Apply for CARITAS Funding Bring forward your ideas to improve patient experience within the hospital "*" indicates required fields Proposal InfoTotal Amount Requested ($Cdn)* Amount must be in under $5,000 CDN, including taxes, delivery, and installationTitle of Project* Department* Team InfoTeam MembersNameDisciplineDepartmentEmail Add RemovePress plus symbol at the end of the row to add additional team members Have you applied to any other committees for funding through RCH Foundation?Check all that apply PAIF Major Equipment Auxiliary CARE AIM Quality Improvement CARITAS Other Please indicate what other funding you applied for:* Are you applying for a piece of equipment?*YesNoIs this item currently on the approved FHA capital equipment list?* Do you have supporting documentation? Please attach all – quotes, pictures, impact of use, etc. Drop files here or Select files Max. file size: 2 MB. Problem: Provide a summary of the problem you aim to solve.*Solution: How will you solve this problem?* AIM Statement: What do you plan to achieve? (with metrics)**See instructions belowMetrics. How will you know that a change or improvement has been made?**See instructions belowAIM Statement An AIM statement outlines what you are trying to achieve or accomplish through your patient experience project. This is your “North Star” that describes what success looks like for your project. How much? (outcome measure, numerical goal for the project) By when? (time frame) For what/whom? (target population, system, process, and/or setting) SMART Goal (specific, measurable, applicable, realistic and timely). Example: “To increase patient mobility on 4S by 50%”. Metrics Each project should have 1-3 outcome measures to track the impact of the funding. These measures are indicators that patient experience improvements have been made. Patient wait times Infection rates Patient satisfaction at discharge Reduced anxiety in patients Compliance to post-op care plan Example: “90% of patients feel the education reduced their anxieties regarding the procedure”. Review Project leaders must update the Foundation on the progress of their initiative every 6 months until completion. If further funding is required, the project leader can submit an application to for further funding to continue the project. What is working? What can be improve? Steps forward. Submit metrics. When approved, you will be forwarded a project status form to submit your metrics. BudgetCostsItemCost Add RemovePress plus symbol at the end of the row to add additional line itemsAdditional CostsTax, shipping, maintenanceItemCost Add RemoveTotal Cost* Department Manager SignaturePlease save the form and use the link to review with your department manager. Your manager's signature is required to proceed with the applicationName (print):* Signature*NameThis field is for validation purposes and should be left unchanged.
