1 Board Orientation Session 2016Sections The Broader Context Four Villages: Community – Programs and Services Legislation Four Villages: The Organization Governance: Model and Tool Kit Four Villages: Operations What is the broader context in which the FVCHC operates in For reference throughout the year
2 Context, Brief History, Population HealthBoard Orientation 2016 Context, Brief History, Population Health
3 Medicare Canada Health ActCornerstone of our publicly funded Health Care System Bans: Extra-billing, User charges Ensures: All residents of Canada eligible Have access to medically necessary hospital & physician services Based on need and not the ability to pay Our medicare system is enshrined in the Canada Health Act
4 Canada Health Act - PrinciplesPublic administration Comprehensiveness Universality Portability Accessibility Public administration: administration of the health care insurance plan must be carried out on a non-profit basis by a public authority Comprehensiveness: all medically necessary services provided by hospitals and doctors must be insured Universality: all insured persons must be entitled to public health insurance coverage on uniform terms and conditions Portability: coverage must be maintained when moving or traveling within Canada, and when traveling outside Canada Accessibility: reasonable access by insured persons to medically necessary hospital and physician services must be unimpeded by financial or other barriers
5 CHC History - Ontario Started in 60s & 70sInspiration for CHCs in Ontario came from the Sault St. Marie group practice ? Started in Ontario in early 70s as an ‘alternative to fee-for- service’. Approach to introduce CHCs in Ontario (to prevent OMA opposition) was to target for “underserved and/ore marginalized communities and populations having issues with access to care” and then seek to spread for use by all Ontarians Today in Ontario, there are 73 CHCs serving 110 communities and 3.5% of Ontarians
6 Four Villages - Short History29 April Opens under the name “Frank O’Leary Community Health Centre” Changes name to “The Four Villages Community Health Centre” approval of Dundas Site - a satellite operation to improve access and meet health needs of those living in the Gooch-Cooper Mills, north High Park and Junction sections of the catchment area two sites: Bloor site – 1700 Bloor Street West Dundas site – 3446 Dundas Street West, Unit 2 2016 – Four Villages Celebrates 25th Anniversary
7 FOUR VILLAGES… VISION MISSION VALUESTo be a leader in building an inclusive, sustainable and healthy community MISSION Committed to the social determinants of health, The Four Villages Community Health Centre provides accessible, interdisciplinary primary health care, improving individual and community health. As an accredited, community based, publicly funded healthcare organization, we lead, advocate and engage in innovative collaborative approaches and partnerships. VALUES Collaboration, Respect, Empowerment, Excellence, Diversity
8 CHC Model of Care
9 AOHC & CACHC Association of Ontario Health Centres (AOHC)Provincial organization to assist CHCs with information sharing, coordination and advocacy Also the body from which CHCs secure electronic health record Four Villages is a member Canadian Association of Community Health Centre Centres (CACHC) Promotes a national CHC vision Four Villages is NOT a member CACHCA objectives: Promote national CHC vision Advocacy for CHCs to be to total populations Discuss and address common issues Information exchange & dissemination Promote the definition and role of CHCs
10 Four Villages’ FundingOperating funding and provincial oversight for Ontario CHCs were devolved from the Ministry of Health and Long Term Care (MOHLTC) to the LHINs in 2007 Capital funding approval remains with the MOHLTC Four Villages receives 98% funding from TCLHIN (other from City of Toronto; Ontario Trillium Foundation and donations)
11 Population Health Population health is the health outcomes of a group of individuals (usually defined within a geography), including the distribution of such outcomes within the group. It is an approach to health that aims to improve the health of the wholepopulation particularly for individuals who lack access to care or engage the system in the wrong place and times Population Health complements the Triple Aim goals of improving the patient experience of care, improving population health and reducing per capita cost....
12 Population Health Population Health [approach can] improve health outcomes by focusing on three inter-related approaches: Identifying and analysing the distribution of specific health statuses and outcomes within a population Identifying and evaluating factors the cause the health outcomes Identifying and implementing interventions that modify the determinants of health outcomes
13 Services Provided by Four VillagesPopulation Health Services Provided by Four Villages Give our voices (advocacy) to… D. Kindig. G. Ihsam,, “Population Health Improvement: A Community Health Business Model that Engages Partners in All Sectors” Frontiers of Health Services Management. Vol 30:4, Summer 2014 D. Kindig. G. Ihsam,, “Population Health Improvement: A Community Health Business Model that Engages Partners in All Sectors” Frontiers of Health Services Management. Vol 30:4, Summer 2014
14 Four Villages’ Strategic Plan
15 Population Health Promotion Framework
16 Four Villages OperationsOUR CLIENTS - PRIORITY POPULATIONS Seniors Families with children who are also newcomers Youth Areas of Focus: Mental Health and Additions; Chronic Disease Prevention and Management HOURS OF OPERATION Monday to Thursday: 8 a.m. to 8 p.m. Friday: 8 a.m. to 5 p.m. After Hours: Physician “On-Call” CATCHMENT AREA Roncesvalles/Dundas/CN tracks – St. Clair – Humber River – Lake Ontario Others as per partnership contracts (example: Early Years 2 Program) COMMUNITY NEEDS Needs assessments (as needed)
17 Collaboration Amongt CHCsRegional ED/CEOs Meetings CHC EDs from regional networks Toronto EDs Network meets monthly Provincial ED/CEOs’ Meetings Take place twice a year G7 & G3 NEW “LHIN Sub Regions” (Sector Collaborative tables being developed)
18 Our Communities Served “West Toronto Sub Region”Board Orientation 2016 Our Communities Served “West Toronto Sub Region”
19 Community We Serve & West Toronto Sub RegionThis is a map of our catchment area. To give you a better feel for the area, we have taken some pictures of sites where we offer a lot of programs, or that have special significance for Four Villages. The dots marking those sites.
20 Community Population of over 76,000 people 2011 census shows:22% to 33% of the families in The Four Villages’ neighbourhoods are composed of lone parent households Top languages spoken for non-English speaking households: Polish, Russian, Ukrainian, Serbian, Spanish, Portuguese, Vietnamese and Hungarian Lambton Baby Point - highest percentage of children (aged 0-19), 26.5%, High Park-Swansea has the highest percentage of seniors, 15.6% 23% to 41% of the seniors (aged 65 and over) live alone (High Park North %, City of Toronto %)
21 Community Four Villages community has higher than the City of Toronto prevalence of asthma and mental health problems The Junction has a high incidence of diabetes, chronic obstructive pulmonary disease (COPD), teen pregnancies, and low birth weights, with teen pregnancies and low birth weights higher than the City of Toronto Issues of substance abuse reported by staff of Four Villages and the CCAC
22 Community The areas of highest needs:Junction, south Swansea , Gooch, Cooper Mills and The Valley (Dundas West and Jane), 100 High Park Avenue and Quebec Avenue Higher levels of seniors living alone, lone parents, poverty and recent immigration The emerging problem at Gooch-Cooper Mills and Swansea Mews is gun violence. Very few services and programs exist to support the residents of these areas, with the exception of those offered through Four Villages
23 Snapshot of the Clients Served in 2015-16High diversity 38.6% of the clients seen last year are born in Canada 12% are newcomers (in Canada, 10 years or less) 72% listed English as their preferred spoken language, with Spanish/Castilian being the next most preferred language (8%) Top countries of origin: Canada, Mexico, Poland, Malta, Ukraine, UK, India, Colombia, US, and Lithuania 4% are non-insured or have Interim Federal Health (IFH) insurance 25% of clients are seniors (65+), of those 65% are >75+ 9.5% of clients are in the 10 – 24 age range high diversity: clients come from over 90 countries and speak over 40 languages 36% of clients are seniors (65+) an increasing proportion of our clients are over age 80 (50% of seniors and 18% of clients overall are more than 80 years old) chronic conditions predominate among client needs addressed including multiple conditions (>25% of client visits were related to diabetes, arthritis, heart diseases, chronic pain and approximately 10% related to mental health, addictions or stress) clients have lower income and lower education compared to the catchment area and LHIN average 5% of primary care clients and 10% of Early Years clients do not have health insurance
24 Snapshot of the Clients Served in 2015-2016Most frequent reasons clients see Four Villages providers: Diabetes Hypertension Mental Health (and Addictions) Issues (Anxiety, depression, feeling stressed out) Diet-related concerns (visit for advice on healthy eating) Screenings/Well Child/Pre- and post-natal care Health Examinations Foot Care Independence at home (Occupational Therapy) Immunizations Medication renewal, medical test results Pain management/Rehabilitation: knee pain, back pain Social Work related issues: immigration issues, financial problems, counselling, parenting support Third Party needs (forms, WSIB, Ontario Works, etc.) Capacity Building (Health Promotion) high diversity: clients come from over 90 countries and speak over 40 languages 36% of clients are seniors (65+) an increasing proportion of our clients are over age 80 (50% of seniors and 18% of clients overall are more than 80 years old) chronic conditions predominate among client needs addressed including multiple conditions (>25% of client visits were related to diabetes, arthritis, heart diseases, chronic pain and approximately 10% related to mental health, addictions or stress) clients have lower income and lower education compared to the catchment area and LHIN average 5% of primary care clients and 10% of Early Years clients do not have health insurance
25 Program Sites – Examples Programming offered over 40 sites
26 Providers, Services and Program OfferedBoard Orientation 2016 Providers, Services and Program Offered
27 An Inter-Professional Model of CarePROVIDERS Family Physicians – 4 at Bloor, 3 at Dundas Nurse Practitioners – 2 at Bloor, 1 at Dundas Registered Nurses – 1 at Bloor, 2 at Dundas Dietitians – 2 at Bloor, 2 at Dundas Physiotherapists – 2 at Bloor Occupational Therapist – 1 at Bloor Chiropodists – 2 at Bloor, 1 at Dundas Social Workers – 2 at Bloor, 2 at Dundas Community Health Workers – 1 at Bloor, 4 at Dundas Project Staff – 3 Program Support Workers, 1 Guys Can Cook Project Coordinator Clinical Assistant – 1 for both sites Primary Care Coordinator Intake Worker ADMINISTRATIVE SUPPORT STAFF Front Desk - 3 Receptionists and 1 Medical Secretary at each site Data Manager/Health Planner, IT Coordinator, HR Manager, Facilities Manager, Communications and Community Engagement Coordinator, Exec Assistant Management – 2 Directors and CEO
28 Organizational Chart
29 Programs and Services Services and programs are provided at individual, group and community levels with a focus on: Treatment Care Coordination Prevention of illness Health promotion and capacity building Community Initiatives Other components of programs and services delivery: Training Best practices development and implementation Professional development and networking Volunteer program Emphasis On: accessible, client-centered, interdisciplinary, and coordinated care to enhance client capacity and quality of care, and on building partnerships
30 Four Villages Programs, Services & PartnershipsSeniors & Chronic Disease Prevention and Management (CDPM) IMPACT Assessment (various providers) Polish Chapter of the Canadian Diabetes Association – Canadian Diabetes Association Foot Care and Nurse Clinics – Evangeline Shelter Seniors & Mental Health and Addictions (MH&A) Getting on With Life and It’s Challenges (GOWL) – Regeneration Housing and Support Services Expressive Art Therapy Group for Women – Polycultural Immigrant and Community Services
31 Four Villages Programs, Services & PartnershipsEarly Years (three other CHCs) Healthy Child Screening – Davenport & Parkdale CHC’s, Child Development Institute, St. Joseph’s Health Centre and many more… Peer Nutrition Programs – Toronto Public Health Swansea After School Program – Toronto Community Housing Family Drop-in Programs – Ontario Early Years Centre, College Montrose Children’s Place Healthy Women, Health Babies Counselling Time-Out Child Psychiatry
32 Four Villages Programs, Services & PartnershipsYouth Youth Cooking Club Tutor It Up! Guys Can Cook – West End Urban Health Alliance Time Out – Planned Parenthood Toronto Leadership Program – Toronto Community Housing
33 Four Villages Programs, Services & PartnershipsCollaborative Care Supporting frail seniors living at home – West Toronto Support Services Shared Care Psychiatric Care – St. Joseph’s Health Centre and CAMH Case Management for individuals with mental health and/or addictions problems – Reconnect Mental Health Services
34 Legislation, Multi-Service Accountability AgreementBoard Orientation 2016 Legislation, Multi-Service Accountability Agreement
35 Toronto Central Local Health Integration Network (TCLHIN)TCLHIN Strategic Plan TCLHIN: One of 14 LHINs across Ontario
36 Relationship with TCLHINMulti-Sector Service Accountability Agreements (MSAA) Three year agreement (2014 to 2017) All terms and conditions in order to receive provincial funding from the TCLHIN Very detailed Currently lots of micro oversight Being extend (to 2018) While should have been for three years, practice has been to “negotiate annually” Given no new funding for past several years, negotiations have been simply “renewing volumes and spending” CAPS (Community Annual Planning Submission) Budget “request” to TCLHIN under MSAA where TCLHIN approves funding based on service provision volumes MSAA Reporting (Quarterly) Reporting on Performance of Key Indicators (negotiated annually)
37 Ontario’s Health System Transformation AgendaMany provincial and LHIN reports (and provincial legislation) have been released (passed in the legislature) over the past three decades seeking to continuously improve and/or make fundamental changes to the delivery of health care in Ontario. Recent reports, documents, and legislation include Patients First (Legislation re: system restructuring for CCACs and primary care) “Price Report” (Primary Care Reform) TCLHIN Restructuring documents (Sub Regions and Administration; Local Collaboratives) “Advancing Integration” (soon to come is plan to implement seven recommendations) Saturday November 26th! Emphasis on population health & social determinates of health approach, versus a strong focus on hospitals and high-tech interventions
38 CHC Evaluation and Performance MeasurementsEvaluation of the CHC model has been viewed as being complex and difficult in order to assess: Treatment Prevention of illness Promotion of health and capacity building Performance targets are included in the funding agreements (MSAA) with the TCLHIN
39 Report on Key Performance Indicators to TCLHIN (Scorecard)Client Measures Category Item Measure Goal Strategy System Evolution # of Coordinated Care Plans completed 20 Access to Primary Care Average # of MD/NP visits of top 50 frequent/repeat users per year 13.5 Driving Programs % of Mental Health & Addictions medical clients accessing Allied Health + Programs 55% % of service clients accessing Programs 12% % of clients aged 50+ years accessing Activation Programming 9% QIP Reduce ED visits % clients visited ED for conditions Best Managed Elsewhere** <9% Health Promotion % of clients (65+) received influenza immunization 61% Client Satisfaction Survey Client Experience result- % responding Always or Often to "How often do the staff explain things in a way that is easy to understand?"* 93% Client Experience result- % responding Always or Often to "How often do the staff tell you about treatment options and involve you in decision about the best treatment?"* 91% Client Experience result- % responding Always or Often to "How often do the staff members spend enough time with you during an appointment?"* 95% Client Experience result - % responding On the same day to "How quickly could you get an appointment to see a doctor, nurse or nurse practitioner?"* 41% Client Experience result - % responding Always or Often to "How often can you get an appointment when you need one?"* 87% MSAA Cervical Cancer Screening Rate (PAP Test) 85% Colorectal Screening Rate 66% Interprofessional Care Inter-Professional Diabetes Care Rate 98% Influenza Vaccination Rate 35% Breast Cancer Screening Rate 64% Panel Size 75% Organizational - Clients Served # of total unique individuals served across the entire organization 5157 Financial Measures Financial Balanced Budget - Fund Type 2 >0% Proportion of Budget spent on Admin 25-30% Percentage Total Margin Variance Forecast to Actual Expenditure <5% Human Resources MD/NP Retention Rate $ 100%
40 Local Health System Integration Act (LHSIA) 2006Defines the work of LHINs (Local Health Integration Networks) Directs integration Each health service provider (HSP) shall separately and in conjunction with each other identify opportunities to integrate the services of the local health system to provide coordinated, effective and efficient services. integrate” can mean: to co-ordinate services and interactions between different persons and entities, to partner with another person or entity in providing services or in operating to transfer, merge or amalgamate services, operations, persons or entities to start or cease providing services to cease to operate or to dissolve or wind up the operations of a person or entity, The neighbourhoods of our catchment area as developed by Public Health. Neighbourhoods don’t necessary coincide with the villages of Four Villages, but a lot of data is available to us at the neighbourhood level.
41 Commitment to the Future of Medicare Act 2004Recognizes that Medicare – our system of publicly funded health services – reflects fundamental Canadian values and that its preservation is essential for the health of Ontarians now and in the future Confirms the commitment to the principles of public administration, comprehensiveness, universality, portability and accessibility as provided in the Canada Health Act Continues to support the prohibition of two-tier medicine, extra billing and user fees in accordance with the Canada Health Act Romero House, an organization supporting refugees, has three houses in the neighbourhood. Our EY2 team works a lot with Romero House. We are the primary health care provider to residents.
42 Freedom of Information and Protection of Privacy Act (FIPPA) OntarioProvides individuals a right of access to records held by public bodies and regulates how public bodies manage personal information. Individuals may request access to records relating to: administrative and operational functions, financial considerations and decisions, and personal information Provides an independent review process for people who disagree with access and privacy decisions made by public bodies under the Act. NOTE: FIPPA covers personal, administrative and financial information. PHIPA (next slide) covers only personal health information. Romero House, an organization supporting refugees, has three houses in the neighbourhood. Our EY2 team works a lot with Romero House. We are the primary health care provider to residents.
43 Personal Health Information Protection Act (PHIPA), 2004Governs the collection, use and disclosure of personal health information and not other types of information. Establishes rules for the collection, use and disclosure of personal health information about individuals that protect the confidentiality of that information and the privacy of individuals with respect to that information, while facilitating the effective provision of health care. Provides individuals with a right to require the correction or amendment of personal health information about themselves Provides for independent review and resolution of complaints with respect to personal health information Romero House, an organization supporting refugees, has three houses in the neighbourhood. Our EY2 team works a lot with Romero House. We are the primary health care provider to residents.
44 Broader Public Sector Accountability Act 2010Protects the interest of taxpayers by strengthening accountability for organizations that receive public funding. Principles: Accountability – Transparency – Value for Money It requires that organizations establish rules on perquisites. Key features: No perks, no use of lobbyists, no special privileges Procurement of goods and services policies in place
45 Excellent Care for All Act 2010Requires a Board Quality Committee: Annual quality improvement plans Regular client and staff satisfaction surveys Post declaration of values Create clients relations process Executive compensation linked to achieving improvements Created HQO Romero House, an organization supporting refugees, has three houses in the neighbourhood. Our EY2 team works a lot with Romero House. We are the primary health care provider to residents.
46 Ontario Not-For-Profit Corporations Act, 2010Ontario’s Not-for-Profit Corporations Act (ONCA) provides a legal framework for not-for-profit corporations, including charitable corporations. It sets out how not-for-profit corporations in Ontario are created, governed and dissolved. ONCA is not expected to come into force before 2016 but has STILL NOT BEEM proclaimed Preparing for ONCA Three-year transition period will allow Four Villages to make any necessary changes to our incorporation and other documents to bring us into conformity with ONCA. For example, corporations may need to make changes to their by-laws, letters patent, supplementary letters patent and special resolutions. After the transition period, these documents will automatically be considered amended to the extent necessary to bring them into conformity with ONCA.
47 Board Member Roles and ResponsibilitiesBoard Orientation 2016 Board Member Roles and Responsibilities
48 Role of Board in the OrganizationUnder the Governance section there is a list of Board Roles and Responsibilities The Board is the governing body of the organization As such, the Board: ensures that the operations are guided by a clear Vision and Core Values provides strategic leadership delegates operations to the CEO manages the CEO and monitors organizational performance ensures that good practices are in place
49 Board’s Roles and ResponsibilitiesStrategic Governance: establish vision, mission and values - provide strategic leadership, goals and priorities - evaluate organizational performance - contribute to achievement of organizational strategic goals Operational Oversight: fiduciary role - policies and procedures are in place and implemented - management of CEO Board Self-governance: governance policies and procedures are in place - Board development - Board performance - Board succession planning and continuity Community and Partner Relations: engage partners to better respond to change and community needs – advocate for clients, community and CHC model Resource Development: adequate organizational resources – fund raising plan
50 Role of Staff Staff deliver services and programs within the Vision and Strategic Goals to meet clearly identified needs There are 3 levels of staff: Direct providers – an inter-professional team of professionals working collaboratively Support staff – a team of skilled individuals who support the delivery of services and programs Management – a team of individuals who provide on going strategic leadership and oversee performance and the delivery of programs and services and administrative systems. The Chief Executive Officer is directly accountable to the Board
51 Students & Volunteers STUDENTSFour Villages is a training organization Students learn about the CHC inter-professional and CHC model delivery of integrated primary health care (treatment, prevention of illness, promotion of health and capacity building) VOLUNTEERS Volunteers get involved in program activities, governance and administrative support Volunteers learn about the CHC model and contribute to the organization (governance, programs, administrative support)
52 Board Accountability Vision – Mission – Core ValuesStrategic Plan – directions and goals Oversight and Evalution of CEO Scorecard (QIP, MSAA, Strategic Plan) M-SAA Compliance Reports Quarterly Financial and audited reports Meeting evaluations Board recruitment and succession planning Annual Board Retreat Accreditation compliance
53 Chief Executive OfficerThe Chief Executive Officer is the Board’s single official link to the operations The Board sets the Executive Limitations of the CEO – monthly and annual reports (risk management, quality and compliance with legislation) The Board Chair and Vice Chair complete annual performance review of the CEO and revise his/her Performance Agreement Communication with Staff Communication between Board and Staff members regarding management of the operations is channeled through the CEO In cases of grievance, Board and Staff follow the grievance procedures as set forth in the Organizational Manual
54 Board Performance ReviewRegular Evaluation: Board and Committee meetings Board Activities and Achievements Review Board Member Opinion Survey Board Member Self-Assessment Annual Board Retreat: May Board Evaluation Set directions for next year Defines educational plan for next year
55 Meeting Rules, Procedures and ATTENDANCEGround rules for meetings Roberts Rules of Order and Parliamentary Procedures BOARD ATTENDANCE BY- LAW # 1 (SECTION 4.7.e.) If the director fails to attend at three (3) consecutive meetings of the Board of Directors without leave of the Board, her/his office as director shall be deemed as vacant
56 Board Guiding PrinciplesLeadership Transparency Functional Team Conflict of Interest
57 Conflict of Interest A conflict of interest exists when a director makes or takes part in a decision affecting the Corporation’s affairs and the director has a financial or other interest in or gets benefit from that decision. It also includes preferential consideration, financial benefits, rewards or services granted to immediate family members, friends or associates.
58 When there is a conflict of interest…..The conflict must be declared and disclosed It must be recorded in minutes The board member must leave the meeting and remain absent while the matter is considered and returns once that matter is decided. Failure to declare a conflict, if brought to the Board’s attention, results in formal review and if board member(s) is/are found to be in conflict can result in: Decision reviewed and new vote taken if deemed necessary Board Member removal from board Criminal proceedings
59 Board Members As ClientsAt Four Villages, Board members may be clients Being a Board member, however, does not confer special privileges for services as a client At appointments, Board members and Staff are required to maintain their respective roles as provider and client
60 Board Support Board insurance – HIROC ( more on next slide)Approved related expenses to ensure attendance – i.e. care-giving Ongoing orientation and relevant information, access to: Board President – Board contact list available in the portal Other Board members – as above CEO – as above
61 Board Insurance H.I.R.O.C = Healthcare Insurance Reciprocal of CanadaHIROC provides risk management support for Directors (governors) liability – total $10,000,000: errors and omissions, personal individual and corporation assets, costs of defending against allegations (judgments or settlements)
62 Expense Support Expense reimbursement arising of duty as Board are provided for (if approved in advance and subject to budget): Family care support Approved meetings incurred costs (registration, transportation
63 Proposed Board Standing CommitteesExecutive Committee (established August 2014) Finance Committee (established in August 2014) Fundraising and Community Engagement Committee (established 2014 as a merger of Fundraising and Advocacy Committees) Governance Committee (established 2014 as a merger of Board Dev’t and Nominating Committees) – (Board considering separating roles into two committees) Quality Committee (established in 2011)
64 Accountability and Quality SystemsStrategic Planning - Evaluation – Performance Management Risk management framework and system – to be developed Policies – continuous updating Organizational Performance – Balanced Scorecard Accreditation Financial Reporting and Auditing Quality Improvement Plan
65 Risk Management (Integrated Risk Management)Services and Programs Clients staff and volunteers Property Building Infrastructure ( telephony, internet, access to utilities) furnishings & equipment (assets) Financial Resources funder/donor confidence Reputation/credibility Communications/media Public/Funder perceptions Areas of Risk
66 Planning & Performance Review CycleStrategic Planning Every 3 Years ANNUAL OPERATING PLAN Annually Prepared by CEO PERFORMANCE REVIEW Annually MONITORING & REPORTING (Score Card) IMPLEMENTATION Annual Strategic Initiatives
67 Organizational Policy Manual (17 Chapters)Guide to the Manual Accountability & Quality Systems Policy Development Orientation to the CHC Model and Four Villages Rights, Responsibilities and Code of Conduct Governance Financial Management Personnel Occupational Health and Safety Infection Control Services and Programs Administration Records Management Information Technology Students Volunteers Research