Best Practice Champions for Smoke-Free Pregnancies Request for Workshop Host Sites

The Registered Nurses’ Association of Ontario (RNAO) is requesting applications from interested and eligible health care organizations engaged in primary care and working with pre and post natal women and their families in smoking cessation to act as a Host Site for a Best Practice Champions for Smoke-Free Pregnancies Workshop delivered on-site.

BackgroundEstablished in 2002, the Best Practice Champions Network® has engaged thousands of nurses and other health care professionals from across Ontario and hundreds more throughout Canada and the United States. The Best Practice Champions for Smoke-Free Pregnancies is a new workshop which will expand the reach of the Champions Network to those nurse practitioners and primary care nurses who work with pre and post natal women and their families in smoking cessation. All nurses and allied health providers who attend the one-day Best Practice Champions for Smoke-Free Pregnancies Workshop may participate in the Champions Network. The Champions Network provides Champions with access to a variety of resources and supports including e-bulletins, social networking, regular knowledge exchange teleconferences/webinars, additional workshops and other learning events on relevant topics, as well as funding opportunities to support further education and networking.

Funded by the Province of Ontario’s Ministry of Health and Long-Term Care, all Ontario-based Best Practice Champions for Smoke-Free Pregnancies Workshops and other continuing education offerings are provided free of charge.

The Best Practice Champions for Smoke-Free Pregnancies Workshop integrates a focus on the priority client population of pre and post natal women and their families to build capacity to those nurse practitioners and nurses who work in primary care and community sectors who work with pre and post natal women. The workshop’s global objectives as they relate to pre and post natal women and their families include the following:

1. To augment the knowledge and skills related to assessment, brief and intensive interventions related to smoking cessation

2. To enhance existing knowledge and skills related to interdisciplinary teamwork and leadership 3. Increase awareness of key resources in smoking cessation that can enhance effective primary care

service in smoking cessation 4. Utilization of RNAO’s Toolkit: Implementation of Best Practice Guidelines (2nd ed.), to more

effectively learn how to conduct a needs assessment and gap analysis in order to identify the

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practice change to be implemented, engage stakeholders, assess their organization’s readiness for change and develop a plan for implementing best practice recommendations in their work setting.

Partnership DescriptionThe RNAO is seeking Host Site Organizations who meet the criteria listed below and who are interested in hosting a Best Practice Champions for Smoke-Free Pregnancies Workshop.

While ongoing communication and engagement of Best Practice Champions for Smoke-Free Pregnancies at the Host Site and RNAO is expected following the workshop, the duration of this specific partnership opportunity between RNAO and the Organization will conclude following the delivery of the workshop(s).

Eligibility Criteria:The service provider is eligible to apply as a Host Site if able to meet the following requirements:

Demonstrated interest and involvement in evidence-based clinical practice through the implementation of RNAO best practice guidelines.

Priority given to those host sites in primary care, public health or home health care Commitment to supporting a cohort of their own staff to attend the workshop.

o The Host Organization may reserve a maximum of 40% of workshop spots for internal staff, with the balance to be reserved for external participants.

Availability of a space appropriate for a full-day interactive workshop in a configuration conducive to small group work (i.e., half round table set up).

o Workshop space must accommodate approximately 50 participants for a Best Practice Champions for Smoke-Free Pregnancies session.

o Note: Organizations located in Northern Ontario or rural areas may be eligible for flexibility with regard to room size.

Availability of related resources and technology/equipment to support such a workshop, including information technology support and facilities that can support catering.

Ability to host a workshop at a mutually agreeable time between June 2014 and February 2015. Ability to assist with promotion and marketing of the workshop within the Host Site and

surrounding community through existing networks. Ability to provide on-site logistical support during the planning for, delivery of and follow up

immediately after the workshop. While not a requirement, the capacity and logistical support to connect with the Ontario

Telemedicine Network within the workshop space would be considered an asset.

Please note that all Workshop facilitation and materials will be provided by RNAO staff and workshop facilitators. The Best Practice Champions for Smoke-Free Pregnancies Workshop program funding does not allow for alterations or customization of workshop content.

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Roles and Responsibilities

The role of the Host Sites will be as follows: Enter into an agreement with RNAO for hosting one or more full- day workshop(s), at a

mutually agreeable date. This will involve the provision of: a contact person, workshop space, support for logistical details such as the arrangement of catering, receiving and short term storage of workshop materials immediately in advance of and following the workshop, and necessary technical support.

Promote and market the workshop to participants within the Host Site and to other organizations within the region to support participant registration.

Commit to sending a cohort of their nursing staff to the workshop. Communication with RNAO regarding site details, workshop registration and other logistics. Provide appropriate set up of venue the day of the workshop including room set up (half

rounds of 4-6 chairs) and audio/visual equipment (microphone, laptop/computer, projector, screen, speakers, and flip chart paper).

The role of the RNAO in relation to the Host Sites will be as follows: The RNAO will fund all direct costs for the workshop, including costs related to the rental of

workshop space (as necessary), catering, workshop materials, any required equipment. The RNAO will be responsible for preparing all workshop materials. The RNAO will provide administrative support staff to assist with liaison and coordination

activities related to the workshop, including on-site logistics, coordination and registration. This may involve RNAO visiting the host site to ensure facilities are appropriate for the workshops to be provided. All expenses related to salary and expenses for the facilitator and any RNAO staff support will be the responsibility of RNAO.

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Instruction to Applicants:

1. Applications must be submitted using the form below (plus required attachments), and be received by the Registered Nurses’ Association of Ontario before 3:00 pm EDT on Thursday May 8, 2014.

2. Applications should be submitted via email, with all items requiring signature scanned at high resolution. Applicants will receive a confirmation email upon receipt of application.

3. Applications should be directed to:Katherine WallaceSmoking Cessation Program ManagerRegistered Nurses’ Association of Ontario158 Pearl Street, Toronto, Ontario M5H1L3kwallace@rnao.caPhone: 416-907-7957/ 1-800-268-7199 x205

4. Submission of an application is not binding, nor does submission guarantee acceptance. It is anticipated that RNAO will be unable to accommodate all applicants; however, every effort will be made to arrange alternate participation opportunities for Host Site Applicants who are not selected.

5. The RNAO has the right to cancel this Request at any time and to reissue it for any reason without incurring any liability and no applicant will have any claim against RNAO as a consequence.

6. A Review Committee established by the RNAO will review each submission. The RNAO reserves the right to determine the qualitative aspects of all proposals relative to the evaluation criteria.

Selection of Host SitesIn selecting Host Sites, RNAO will endeavour to address the following considerations:

Representation, parity and equitable distribution of workshop opportunities across Ontario and across sectors of care.

Anticipated success in engaging internal Champions in the implementation of best practice guidelines, as demonstrated by past successful efforts and/or future plans for implementation.

Cost effectiveness, particularly regarding workshop space and catering expenses. Partnerships and linkages with other health care providers are viewed as a strong asset for

applicants. RNAO is particularly interested in working with organizations that can leverage these connections to support promotion and dissemination of the workshop opportunity, and workshop registration.

The ability to offer a venue with the capacity and logistical support to connect with the Ontario Telemedicine Network is not required, but will be considered an asset.

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Best Practice Champions for Smoke-Free Pregnancies Workshop Host Site Application

All organizations interested in this opportunity must submit an Application, to be received by RNAO no later than 3:00 PM EDT on Thursday May 8, 2014. Applications should be sent via email to Katherine Wallace, Smoking Cessation Program Manager, at kwallace@rnao.ca, with all items requiring signature included via high-resolution scan.

ORGANIZATIONAL SUPPORT1. Organizational

ContactName of Organization:Name:Title:Mailing address:Phone Number:Email Address:The Local Health Integration Network (LHIN) in which the organization is located:

2. Please indicate your anticipated number of participants for the workshop (note that on average workshops are structured to work with a group of 50 participants.

4. In what period would your organization prefer to host the session(s)? If your organization is available during multiple periods, please indicate your first and second choice. June, July, August 2014 September, October, November 2014 December, January, February 2014/2015

5. Please provide a brief description of your Organization, including: Organizational Structure (i.e., single-site, multi-site, etc) Organization size (i.e., number of staff, clients registered, etc) Patient/client population served

Insert response using the space below (300 word limit):

6. Please provide information that demonstrates and supports the organization’s interest and involvement in evidence-based clinical practice through the implementation of RNAO best practice guidelines. For example, organizations may describe any past, current or planned experiences implementing RNAO best practice guidelines, or involvement in initiatives related

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to best practices, including strategies for engaging and integrating Champions.

Insert response using the space below (300 word limit):

7. Please provide a letter of support from Chief Nursing Executive/Officer, Executive Director or equivalent, confirming organizational support for this application. Letter should indicate support for involvement in this initiative, including support to enable a sizeable cohort of nurses from your organization to attend the workshop. Please attach this letter as an appendix.

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STRATEGIES FOR COLLABORATION AND DISSEMINATION8. All Host Sites must play a key role in promoting and marketing the workshop opportunity.

What strategies and approaches will the Organization employ to market and promote the workshop both internally and externally? What networks will be utilized for workshop promotion – how will you make your staff (internal) and other individuals and organizations in your area (external) aware of this opportunity? Please provide a detailed response. Examples of strategies may include descriptions of partnership agreements, and representation at regional or sector-specific bodies and/or initiatives

Insert response using the space below (300 world limit):

LOGISTICAL INFORMATION8. Who is

responsible for supporting on-site logistics?

Name:Title:Mailing address:Phone Number:Email Address:

9. Please provide a brief description of the proposed space to be used for the workshop, including the location. If available, please include room set up/capacity charts, pricing information, and other venue details as appendices.

Additionally, please respond to the following: What is the maximum room capacity when configured in a format conducive to small

group work (tables of 6-8)? _________________________ Are the building, workshop space and washrooms accessible for individuals who use

mobility devices? Yes NoComments:_____________________________________________________________

What technology and resources are available on-site to support the workshop? Microphone (wired/ wireless) Computer Flip Chart(s) Speakers/Sound Equipment Projector Projector Screen Other (please describe): ___________________________________________

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LOGISTICAL INFORMATION10. Does the workshop space have the ability to access the Ontario Telemedicine Network (OTN)?

Yes No Unsure

If so, would your Organization be willing to, and be capable of, supporting participation from other sites via OTN? Yes No Unsure

11. Please describe the capacity for catering at the workshop venue (i.e., catering can be made available within the room or in another nearby room; are there any challenges, restrictions or policies we should note, etc).

Insert response using the space below(300 word limit):

Does the venue/workshop space offer on-site catering? Yes No Unsure Is the use of on-site food services a requirement for using the space?

Yes No Unsure Do you have any relationships with external catering companies that you would

recommend for this event? Yes No Unsure

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REQUIRED APPENDICESPlease place a checkmark in the appropriate box to indicate that you have included the following appendices:

Letter of Support from Chief Nursing Executive/Officer , Executive Director or equivalent, confirming organizational support for this application (required)

Summary of Anticipated Costs, using RNAO Budget Template (required) Room-set up and/or capacity charts (optional) Other (please describe) _________________________________________

DISCLAIMER AND SIGNATUREPlease initial to indicate your agreement with the following:

_____ I understand that submission of this Application does not guarantee that my Organization will be selected as a Host Site.

_____ I understand that all Workshop facilitation and materials will be provided by RNAO staff and appointed consultants, and that workshop content may not be altered or customized.

_____ I understand that, if selected, no more than 40% of workshop spots may be reserved in advance for staff from the Host Site.

Applicant’s Signature: ______________________________________ Date _______________Name and Title (please print): _____________________________________________________ ____________________________________________________

For more information, clarification or assistance, please visit our website or contact Katherine Wallace, Smoking Cessation Program Manager:kwallace@rnao.ca/ 416-907-7957 / 1-800-268-7199 x205

This program is funded by the Government of Ontario’s Ministry of Health and Long Term Care

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Best Practice Champions for Smoke-Free Pregnancies Workshop Host Site Application Budget: Summary of Anticipated Costs

A completed budget outlining all direct financial costs associated with hosting Best Practice Champions for Smoke-Free Pregnancies Workshops at your site must be included with all applications. Please provide as much detail as possible.

Instructions to Applicants: Provide a budget for 50 participants. All costs should be listed as a dollar figure. Any in-kind support must be clearly identified as such. For example, under “Promotional and

Marketing Costs”, you may list “in-kind” as the Estimated Cost, with the Comment “Flyers to be circulated electronically and/or printed by Host Site”.

All costs related to administrative and/or logistical support provided by Host Site staff must be provided in-kind.

Budget Items and Notes Estimated Cost Comments/Explanation

Venue and Room Costs

All workshop spaces must support a small-group activity configuration, and accommodate up to 50 participants Food and Beverage Costs in a per person format with the anticipated number of 50 participants

Food and beverage costs should include:

A light breakfast (continental) A light lunch (e.g., sandwiches

and soup,/salad) A morning coffee break An afternoon coffee break Any delivery fees, dishes and

cutlery supplies/rentalsAudio Visual and Technology costs

The following must be available for all sessions:

Microphone and related speakers/amplification equipment

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Projector screen Technical assistance, labour or

set-up chargesIf any equipment needs to be rented, these expenses should be itemized here. RNAO will provide a projector and laptop if required.Promotion and Marketing CostsMiscellaneous (please specify)

Total

Where appropriate, please list and mark any costs related to OTN videoconferencing (e.g., bridging software fees)

Maximum Total Budget Request from RNAO

I declare that the above represents a reasonable estimate of all appropriate costs for hosting a Champions Workshop.

Applicant’s Signature: _________________________________________ Date _________________

Name and Title (please print): __________________________________________________________

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