechanisms, as the Bard fulfills its gvernance rle. As part f cntinued funding, a FHT must demnstrate annually that it is making best effrts t meet this requirement 1. The cntract states: The [FHT] shall use its best effrts t ensure that its bard f directrs pssess skills in the fllwing areas: strategic planning, clinical skills, prgram develpment, adequate finance, risk management, human resurces, and planning. If the [FHT] has identified gaps in these skills, it shall make best effrts t address gaps thrugh educatin r by retaining external expertise. The [FHT] shall prvide an updated attestatin in the frm attached as Schedule A Appendix 2 with each Annual Financial Reprt. (MOHLTC/FHT Funding Agreement, Schedule A, Appendix 1) The frm in Schedule A - Appendix 2, titled Skills-Based Bard Matrix, ffers further clarificatin f the required skills as well as cnfirmatin that the Bard can acquire these skills in ways ther than Bard membership. The frm (prvided as Appendix A in this tlkit fr easy reference) includes: - Nine categries f required Bard knwledge/skill/experience fr the Bard: Strategic Planning, Clinical Skills, Prgram Develpment, Human Resurces Management, Financial Management/Audit, Risk Management, Quality Imprvement, Perfrmance Measurement, and Gvernance/Accuntability Management. - Space t identify additinal ptinal skills such as Legal, Dispute Reslutin, Cnflict f Interest, Public Cmplaints, IT, Cmmunity Relatins, and Capital Planning. Where the FHT s wn assessment shws that a listed skills categry is nt currently fund n the Bard, the frm prvides space t describe hw the FHT plans t acquire this skill in ther ways, such as thrugh cmmunity members/external resurces n Bard cmmittees, r special advisrs t supprt the Bard. Each year the FHT is required t submit the frm fllwing its assessment f the knwledge/skills/ experience f each Bard member in the nine categries (plus ptinal skills if included by the FHT). 1 MOHLTC has cnfirmed that the requirement t make best effrts t ensure the FHT s Bard f Directrs pssesses the skills described in Appendix 1 will be enfrced ne (1) year frm the effective date f the FHT Agreement. 4

5 B. Backgrund/Cntext 1. Why Bard Skills are Increasingly Imprtant An effective and skilled Bard is an essential part f a high perfrming rganizatin 2. The Bard s ability t fulfill its rle with a high degree f skill and cmpetence has a direct impact n the success f the rganizatin it gverns: Gd gvernance, cmbined with strng management and a cmmitted staff team can: be a psitive frce fr change and innvatin, prvide leadership (within the rganizatin and utside), build scial capital, and ensure the rganizatin achieves its gals and purpse, and uses its resurces wisely and effectively. A prly gverned rganizatin will rarely achieve success in meeting its perfrmance gals. A high perfrming Bard will prvide the leadership, stewardship and versight that will guide and enable rganizatinal success. (AFHTO Fundamentals f Gvernance, p. 19) The Bard s rle, and the resulting skills required f its members, naturally evlve ver time as the rganizatin matures. The Bard f a new entity may fcus largely n its fiduciary duties (ensuring the rganizatin meets its legal and financial bligatins, and verseeing rganizatinal perfrmance) while ver time it will find it easier t fulfill thse duties and spend mre time n larger, mre strategic and future-fcused matters. The Bard s capacity t prvide effective gvernance leadership must evlve as the rganizatin itself evlves in respnse t new pprtunities and stakehlder requirements, such as funders. Nwhere is this mre apparent than in Ontari healthcare where nging health system transfrmatin includes new rles and accuntabilities fr health prvider rganizatins and increased expectatins fr Bards t prvide strng gvernance leadership fr bth their wn rganizatin and the health system as a whle. Specifically, health prvider Bards are nw expected t: - Demnstrate they have the skills and prcesses necessary fr key gvernance functins such as financial versight, strategic planning, risk management and perfrmance management f the ED/CEO. - Be knwledgeable abut quality and play a direct leadership rle in quality imprvement. 2 There are many articles in the published literature identifying Bard skills and a skills-based apprach t Bard cmpsitin as essential fr a high perfrming Bard. One such article is: Creating a High Perfrmance Bard, Harvard Business Review, available at Perfrmance-Bards.pdf 5

6 - Understand the prfile and needs f the ppulatin their rganizatin serves as well as the prfile and needs f the brader cmmunity. - Be aware f marginalized ppulatins and the barriers they face in accessing and using healthcare services, and ensure the rganizatin takes a health equity apprach in planning and delivering health services. - Ensure the rganizatin engages patients, families and caregivers and take their input int accunt in the Bard s wn planning, pririty setting and versight f the rganizatin. - Reprt t funders n gvernance practices and fulfillment f key gvernance standards such as managing cnflicts f interest. - Cntribute t greater integratin and cllabratin acrss the health system, including building relatinships with Bards f ther healthcare rganizatins. All f these develpments are causing Bards acrss the health system t lk clsely at the skills, knwledge and expertise that they need arund their Bard tables. Fr FHTs, these expectatins are clearly reflected in the gvernance requirements utlined in the new FHT cntract and in the specific list f Bard skills that FHTs are required t demnstrate that the Bard either has amngst its membership r has access t thrugh ther arrangements. 2. Clarifying Terms: Bard Membership versus Bard Cmpsitin There are tw cmpnents t the make-up f any Bard 1) the grup f peple wh sit arund the Bard table and 2) the cmbinatin individual characteristics that each persn in the grup brings t the Bard. It is imprtant t be clear which cmpnent yu are talking abut when discussing a skills-based Bard. Fr the purpse f this tlkit: - Bard membership refers t the grup f individuals wh sit arund the Bard table. Bard membership is defined by the rules set ut in the rganizatin s Bylaw, including wh is eligible t be a Bard member, the prcess fr electin t the Bard by the rganizatin s members, and whether certain seats n the Bard are designated fr a persn r persns elected by a certain grup f the rganizatin s members. - Bard cmpsitin refers t the cmbinatin f individual skills, experience, qualificatins and persnal characteristics that all Bard members tgether bring t the Bard. Bard cmpsitin tends nt t be defined in the rganizatin/crpratin s Bylaw but rather in Bard plicy and related tls such as a Bard skills matrix. 6

7 Talking abut a skills-based Bard is clearly abut Bard cmpsitin nt Bard membership but the tw are inextricably linked. If the Bylaw defining wh is eligible t sit n the Bard limits Bard membership t thse belnging t a grup f peple with highly similar skills and experience, it is mre challenging t achieve the diversity f skills and experience needed fr effective functining f a Bard. The new FHT cntract des nt require FHTs t change their Bard membership but sme FHTs, especially thse with a prvider-based mdel, may be challenged t meet the new skills requirements withut als cnsidering expanding wh is eligible t sit n the Bard. Where the FHT s Bard membership is defined in its Bylaw, a Bylaw change will be needed fllwing the prcess utlined in the Bylaw. 3. Cmmn Cncerns Abut a Skills-Based Bard There are several cmmn cncerns that peple think f when they hear the term skills-based Bard. Many f these can be addressed by a clearer differentiatin between Bard membership and Bard cmpsitin, a different apprach t the skills matrix, and clear prcesses fr using identified skills gaps t infrm recruitment and nging Bard skills develpment. The fllwing is a summary f cmmn cncerns and hw the appraches and tls discussed in the remainder f this tlkit address them. CONCERN The bard will be ppulated by peple wh have prfessinal qualificatins (such as legal, accunting) but are discnnected frm ur membership and ur rganizatin s purpse. We wuld need a very large Bard t have all the skills listed n ur skills matrix sitting arund the Bard table. HOW IT IS ADDRESED - Every Bard member, regardless f backgrund and hw they came t the Bard, must act in the best interests f the rganizatin and its membership be cmmitted t the Missin f the rganizatin. - It is the Bard s and rganizatin s respnsibility t ensure prper rientatin f new Bard members and nging educatin f Directrs s they take the membership, pririties, prgrams and cmmunity int accunt in all decisins. - Each Bard member brings a range f experiences, skills, knwledge and persnal characteristics. - Existing Bard members can develp new expertise t fill a Bard gap (i.e. a Bard member taking curses n quality t becme the Bard s quality expert). 7

8 We dn t cntrl wh vlunteers fr the Bard s we cannt predict r cntrl the makeup f the Bard. We dn t want t lse a really gd candidate because they dn t fill the ne skills gap we need t fill this year. There is n way t have a representative f every cmmunity r every sub-ppulatin in ur cmmunity n ur Bard. Skills such as HR and IT are the purview f management it is their jb t prvide this expertise and the Bard shuldn t be ding management s jb. - The recruitment prcess needs t be rbust enugh t identify candidates with the desired prfiles these peple exist, the challenge is finding them. This includes reaching beynd the persnal cntacts f existing Bard members. - Each skill listed n the matrix is nt necessarily needed n the Bard all the times (i.e. capital planning expertise). - The Bard can access specific expertise in ther ways if/when needed (i.e. hiring a lawyer t advise the Bard, r having an IT expert jin a Bard cmmittee). - Cmpsitin f the Bard is a cre respnsibility f the Bard and it needs t be practive abut recruiting and managing the makeup f the Bard. - Unslicited candidate applicatins shuld always be welcme but there must als be a fcused recruitment effrt when specific skills gaps exist. - Recruitment cmmunicatins can clearly state the specific experience r characteristics the Bard is lking fr (see Appendix D and E). - Judgement is needed in assessing every candidate. If a candidate brings imprtant experience t the Bard but nt the ne particular skill the Bard needs nw, cnsider different ptins, such as: bring them n the Bard anyway and fill that skill gap next year (nly if nt urgent and yu are sure there will be further vacancies next year) invite them t jin a Bard cmmittee t engage them until anther Bard vacancy pens up. - While peple cme t the Bard frm certain grups, nce arund the table they cannt represent the interests f ne grup ver anther - they must act in the interests f the rganizatin as a whle. - The gal is t have a range f backgrunds and perspectives t reflect the diversity f the cmmunity, nt t have peple represent every specific grup. - It is true that mst f the specific skills areas cnsidered imprtant fr the Bard are als needed by management. - The distinctin is that Bards need this knwledge nt t d (r re-d) management s wrk but rather t prperly assess management s recmmendatins and make infrmed decisins based n, but independent f, infrmatin prvided by management. 8

9 4. Other Cnsideratins Related t Bard Cmpsitin There are several ther aspects f gvernance t cnsider when implementing a skills-based apprach t Bard cmpsitin. - Size f the Bard The number f Bard psitins directly impacts hw easy r hard it is t achieve a desired level f diversity arund the Bard table. The fewer Bard psitins, the greater need t attract individuals with a wider variety f skills, experience and persnal attributes and these peple can ften be mst difficult t identify. - Organizatinal capacity t supprt a highly skilled Bard A highly skilled gvernance Bard relies n an equally high level f rganizatinal supprt and staff expertise t d its wrk. Gvernance and rganizatinal plicies, management supprt and reprting t the Bard, and gvernance prcesses such as cmmittee wrk and recruitment all need t functin at a higher level t supprt the Bard. Smaller rganizatins can be challenged t prvide the staff expertise and the rganizatinal resurces required t supprt the Bard. - Alignment f gvernance mdel with new skills requirements and rganizatinal accuntabilities This tlkit fcuses n enhancing the skills-based capacity f the Bard within the FHT/NPLC s current gvernance mdel. Fr sme FHTs, hwever, the new Bard skills requirements and increased expectatins t align with cmmunity and health system gals may cause a FHT t assess whether its current gvernance mdel needs t evlve. This wuld require the fllwing steps 3 : Review/revise existing Bylaw requirements related t Bard eligibility, nminatin and electin prcess, Bard size and cmpsitin. Identify changes needed, if any, t membership f the crpratin (the peple wh elect the Bard) and identify/discuss ptins. Cnsult with existing crpratin members abut ptins and supprt fr a future directin. Their supprt will be needed if a change f Bylaw is required. Develp a step by step prcess fr member cmmunicatins and apprval, including calling a special meeting f the members if required. 3 These steps are intended nly as examples. Any FHT cnsidering changes t their gvernance mdel shuld be guided by their Bylaw and unique circumstances. AFHTO will prvide advice and supprt if requested. A webinar describing ne FHT s experience mving frm a prvider-based t a mixed prvider/cmmunity-based mdel is available n the AFHTO website (Strategies fr Building and Maintaining an Effective Bard). 9

10 C. Develping an Enhanced Skills Matrix 1. A Fur-Part Apprach t Bard Cmpsitin A high functining Bard is cmprised f individuals with the range f knwledge, expertise, experience and persnal attributes that, put tgether, enables the Bard t fulfill its rle n behalf f the FHT/NPLC s Members and ther stakehlders. When thinking abut the Bard cmpsitin there are multiple factrs t cnsider - Bylaw requirements fr Bard membership, key skills and knwledge fr gvernance leadership, and diversity f individual skills and perspectives t reflect the peple and cmmunity served. Yet very ften a Bard skills matrix fcuses nly n a small subset f these the prfessinal qualificatins r skills. This tlkit presents a mre hlistic apprach t thinking abut Bard cmpsitin that includes, but is nt limited t, thse skills. It prvides a framewrk fr thinking abut the different aspects f Bard cmpsitin thrugh fur sequential filters: Filter 1: General Characteristics fr Bard Leadership Filter 2: Characteristics t Reflect the Organizatin s Members and Missin Filter 3: Skills and Experience fr Effective Gvernance Filter 4: Individual Characteristics t Reflect Our Cmmunity Each filter is described in detail belw and a sample Bard Cmpsitin Planning tl using the fur filters is fund in Appendix B. There are several pints t keep in mind when lking at the cmpsitin planning tl in relatin t yur FHT/NPLC Bard: - Many FHTs and NPLCs already take this brader apprach when thinking abut Bard cmpsitin Appendix B is a suggested apprach t dcument this thinking. 10

11 - There is n ne-size fits all apprach t the make-up f a Bard. The tl is a guide and each FHT/NPLC can custmize the cntent f each filter. - The tl is nt intended as a checklist f equally imprtant characteristics. Sme are musthaves (i.e. the skills required by MOHLTC in the new FHT cntract) while thers may be nice t have but ptinal. - The cmplete list f must-have and ptinal characteristics f a Bard may change ver time depending n the FHT/NPLC s pririties and circumstances. Fr example, if the FHT/NPLC is undertaking a significant capital prject, the desire t have smene n the Bard with capital planning r capital financing expertise culd be mved frm ptinal t a must have gvernance skill fr at least the perid f the capital prject. - Once the Bard cmpsitin planning tl is develped fr yur wn Bard, it becmes a reference fr the Bard s annual recruitment effrts and its use can be integrated int existing Bard plicies n Bard recruitment and nminatin/electin. 2. Develping r Enhancing Yur Bard s Cmpsitin Matrix This sectin prvides a step-by-step discussin f hw t develp r enhance yur FHT/NPLC s Bard skills matrix. A sample tl is included as Appendix B. Filter 1: General Characteristics fr Bard Leadership This filter cnfirms the expectatin that every Bard member will demnstrate a cmmitment t the FHT/NPLC and certain leadership characteristics required f every Bard member. It establishes a cmmn fundatin f cmmitment and perfrmance acrss the Bard and addresses the ften-heard criticism that a skills-based Bard results in a grup f highly skilled prfessinals but with n cmmitment t the rganizatin. This filter culd include the fllwing: Filter 1: General Characteristics fr Bard Leadership - that the Bard member is, r will becme, a member f the crpratin (likely required in yur FHT/NPLC Bylaw). - that they are cmmitted t the FHT/NPLC Missin. - the general leadership skills expected f each Bard member such as wrking cllabratively and willing t cmmit the time required. - that each Bard member cmmits t fllwing the FHT/NPLC s cnflict f interest rules. - any ther requirements f Bard members stated in the Bylaw r identified by the FHT/NPLC. 11

12 Filter 2: Characteristics t Reflect the Membership and Missin This filter sets ut the desired prfile f the Bard as a whle t reflect the FHT/NPLC membership and its Missin. It prvides a place t dcument any Bard membership r cmpsitin requirements set ut in the Bylaw and t establish any ther characteristics yur FHT/NPLC feels are essential t reflect the members r Missin at the Bard table. It culd include: Filter 2: Characteristics t Reflect the Members and Missin - different gegraphic areas if yur FHT/NPLC cvers a large and/r diverse gegraphic area and it is imprtant t have Bard members frm different regins. - different FHT/NPLC prgrams (such as mental health, addictins, geriatrics) if there is a desire t have Bard members with knwledge f varius prgrams acrss the rganizatin. - (if yur FHT membership includes physicians and/r there are physicians n the Bard) a crsssectin f physician characteristics including practice area, stage f practice, practice setting and practice type. - a variety f physician services grup types if there are multiple in yur FHT. - any ther characteristic deemed imprtant t reflect yur FHT/NPLC membership and Missin. Filter 3: Skills and Expertise fr Effective Gvernance This filter fcuses n the skills and expertise required n the Bard as a whle. A skill may be held by ne r mre individuals n the Bard but it is expected that at least ne persn will have mre than a general level f knwledge. Fr FHTs, this filter wuld include at minimum the skills listed in the new FHT cntract. Filter 3: Skills and Expertise fr Effective Gvernance - skills cnsidered essential fr at least ne persn t have n the Bard t supprt the Bard s gvernance rle and respnsibilities, including: Clinical/Prgram Management Human Resurces Management Financial Management/Audit Risk Management Strategic Planning Quality Imprvement Perfrmance Measurement Gvernance/Accuntability Management 12

13 - ther skills such as Legal, Dispute Reslutin, Cnflict f Interest, Public Cmplaints, IT, Cmmunity Relatins, Capital Planning. Filter 4: Individual Characteristics t Reflect Our Cmmunity This final filter prvides a place fr the FHT/NPLC t identify the extent t which the Bard as a whle shuld reflect the diversity f the cmmunity. Sme Bards cnsider this a pririty given their membership and Missin and make extra effrt t reach ut and attract qualified Bard members frm many different parts f the cmmunity. It is up t yur FHT/NPLC t determine yur wn apprach and whether certain characteristics are mre imprtant given yur membership, yur patient ppulatin and yur cmmunity. This filter culd include: Filter 4: Individual Characteristics t Reflect Our Cmmunity - Gender - Sexual rientatin - Language - Specific ethnic/racialized/cultural grups - Other ppulatins r grups in the cmmunity. D. Enhancing the Skills-Based Capacity f the Bard This sectin utlines fur steps t enhancing the skills-based capacity f the Bard building n the apprach t Bard cmpsitin described abve. On many Bards, the actins described belw are delegated t a nminating r gvernance cmmittee but fr ease f reading, they are described here as actins f the Bard. Step 1. Assess and Identify Skills Gaps Sme Bards review their Bard makeup annually while thers d it infrequently r as vacancies ccur. It is gvernance best practice t assess the Bard s cmpsitin annually t ensure it has the skills needed t fulfill its gvernance rle. The assessment als helps t infrm skills pririties fr future recruitment and nging Bard discussins abut successin planning n the Bard. The FHT cntract requirement that FHTs review their Bard skills annually is in line with this practice. The skills matrix is a key tl fr assessing the verall makeup f the Bard and each Bard can create a matrix t reflect the cmplete set f characteristics, skills and experience desired n the Bard. 13

14 Appendix A is a cpy f the skills matrix required by MOHLTC and it fcuses n required skills and experience t be fund r the Bard, r accessible t the Bard thrugh ther means. Appendix C is a sample f a brader skills matrix built upn the fur filters f the Bard cmpsitin tl n Appendix B, with the MOHLTC skills requirements included within. The matrix is filled in with prfiles f each Bard member. Often each Bard member cmpletes their wn prfile and these are cmpiled int a single matrix fr the Bard. Once a Bard member s prfile is cmpleted the first time, they can simply update it in subsequent years. Fr example, a Bard member wh has recently cmpleted a curse in risk management may nw rate their risk management skills as a 3 rather than a 1 as identified in the past. Once there is a cmpsite picture f the Bard s current makeup, the Bard can then assess whether there are certain characteristics r skills missing n the Bard that need t be filled thrugh future recruitment, Bard educatin r by accessing the expertise in ther ways. There are a few ther things t keep in mind when assessing yur Bard s current cmpsitin: - Sme skills gaps are mst easily identified (such as whether there is a financial r legal expert n the Bard) but identifying gaps in ther aspects f Bard makeup, such as whether the Bard adequately reflects an apprpriate crss-sectin f the physician membership is mre f a judgement call by thse ding the assessment. - It is nt uncmmn fr sme individuals filling in a Bard skills matrix t rate their wn skills mre highly than thers might. This is nt an exact science and the Bard must use its wn judgement in assessing whether additinal expertise is needed by the Bard. - Having smene n the Bard with a specific qualificatin r high level f skill enhances Bard discussins but des nt make that persn slely respnsible fr that area f Bard decisin making. Decisins are made by the Bard as a whle and every Bard member is respnsible t ensure they feel prperly infrmed and understand the issues befre making a decisin. - Underlying any assessment f Bard skills is the assumptin that the Bard is supprted by an effective and experienced management team. Assessing the Bard s cmpsitin is abut determining the ptimal makeup f the Bard t fulfill its fiduciary, strategic and versight respnsibilities, nt t take the place f r t re-d the wrk f management. Step 2. Develp a Plan t Enhance Bard Skills The main gal f building a skills-based Bard is always t achieve the mst highly skilled and experienced grup f peple as pssible arund the Bard table. While the surest way t achieve this is t recruit skilled peple t the Bard, there are ther appraches t bringing needed skills and expertise t the Bard. The fllwing are strengths and challenges f varius cmmn appraches. 14

15 APPROACH STRENGTHS CHALLENGES Recruit smene t the Bard with specific skills/expertise - Brings the expertise right nt the Bard where it is part f part f all Bard deliberatins. - Can be challenging t find and recruit a suitable candidate. Supprt the educatin f ne r several Bard members interested in a specific subject r skill Increase the whle Bard s knwledge f a key area f Bard respnsibility (such as quality) Hire an expert t advise the Bard n specific tpics r Bard matters (such as legal r IT) Establish an advisry grup t the Bard with prcesses that ensure its advice directly infrms Bard decisins Recruit experts t Bard cmmittees (rather than the Bard - Brings the expertise right nt the Bard where it is part f part f all Bard deliberatins. - Prvides a benefit t the vlunteer Bard member. - Up-skills the whle Bard which imprves verall Bard functining in a subject area. - Prvides the Bard with specialized expertise when needed. - Engaging the same expert ver time ensures their familiarity with the rganizatin, its pririties and stakehlders. - Engages a brader grup f stakehlders t infrm Bard decisins. - Purpse f the advisry grup can be tpic-specific (such as a Cmmunity Advisry Cmmittee during strategic planning) r have an nging and general fcus (such as a standing Patient and Family Advisry Cuncil). - Expertise is integrated int cmmittee deliberatins and recmmendatins t the Bard - Cst f Bard educatin prgrams and curses. - Additinal time cmmitment fr the vlunteer Bard member. - Sme areas (such as financial, legal) require a higher level f expertise than the whle Bard is likely t develp. - Can be cstly. - Expertise is ften tpic specific and time limited. - Expertise is nt integrated int nging Bard deliberatins and decisin-making. - Recruiting and supprting a vlunteer advisry grup (in additin t the Bard) requires resurces. - Additinal Bard time required fr advisry grup meetings. - The Bard must seriusly cnsider the advice (nt windw dressing) and demnstrate that the advice impacted Bard decisins. - Advice is ne step remved frm the Bard and nt available during Bard discussin and decisins. 15

16 Step 3. Fcus Recruitment t Address Gaps Sme Bards will have a systematic Bard recruitment prcess while ther Bards will take a much less frmal apprach t recruiting individuals t the Bard. Regardless f yur prcess, the essential element t building a skills-based Bard is t put the skills and experience yu want at the centre f the recruitment. The fllwing are sme cmmn ways t bring a skills-based fcus t Bard recruitment: - Create a recruitment annuncement r letter highlighting the desired skills A sample letter fr recruiting external cmmunity members is prvided in Appendix D. A sample letter fr recruiting candidates frm within the FHT/NPLC is prvided in Appendix E. - Target cmmunicatins t places where yu are likely t find suitable candidates Fr example, if yu are lking fr individuals with knwledge f health care and prir Bard experience ask ther lcal health rganizatins (hspitals, cmmunity health centres, cmmunity service agencies etc.) t distribute yur recruitment ntice. - Ask peple t submit a brief statement f interest Ask candidates t describe their interest in vlunteering n the Bard and their backgrund/qualificatins including hw they meet any specific skills r experience the Bard is lking fr. - Review applicatins fr fit with yur Bard needs and skills matrix. - Interview a shrt list f candidates wh meet yur needs as well as thse wh have excellent qualificatins verall. On sme Bards, certain Bard seats are designed fr electin by a subset f the rganizatin s membership. While it can be mre challenging t find candidates with specific qualificatins the smaller the candidate pl becmes, it is still advisable t cmmunicate the Bard s needs t the subgrup f members and encurage them t take these needs int cnsideratin when electing individuals fr their designated Bard seat(s). Step 4. Enhance Bard Skills Thrugh Educatin Much f the discussin thus far has fcused n building Bard skills thrugh recruitment but a fcused and nging Bard educatin prgram is equally imprtant t building a highly skilled Bard. The fllwing are appraches t enhance yur Bard s skills thrugh educatin and training: - Orientatin f new Bard members Orientatin is essential fr new Bard members t becme active cntributrs at the Bard table. Orientatin shuld prvide a slid verview f the FHT/NPLC (including Missin, prgrams and services, finances, strategic plan etc.), its patients and ther stakehlders, and the Bard s rle and imprtant gvernance prcesses such as hw cnflicts f interest are managed. Orientatin fr new members shuld be held befre 16

17 their first Bard meeting and can be pen t existing Bard members wh wuld like at attend as a refresher. - Onging Bard educatin Many Bards set aside a certain amunt f time in the Bard calendar fr educatin. Tpics shuld be identified with the Bard s input and fcus n addressing identified knwledge gaps (i.e. strategic planning, risk management), tpics f Bard interest (i.e. cmmunity cnsultatin feedback) r backgrund fr a specific strategic issue cming later t the Bard fr decisin. - Skills develpment fr individual Bard members As resurces permit, Bard members shuld be encuraged t enhance their wn gvernance skills. This culd include taking curses n a specific skills area needed n the Bard, such as quality. E. Using This Tlkit All AFHTO members are encuraged t review this tlkit and adapt its cntents t yur needs. If yu have any feedback n this tlkit r wuld like further supprt in creating r enhancing yur skills-based Bard, please cntact: Bryn Hamiltn Prvincial Lead, Gvernance and Leadership Prgram Direct Phne: bryn.hamiltn@afht.ca 17

18 APPENDIX A MOHLTC-FHT Cntract Schedule A Appendix 2 NOTE: Belw is a cpy f the Cntract Schedule A Appendix 2 frm. It is prvided here nly as reference. The actual frm t be cmpleted and submitted is prvided by the Ministry in Excel frmat. Bard Members Bard Member 1 Bard Member 2 Bard Member 3 Bard Member 4 Bard Member 5 Bard Member 6 Bard Member 7 Name Current Psitin n FHT Bard Years n FHT Bard Knwledge, Skills, Experience Indicate yur knwledge, skills and experience fr each categry: Advanced = 3 Gd = 2 Fair = 1 Nne = 0 Strategic Planning Clinical Skills* Prgram Develpment Human Resurces Management Financial Management/Audit Risk Management Quality Imprvement Perfrmance Measurement Gvernance/Accuntability Management Other** (specify) Other** (specify) Other** (specify) Cmments (ptinal) Bard Member 1 Bard Member 2 Bard Member 3 Bard Member 4 Bard Member 5 Bard Member 6 Bard Member 7 * Clinical skills culd cme frm clinicians affiliated with the FHT r frm smewhere else in the cmmunity **Other categries can include Legal, Dispute Reslutin, Cnflict f Interest, Public Cmplaints, IT, Cmmunity Relatins, Capital Planning Where there are gaps in the categries abve (i.e. scre f 0 r 1 fr all bard members), hw des the rganizatin plan t acquire these skills in ther ways? E.g. cmmunity members/external resurces n bard cmmittees, r special advisrs t supprt the bard.

19 APPENDIX B Sample Bard Cmpsitin Planning Tl NOTE: This tl is intended as a guide and can be adapted by a FHT/NPLC t suit yur wn Bard cmpsitin requirements and preferences. FILTER 1: GENERAL CHARACTERISTICS FOR BOARD LEADERSHIP PURPOSE Establishes a desired prfile f every individual n the Bard. Any persn with these characteristics is eligible t be cnsidered fr a Bard psitin. INDIVIDUAL CHARACTERISTICS - Member f FHT/NPLC (r becmes a Member within a perid f time defined in Bard plicy) - Cmmitment t the FHT/NPLC including its Missin, Visin, Values - Demnstrated leadership skills (cnsensus builder, change agent, able t wrk effectively as part f a team) - Cmmitment t identify and manage cnflicts f interest - Ability t cmmit the time and effrt required f the psitin FILTER 2: CHARACTERISTICS TO REFLECT THE MEMBERS AND MISSION PURPOSE Membership f the Bard as a whle shuld reflect the variety f characteristics f the FHT/NPLC, its members and missin. The gal is a diversity f characteristics, nt a check beside each ne. Where there are ex ffici Bard member psitins r ther Bylaw requirements fr a Bard member t be elected n behalf f a grup f members thse are included in this filter. CHARACTERISTICS - Characteristics f the FHT/NPLC such as: - gegraphic areas/sub-lhin regins the FHT/NPLC serves - different FHT/NPLC prgrams (i.e. primary care, mental health, addictins, prenatal, etc.) - Patient ppulatins served - Characteristics f Physician Membership, such as: - Stage f practice (0-5 years, 5-10 years, years, ver 20 years) - Practice setting (remte, rural, twn, urban, suburban, inner city) - Practice type (sl, grup/nn-academic, grup/academic, etc.) - Physician Services Grup type(s) within the FHT (i.e. FHNs, FHOs, Rural and Nrthern Physician Grup) - Characteristics f Nn-Physician Membership (if applicable), such as - Inter-prfessinal practice - Other? - Characteristics t reflect cmmunity members f the FHT/NPLC - Experience in r cnnectin t ther health care sectrs and rganizatins, such as: - Lcal Health Integratin Netwrk(s) - Hspital(s) - Cmmunity Health Centre(s) - Lng-term Care hme(s) - Cmmunity services/hmecare - Cmmunity mental health and/r addictins services 19

20 APPENDIX B Sample Bard Cmpsitin Planning Tl (cntinued) FILTER 3: SKILLS AND EXPERTISE FOR EFFECTIVE GOVERNANCE PURPOSE T prvide quality gvernance, exercise due diligence n behalf f the Members and meet MOHLTC cntract requirements, certain skills are required t supprt Bard decisin-making. A skill may be held by ne r mre Bard member. If a skill is nt held by at least ne persn, the Bard can acquire it in ther ways, such as thrugh educatin r retaining external expertise. AREA OF EXPERTISE - Skills listed in the MOHLTC/FHT cntract: - Clinical/Prgram Management - Human Resurces Management - Financial Management/Audit - Risk Management - Strategic Planning - Quality Imprvement - Perfrmance Measurement - Gvernance/Accuntability Management - Other skills and expertise t cnsider per the cntract: - Legal, Dispute Reslutin, Cnflict f Interest, Public Cmplaints, IT, Cmmunity Relatins, Capital Planning FILTER 4: INDIVIDUAL CHARACTERISTICS TO REFLECT THE COMMUNITY SERVED PURPOSE A diversity f these characteristics acrss the Bard as a whle strengthens the Bard s ability t reflect and understand the needs f the cmmunity the FHT/NPLC serves. CHARACTERISTICS - A range f persnal characteristics fund in the cmmunity - Gender - Language - Francphne/Other Language in the cmmunity - Cultural Backgrund - Sexual rientatin - Other ppulatins r characteristics in the cmmunity that are imprtant t the FHT/NPLC FHT/NPLC BOARD 20

21 APPENDIX C Sample Fur-Part Bard Skills Matrix NOTE: This matrix can be adapted by a FHT/NPLC t suit yur wn Bard cmpsitin requirements and preferences. It is nt t be submitted t MOHLTC. Bard Members Bard Member 1 Bard Member 2 Bard Member 3 Bard Member 4 Bard Member 5 Name Dr. Jsie Rssi Dr. Bb Jnes Marc La Fntaine Current Psitin n the Bard/Years n the Bard Treasurer/5 Member/10 Cmmunity Member/2 General Characteristics fr Bard Leadership (required) - Member f FHT/NPLC Yes Yes Yes - Cmmitment t Visin, Missin, Values Pririties Yes Yes Yes - Cmmitment t identify/manage cnflicts f interest Yes Yes Yes - Leadership skills required f all Bard members Yes Yes Yes Characteristics t Reflect the Missin and Members - Gegraphic area Nrtheast Suth Suth - FHT prgrams assciated with Prenatal N/A - Stage f Practice 5-10 years Over 20 years N/A - Current Practice Setting Suburban Rural N/A - Practice Type Grup-academic Sl N/A - Experience/cnnectins with ther sectrs N/A Hspital Lng-term care, CCAC Skills and Experience fr Effective Gvernance - Clinical/Prgram Management Human Resurces Management Financial Management/ Audit Chartered Accuntant - Risk Management Strategic Planning Quality Imprvement Perfrmance Measurement Gvernance/Accuntability Management Cmmunity Relatins (ptinal) Legal (ptinal) Individual Characteristics t Reflect the Cmmunity Served - Gender/Sexual rientatin (ptinal) F M LGBTQ - Language(s) English, Italian English English, French - Cultural backgrund/cmmunity (ptinal) English, Italian English, Irish Algerian 21

22 APPENDIX D Sample Bard Recruitment Letter (External) NOTE: This letter can be adapted by a FHT/NPLC t suit yur wn Bard recruitment prcess and needs. SAMPLE LETTER: Dear, (FHT/NPLC Name) is recruiting vlunteers t serve as Directrs n ur Bard (ptinal additin: r as members f Bard Standing Cmmittees). We welcme applicatins frm individuals wh are passinate abut primary care and embrace ur Visin and Missin. Our skills-based Bard is a reflectin f ur membership and diverse cmmunity and we welcme applicants with a brad range f backgrunds, perspectives and experiences. At this time, we are particularly interested in candidates with any f the fllwing (adapt list as needed): - strng business acumen - quality imprvement experience in a healthcare setting - gvernance experience including prir experience n ther Bards r Bard cmmittees - backgrunds and relatinships in the varius gegraphic and ethn-cultural cmmunities that ur FHT/NPLS serves. The culture f ur Bard is very psitive striving fr excellence and innvatin thrugh penness, mutual respect, healthy debate and strategic thinking. We pride urselves n ur ability t wrk effectively with each ther, as well as with management and external stakehlders. We are cmmitted t prviding the best care fr ur patients and cntributing t a strnger health care system in ur cmmunity. Candidates shuld be driven by the same gals and pririties. (add shrt descriptin f the FHT/NPLC as an rganizatin, its services, strategic plan etc.) If yu are interested in helping t shape the future f ur rganizatin, please cntact (insert name and cntact infrmatin) t request infrmatin abut the applicatin prcess. The deadline fr receipt f applicatins is (insert date). Sincerely, (Chair f Bard r Nminating Cmmittee) 22

23 APPENDIX E Sample Bard Recruitment Letter (Internal) NOTE: This letter can be adapted by a FHT/NPLC t suit yur wn Bard recruitment prcess and needs. SAMPLE LETTER: Dear clleagues, (FHT/NPLC Name) is recruiting vlunteers t serve as Directrs n ur Bard (ptinal additin: r as members f Bard Standing Cmmittees). As part f ur rganizatin yu play an imprtant rle in ur FHT/NPLC achieving ur cllective Visin and Missin. We are lking fr clleagues wh are interested in furthering their cmmitment t ur Missin thrugh a leadership rle n the Bard/Bard cmmittee. Our skills-based Bard is a reflectin f ur membership and ur diverse cmmunity and we welcme applicants with a brad range f backgrunds, perspectives and experiences. At this time, we are particularly interested in candidates with any f the fllwing (adapt list as needed): - strng business acumen - quality imprvement experience in a healthcare setting - gvernance experience including prir experience n ther Bards r Bard cmmittees - backgrunds and relatinships in the varius gegraphic and ethn-cultural cmmunities that ur FHT/NPLS serves The culture f ur Bard is very psitive striving fr excellence and innvatin thrugh penness, mutual respect, healthy debate and strategic thinking. We pride urselves n ur ability t wrk effectively with each ther, as well as with management and external stakehlders. We are cmmitted t prviding the best care fr ur patients and cntributing t a strnger health care system in ur cmmunity. Candidates shuld be driven by the same gals and pririties. If yu are interested in helping t shape the future f ur rganizatin thrugh a leadership psitin n the Bard, please cntact (insert name and cntact infrmatin) t request infrmatin abut the applicatin prcess. The deadline fr receipt f applicatins is (insert date). Sincerely, (Chair f Bard r Nminating Cmmittee) 23