Family Health Teams

Advancing Primary Health Care

Guide to Business Plan and Operational Plan Development

Updated July 2009 Version 3.0

Table of Contents
Introduction ............................................................................................................................................ 3 1. Purpose .............................................................................................................................................. 3 2. Background ....................................................................................................................................... 4 2.1 Business Plan and Operational Plan Summary................................................................................. 4 2.2 What is a Business Plan and Why is it Needed? .............................................................................. 4 2.3 What is an Operational Plan and How is it Different from a Business Plan? ................................. 4 2.4 Your Business Plan and Operational Plan Checklist ...................................................................... 4 3. Business and Operational Planning Framework................................................................................ 6 3.1 Planning Principles:.......................................................................................................................... 6 3.2 Planning Outcomes: ......................................................................................................................... 6 3.3 Quality Improvement and Innovation Partnership ........................................................................... 6 4. Business Plan Elements..................................................................................................................... 7 4.1 Required Elements ........................................................................................................................... 7 4.1.1. Governance and Accountability Structure.................................................................................... 7 4.1.2. Family Health Care Services ........................................................................................................ 7 4.1.3. Human Resources......................................................................................................................... 8 4.1.4 Collaborative Team Practice ......................................................................................................... 9 4.1.5 Physical Location(s) ...................................................................................................................... 9 4.1.6 Information Technology................................................................................................................ 9 4.1.7 Other Programs.............................................................................................................................. 9 4.1.8 Evaluation...................................................................................................................................... 9 4.2 Business Plan: Summary of Timelines........................................................................................... 10 5. Operational Plan (Budget/Service Plan) Template......................................................................... 10 5.1 Instructions ..................................................................................................................................... 10 5.2 Service Plan .................................................................................................................................... 10 5.3 Operational Budget......................................................................................................................... 11 6. Business Plan and Operational Plan Review and Approval............................................................ 11 7. Appendices ....................................................................................................................................... 12 Appendix A: Contact Information Template........................................................................................ 12 Appendix B: Quick Reference Form Critical Details........................................................................ 13 Appendix C: List of Family Health Team Services ............................................................................. 14 Core/Comprehensive Care/ Services (mandatory) ............................................................................... 14 Special Services/ Programs .................................................................................................................. 14 Optional Services ................................................................................................................................. 14 Appendix D: Where to Get More Information ..................................................................................... 16

Introduction
Family Health Care for All The implementation of Family Health Teams is part of the governments Family Health Care for All Strategy, which will improve access to comprehensive family health care for all Ontarians. Through Family Health Teams, patients are able to establish a continuous relationship with health care providers for comprehensive, family health care close to home. As a collaborative team practice, Family Health Teams emphasize health promotion and improved management of chronic disease through both treatment and monitoring, as well as support their patients in improving self-management skills. Keeping patients healthier and chronic disease better managed are key to reducing Emergency Room visits. Family Health Teams are locally driven family health care delivery organizations that include family physicians, nurse practitioners, nurses and a range of other interdisciplinary healthcare providers who are committed to working together collaboratively to provide comprehensive, accessible, coordinated family health care to a defined population, including patients who do not currently have a family physician (e.g. unattached patients). This approach allows physicians to work as part of a team with other health care providers to focus on keeping patients healthy. The vision allows physicians, nurse practitioners and other members of the team to practice together in a positive working environment, sharing and benefiting from the complementary knowledge and skills of their colleagues. New Family Health Teams will support other Ministry of Health and Long-Term Care (the ministry) initiatives including: enrolment of unattached patients, integrated cancer screening, and chronic disease prevention and management, with an increased focus on diabetes in support of Ontarios Diabetes Strategy. If your Family Health Team has not already received funding to support the development of your business and operational plan, please refer to the Guide for Development Grant Application. Additionally, this guide should be read in conjunction with other Family Health Team guides, including: Strategic and Program Planning, Interdisciplinary Provider Compensation, Physician Compensation, Collaborative Team Practice, Interdisciplinary Team Roles and Responsibilities, Chronic Disease Management and Prevention, Information Technology, and Transitional Funding. If you do not have a copy of these guides, please call your ministry contact. All guides are available at: www.health.gov.on.ca/familyhealthteams.

1. Purpose
This guide is intended to provide Family Health Teams with guidelines and requirements for developing the two components required for operational funding: A Business Plan that is a vision for the services and programs the Family Health Team plans to provide, including patient enrolment targets and staffing levels. The Business Plan should include a projection of the timing and costs to accomplish this. An Operational Plan that sets out detailed funding requirements for the Fiscal Year (April 1 to March 31). Each Family Health Team will submit annual Operating Plan for ongoing funding.

2. Background
2.1 Business Plan and Operational Plan Summary
All parties of your Family Health Team should agree to a governance and accountability structure and incorporate as a not-for-profit incorporation prior to the submission of a Business Plan and Operational Plan. Your Family Health Teams business and operational plans should build on the application submitted to the ministry and the initial feedback you received from your ministry contact. It is recognized that you may not adhere exactly to these initial plans as it is expected that they will evolve as you continue to consult, develop partnerships and assess both community and population needs. When estimating the length of your plans, we recommend that you be concise (including using the fewest number of pages possible). The length of the plan should correlate with your business scale and the objectives of the plan. Once your Business Plan and Operational Plan are submitted, the ministry will review and approve certain human resources, operational overhead and one-time costs through an agreement with the ministry. You will be expected to provide reports on progress in meeting your enrolment, program and service targets on recruitment and on financial expenditures. Please note that funding is allocated at the discretion of the ministry.

2.2 What is a Business Plan and Why is it Needed?

Preparing a Business Plan is a requirement to receive funding approval from the ministry for implementation of your Family Health Team. The planning process requires Family Health Teams to understand clearly what they want to achieve, as well as how and when they can reach those goals. The Business Plan is the vision for the Family Health Team and should set out a convincing case or rationale for the funding you are requesting to support the programs and services that you want to provide to your community. The Business Plan must include timelines, milestones and rationale for implementing the supporting infrastructure and resources needed to operationalize your Family Health Team. Not all Family Health Teams will require the same amount of time to become fully operational and, therefore, the timeframe in your plan should reflect your expectations.

2.3 What is an Operational Plan and How is it Different from a Business Plan?
The Operational Plan (budget/service plan) is completed on an annual basis (by fiscal year) and provides detail on the resource requirements for implementing the Business Plan. For the initial Operational Plan, you should consider what the costs will be when your Business Plan is fully realized, both ongoing operational and one-time costs. The ministry requires completion of both the Business Plan and Operational Plan in order to prepare and finalize a funding agreement with your Family Health Team that will describe your services, funding, deliverables and reporting requirements. This agreement will recognize a phased implementation process and funding that will be provided to support this implementation. In return, your Family Health Team governance body will commit to the provision of the services according to the agreed-upon plan with the ministry through a funding agreement.

2.4 Your Business Plan and Operational Plan Checklist

Planning and Budgeting Steps 4

 Below is a checklist of key steps to support the Family Health Team planning and budgeting process. Planning Steps Identify current status; Define future/proposed plan; Validate justification and assumptions; Identify and analyze options for achieving plan; Select best options and processes; Define key benchmarks (e.g. timelines for completing Business Plan and Operational Plan); Determine resources required; Identify major risks that may impact on plan achievement and create risk mitigation strategies; and Identify relevant performance management measures and evaluation criteria.

Working through the Business Plan and Operational Plan Requirements Below is a checklist of requirements that need to be addressed in your Family Health Team Business Plan and Operational Plan. Business Plan (Vision when Operational) Governance and organizational structure; Strategic and program planning; Population characteristics and enrolment plans; Implementation of collaborative team care, including service coordination with other organizations; Description of programs and services; List of providers, job descriptions and recruitment plans; Premises planning; Information technology and clinical information systems; and Timelines to becoming a fully operational Family Health Team.

Operational Plan (Annual Budget/Service Plan) Service Plan, including enrolment target; and Detailed annual resource requirements/budget.

3. Business and Operational Planning Framework

Recognizing that the transition to a new model of primary health care requires more than just the addition of new resources, Family Health Teams will have an opportunity to integrate quality improvement concepts and methods into their planning and activities from the outset.

3.1 Planning Principles:

The business and operational plans should: Increase efficiency with a proactive model of care that responds to the needs of populations as well as individuals, especially those who do not always receive the care they need; Promote a new role for the patient/client as a partner in her/his own care, and in the planning, implementation and evaluation of services; Support the ability for on-going consultation, partnership development and stakeholder engagement, as required; Facilitate a culture of mutual trust, transparency and accountability among all participants; Build on existing infrastructures, information and capacity; Ensure a balance when considering needs, resources, risks and opportunities; Leverage community resources and linkages; Foster a culture of evidence-based practice, enthusiasm for on-going learning and meaningful change; Support the continuing search for ways to improve the care that is delivered; and Be realistic and results oriented.

3.2 Planning Outcomes:

The business and operational plans should: Enable the successful achievement of the Family Health Team vision; Provide a solid foundation for effective and efficient Family Health Team service delivery that is responsive to the defined populations needs; Maximize the value of community and human resources; and Provide a critical path for Family Health Team implementation while allowing flexibility to make adjustments to implementation as a result of feedback and experience.

3.3 Quality Improvement and Innovation Partnership

The Quality Improvement and Innovation Partnership (QIIP), a non-profit transfer payment organization and a key partner in Ontario's Family Health Care for All Strategy, will be supporting the integration of quality improvement concepts and methods as the new Family Health Teams move forward in their planning and formation activities. For more information on QIIP, please visit their website at www.qiip.ca.

4. Business Plan Elements

4.1 Required Elements
Your Family Health Team will be in a position to develop a Business Plan once you have established your governance structure and are well into the process of identifying the vision and objectives of your team. You should have sufficient information about the community that you are planning to serve to allow you to identify the services and programs that could be offered to respond to the communitys needs. Your Family Health Teams vision and objectives should provide direction and a solid basis for planning each of the other elements that will be necessary (i.e. human resources, infrastructure requirements) for establishing and operating your team. Your Business Plan must begin with a summary of the status of your teams governance structure and strategic planning process and then build a case for the services and other elements that will enable your Family Health Team to achieve its objectives. 4.1.1. Governance and Accountability Structure Please refer to Guide to Governance and Accountability. Briefly describe the governance and accountability mechanisms that your Family Health Team has established, including: Type of governance structure/body (community, provider, mixed) and composition; Legal arrangement (name of not-for-profit incorporation) and copy of letters patent; Family Health Team name and contact information [name of proposed Family Health Team must include the words Family Health Team, e.g. ABC Family Health Team (see Appendix A)]; Name of entity or sponsoring organization that will receive and be accountable for funding; Authorized signing officer(s); and Bank Account details for funds: name of bank, bank account number, branch address, account holder name and, if possible, a void cheque should also be provided.

4.1.2. Family Health Care Services

Strategic Plans Please refer to Guide to Strategic and Program Planning and Guide to Patient Enrolment. Describe your Family Health Teams strategic plan, including: The population that the Family Health Team will be serving and its characteristics (population size, geographic boundaries, demographics, health conditions, etc.); Objectives and how they address population needs and service gaps; and Provide information on current numbers of enrolled patients/clients (if applicable) and anticipated numbers to be enrolled, the percentage of these new patients who currently do not have a primary physician, and how this will be achieved.

Core and Special Services/ Programs

For more details also refer to Guide to Collaborative Team Practice, Guide to Chronic Disease Management and Prevention, Guide to Health Promotion and Disease Prevention, and Guide to Local Community Integration. Confirm your intention to provide, or ensure the provision of the full spectrum of core/comprehensive Family Health Team services For each of the proposed core and special services/programs requiring an interdisciplinary team include the following: The name of the proposed programs or service; A brief description of the service/program, including objectives, and how it will address population requirements; Needs and service gaps, and the proposed location of the program/service (e.g. Family Health Team practice site, partner organizations, community); 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; Examples of providers that will provide core family health care services to patients within the proposed Family Health Team, include family physicians, nurse practitioners, nurses and a range of other interdisciplinary healthcare providers who are committed to working together collaboratively; 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; Identify key milestones and timelines for the roll-out of the services/program, including establishing linkages with other service delivery organizations; and A description of plans to measure success of each service/program including plans for ongoing improvement.

4.1.3. Human Resources

Please refer to Guide to Physician Funding, Guide to Interdisciplinary Team Roles and Responsibilities, and Guide to Interdisciplinary Provider Compensation. Provide a brief description of Family Health Team staffing plans, including: A list of existing and proposed staff showing full-time equivalency (based on 40hours per week), including physicians, interdisciplinary healthcare providers and administrative staff ; Job descriptions; and Qualifications.

Identify key milestones and timelines for implementing the staffing/recruitment plans. For those providers already committed, indicate approximate commencement date and attach a letter of commitment; and Identify the method of approved Family Health Team physician compensation and what the current compensation model is for existing physicians (where applicable).

4.1.4 Collaborative Team Practice

Please refer to Guide to Collaborative Team Practice and Guide to Interdisciplinary Team Roles and Responsibilities. Identify how the interdisciplinary team will contribute to achieving the Family Health Team objectives (if already discussed. please refer to the relevant section); and Identify and justify any training requirements to support collaborative care.

4.1.5 Physical Location(s)

Please refer to Guide to Transitional Funding and the Guide to Independent Health Facilities Licensing 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; and Identify key milestones and timelines for addressing the main components of Family Health Team premises preparation, including the need for licensing for special services (if relevant).

4.1.6 Information Technology

Please refer to Guide to Information Technology Indicate whether information technology (IT) funding has already been received, relevant program/source of funding, as well as status of IT implementation; If IT systems have not yet been implemented, indicate key milestones and anticipated timelines for implementing main components; For any IT resources that you will be requesting from the ministry, identify which team members these IT resources will support (Note: the cost of physician IT is NOT supported through Family Health Team funding); and Physician IT is available through OntarioMD.

4.1.7 Other Programs

Identify key milestones and estimated timelines for implementing plans for any research, teaching or other programs not already discussed.

4.1.8 Evaluation

If not addressed above, describe your plans for evaluating Family Health Team effectiveness, or how well the Family Health Team is achieving its intended goals and objectives according to the strategic plan. In the early stages of your Family Health Team, the evaluation could focus on short-term changes that are experienced by providers, patients or the broader community (e.g. patient and/or provider satisfaction, increased level of collaborative care, better management of health conditions, enhanced access to care) for Ontarians without a health care provider.

4.2 Business Plan: Summary of Timelines

Provide a consolidated timeline incorporating the key elements identified in your Business Plan. The chart below is provided only as an example and is not the required format. Example Gantt Chart
Sept. Oct. Nov. Dec. Jan. Feb. March April May June July Aug.

Formative Stage--------------------------Planning Stage -----------------------Pre-Operational Stage--------------- Operational Stage

Initial Meeting with MOH Choose Consultant Strategic and Program Planning Submit /Approval Business and Operational Plans Insurance, Benefits, Auditor

Physicians in Approved Model

Hire Admin Lead

Recruit Human Resources

Develop & Implement Programs

Determine Physical Location (s) & IT Plan

Capital Planning

Develop Community Partnerships/ Local Integration

5. Operational Plan (Budget/Service Plan) Template

The Family Health Team Operational Plan Template can be downloaded on the ministrys website at: www.health.gov.on.ca/familyhealthteams. It is an MS Excel Spreadsheet a separate document from the Guide to Business and Operational Plan Development.

5.1 Instructions
The Operational Plan (inclusive of the budget and Service Plan) template is to be used to confirm your annualized budget based on your Business Plan. Please review the instructions carefully before completing the Schedules.

5.2 Service Plan

Schedule 1 Service Plan

This schedule identifies the types of programs and services provided and the allocation of interdisciplinary healthcare providers to each of these programs and services. All programs and services identified in the Business Plan must be included in the Service Plan.

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5.3 Operational Budget

Schedule 2 Summary Schedule 3 Human Resources Schedule 4a Operating Overhead Costs Schedule 4b Premises Costs Schedule 5 Start-Up/One-Time Costs Schedule 6 Physician and Enrolment Information

Your budget should reflect principles of sound financial planning and management. It should be adhered to as closely as possible, as you move forward with implementation. Specify relevant components being contributed by community partners in the relevant column of the Family Health Team Operational Plan Template: Specify the name of the community organization and key contact person; Identify the status of the contribution (e.g. secured or anticipated date of securing); and Attach a letter of support.

Specify relevant components coming from other sources in the relevant column of the Family Health Team Operational Plan Template: Specify the name of any other contributing organization and key contact person; Identify the status of the contribution (e.g. secured or anticipated date of securing); and Attach a letter of support.

6. Business Plan and Operational Plan Review and Approval

Once the Business Plan and Operational Plan are completed, reviewed and approved by your Family Health Team governance body, they should be submitted, along with all supporting documentation (e.g. letters of commitment from physicians), to your ministry contact. The ministry will review and discuss your plans with you. Adjustments or further clarification may be needed before completion of the Family Health Team Funding Agreement is possible. Your Business Plan and Operational Plan should be submitted to the ministry for review by the date identified at your initial meeting with your ministry contact.

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7. Appendices Appendix A: Contact Information Template

Please include in your Business Plan: Name of Family Health Team Mailing Address Contact Information Contact Name: Tel.: Fax: Email:

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Appendix B: Quick Reference Form Critical Details

Please ensure your Business Plan includes: Total population served; Catchment area; Governance structure established; Current number of enrolled patients, total number of enrolled patients when fully operational and anticipated number of patients enrolled, who previously did not have a family physician (Ontarians without a health care provider); Plans for location(s), staff and services provided at each site; Core services; Special services/programs; Service partnerships; Type of funding partnerships and total contribution; Number and type(s) of providers; and Timeline to become fully operational.

Please ensure your Operational Plan includes: Service Plan with enrolment targets; Operational Budget for your Family Health Team at full operation; and One-time start-up costs (capital, information technology, furnishings and equipment).

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Appendix C: List of Family Health Team Services

The following is a list of core/comprehensive, optional and special services:

Core/Comprehensive Care/ Services (mandatory)

These services must be provided, coordinated or overseen by Family Health Teams. Health assessments (physical examinations); Diagnosis and treatment; Primary reproductive care (e.g. counselling on birth control and family planning); Primary mental health care (early identification and treatment of emotional and psychiatric illnesses and, where appropriate, collaborate with psychiatrists or the Family Health Team 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 homes (through formalized linkages, assist with discharge planning, rehabilitation services, out-patient follow-up and home-care services); Service coordination and referral (coordination of services among the Family Health Team and, where appropriate, referrals to other health care providers and agencies); Patient education and preventative care (e.g. development of self care tools and supports); Access to pre-natal, obstetrical, post-natal maternal care and in-hospital newborn care; Arrangements for around-the-clock care (through extended office hours and the Telephone Health Advisory Service); Chronic disease management programs; and Organized health promotion and disease prevention programs.

Special Services/ Programs

Programs targeted to specific population needs. For example, Diabetes Program may include: Lifestyle Counselling provided by Dietitian and/or Social Worker; Foot Care provided by Chiropodist; and Self-Assessment and Monitoring Education provided by Nurse Practitioner.

Special Programs may also include specialist services (e.g. psychiatry, internal medicine, geriatrics and paediatrics).

Optional Services
Depending on community needs and size, Family Health Teams may wish to provide a number of optional services. For example:

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X-ray, ultrasound, sleep studies, pulmonary function studies, nuclear medicine (IHF-licensed Services); Laboratory services; and Some minor day surgery.

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Appendix D: Where to Get More Information

Here is a list of the tools that can help your Family Health Team develop its Business Plan and Operational Plan Roadmap to Implementing a Family Health Team Guide for Development Grant Application; and Family Health Team Development Grant Agreement Guide to Governance and Accountability Guide to Strategic and Program Planning Guide to Chronic Disease Management and Prevention Guide to Health Promotion and Disease Prevention Guide to Physician Compensation Guide to Collaborative Team Practice Guide to Interdisciplinary Provider Compensation Guide to Interdisciplinary Team Roles and Responsibilities Guide to Community Funding Partnerships and Program/Service Integration Guide to Transitional Funding Guide to Information Technology Guide to Patient Enrolment Guide to Telephone Health Advisory Service (THAS) Guide to Independent Health Facilities Licensing

For Further Assistance

All potential Family Health Teams who have received conditional approval to proceed to the Formative Stage will be assigned a ministry contact. This ministry contact will be your guide to assist you to work through the details and options of establishing a Family Health Team. If you have not yet been assigned a contact, please see our ministry website for additional information: www.health.gov.on.ca/familyhealthteams. The Quality Improvement and Innovation Partnership (QIIP), a key partner in the Family Health Care for All Strategy, has developed a list of consultants with experience working with Family Health Teams, and will be providing mentorship opportunities for new Family Health Teams. For more information on QIIP, please visit their website at www.qiip.ca.

ISBN# 978-1-4435-0652-6 Cat. # 013376 July 2009 Queens Printer for Ontario

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