Tool for applicants: examples of intervention projects

Applying to EXTRA

Application Process

Here are two examples of intervention project proposals from successful applicants to the 2004 EXTRA Call for fellowship applications. These are provided as illustration only and should not be used as exact models. Also, please note that the required components in the preparation of an intervention project proposal for the 2008 competition have been clarified and revised.

Applicants are now expected to provide the following details on the intervention project:

a statement of the problem or issue to be addressed and a preliminary description of the project
the link of the intervention project to EXTRA program objectives and evidence-based management including clear articulation of how the intervention project will be based on evidence from research
the importance of the intervention project to organizational priorities
a statement of expected outcomes
importance of the intervention project to broader system issues
the role of the applicant in the intervention project
consideration of possible ethical/privacy/confidentiality issues, if any exist.

Original texts have been edited to remove any potentially identifying information.

Proposal 1

Title	Introducing Advanced Practice Nurses to Promote Primary Healthcare in Rural [province]
Context	The community [...] is situated in the [region of province] and is part of the [Regional Health Authority], a vast geographic region covering over 232,000 kilometres in [region] with a population base of approximately 700,000 people. [Community] is a small, rural and remote community with approximately forty family practice physicians, and a variety of specialists serving just over twenty thousand residents.
Importance of the project to organizational priorities	One of the stated objectives of [Regional Health Authority] is to establish and maintain effective Primary Healthcare and Chronic Disease Management approaches which provide access to interdisciplinary teams, services and networks that promote shared care relationships, and encourage self-managed care.
Organizational support	The organization has demonstrated commitment to Primary Healthcare Initiatives as well as support for Chronic Disease Management by funding a variety of projects across [the region], including the Congestive Heart Failure Collaborative and the Diabetes Collaborative.
Statement of the problem or issue	The problem I have identified is the scattered and limited uptake of these initiatives by the family practice physicians within our community.
Link to evidence-based management Preliminary description of the project	In my intervention project I am proposing the introduction of an advanced practice Registered Nurse to work with the physicians in the community to promote a primary healthcare model. The nurse would work in the physician's office to support their participation in the Chronic Disease Management collaborative and develop initiatives related to health promotion, prevention and self-managed care. Other interdisciplinary team members would be brought into the clinic, including pharmacy, nutrition, respiratory therapy and physiotherapy to provide a range of education and early detection services. The timing for my proposed intervention project is excellent as far as readiness on the organization's part. Physician acceptance of the collaborative approach is growing across the region and the barrier that is frequently identified is time. I believe introducing this shared care model with an advanced practice nurse will be well supported.
Expected outcomes Importance of the intervention project to broader system issues	The impact of the work will be significant in helping to shape the future of primary healthcare within the [...] region and fits very well within the organization's strategic plan and objectives. The model will also be of value to other rural, remote communities across [the region]. Having [organizational sponsor] available to provide mentorship related to this research work significantly increases the likelihood of success and also lends credibility to the project.

Proposal 2

Title	Development and Implementation of a Balanced Scorecard
Preliminary description Statement of the problem/issue	The Balanced Scorecard, an approach to measuring performance of an organization which links measurement to strategy, was developed in 1992. It is a framework now used by over 50% of Fortune 1000 companies, but relatively few health care organizations, and almost no continuing care organizations. The [organization] is initiating the development of a balanced scorecard specific to the key dimensions of performance for the achievement of its mission and vision and strategic directions.
Goal and purpose Link to evidence-based management	The next step is to identify measures of performance which will enable the organization to monitor its progress in the areas that are critical to its strategy. Wherever possible these will be research based, and benchmarked with peer organizations. Evidence on successful implementation approaches will be used to roll out the measures corporately so that they are owned by the organization (i.e. do not become just another report in a dusty binder), and used to make strategic decisions. This approach will be modified as required and then used to move the process to sites across the organization so that front-line staff see how their day to day activities contribute to achieving the organization's mission and vision. The development of appropriate measures and implementing the scorecard corporately and at site levels, based on evidence of what does and does not work, will be the focus of the EXTRA project.
	Organizational Support for the Intervention Project
Importance of the project to organizational priorities	As noted earlier, this project has been identified as a high priority on the organization's three year strategic plan which was developed by the Executive Management Committee. A corporate steering committee chaired by the applicant has been established to develop and implement the corporate balanced scorecard. A workplan has been developed and is underway. The Corporate Best Practice Committee has agreed to support the development and implementation of "cascaded" balanced scorecards at the centre level once the corporate scorecard is in place.
	Potential Impact of the Intervention Project
Expected outcomes	This project will affect all programs within the largest public continuing care organization in the country. It will create an objective means of monitoring quality and progress on initiatives, which will feed into the ongoing strategic planning process. It is anticipated that this project will significantly change the culture of [the organization].
	Collaborative and Networking Opportunities
Importance of the intervention project to broader system issues	There are very few continuing care organizations (or healthcare for that matter) that have developed and implemented their own balanced scorecard system for monitoring performance. This project will provide a best practice model for others to use. Accountability and monitoring performance are critical within publicly funded health care organizations, and yet few have found useful tools for making this more than a paper shuffling exercise for the benefit of funders. All fellows will be able to contribute ideas to this project, and take back this learning to their organizations.