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Modernizing the FNIHB Clinical Practice Guidelines
PART I STATEMENT of WORK
1.0 Scope
1. 1 Title
Modernizing the FNIHB Clinical Practice Guidelines (CPGs)
1.2 Introduction
The mandate of The First Nations and Inuit Health Branch (FNIHB) is to ensure First Nations and Inuit communities have access to health services; assist First Nations and Inuit communities in addressing health barriers and disease threats, attain health levels comparable to other Canadians living in similar areas; and build strong partnerships with First Nations and Inuit communities to improve the health system.
FNIHB Health services are led nationally by a Senior Assistant Deputy Minister and Assistant Deputy Minister, Regional Operations. The Senior ADM is responsible for four national directorates- Interprofessional Advisory and Program Support (IPASD), Non-Insured Health Benefits (NIHBD), Internal Client Services and Transitions (ICSTD), Strategic Policy, Planning and Information (SPPID). The ADM Regional Operations shares operational responsibility for the delivery of FN health care services among two national directorates - Health Funding Arrangements (HFAD) and Health Infrastructure Support (HISD) and 8 regional offices. Regional Health services are led by a FNIHB Regional Executive Officers.
Health Canada (HC), through FNIHB, provides a continuum of Primary Health Care (PHC)
Services /programs aimed at improving health outcomes for First Nations, including Communicable Diseases Control (CDC), Non-Insured Health Benefits (NIHB), and Public Health (health promotion and disease prevention), as well as access to Primary Care (PC) twenty four hours a day, seven days a week in a total of 77 remote and isolated First Nation Communities (RIFNC) (south of the 60th parallel) serving a population of 95,000 First Nations (FNs). Primary Health Care services are either directly delivered by Health Canada FNIHB or delivered by First Nations (FN) through contribution agreements (transferred).
Registered nurses, based mostly in nursing stations and a few health centers with treatment component, are predominantly the first point of access to the healthcare system and central to the services delivered in these communities. Registered nurses are the largest group of healthcare providers in these communities.
The Clinical and Client Care (CCC) program has a leading role in supporting high quality and safe care delivered within First Nation and Inuit communities. The Clinical Practice Guidelines (CPGs) are key risk management tools that inform the clinical decisions of nurses delivering primary care services. CPGs are guided by current evidence-based data, reflect cultural sensitivity, and are context specific. The CPGs contribute to defining the scope of practice of a community health nurse employed in FNIH nursing stations.
The CPGs are informed by best practices and evidence available at the time they are written. As new evidence is continuously integrated into primary care and nursing practice, and ever increasing amounts of clinical information is available, Health Canada is required to continuously update and maintain the CPGs. The CPGs recently underwent a full review and currently require a revision. The revision of the CPGs has been conducted mainly in-house, utilizing external experts as required. The previous revision cycle was based on a three year timeline but the process was labour intensive, costly, and relied on external expertise whose availability was very limited. The CCC program of the Interprofessional Advisory and Program Support Directorate (IAPSD) identified the need to seek alternate approaches to this process. The three year cycle is no longer sufficient to address the rapid change in clinical information, impacting quality of care and patient safety.
Currently, health organisations are moving toward outsourcing clinical evidence review, validation, updating and maintenance of practice guidelines and care algorithms. The reasons cited for this trend is to allow ready access to expert networks whose role is to translate evidence into clinically applicable tools, allowing more efficient practices at the lowest possible cost while maintaining the highest quality standard. From a financial and standardisation perspective, there are benefits to outsourcing to a vendor with extensive experience in this field. Guidelines and care algorithms are developed using the same evidence based approach for different organisations and can be tailored to accommodate the specific requirements of each setting. This approach provides an integrated transition through the care continuum, resulting in a high quality of care.
In conjunction with the outsourcing of the practice guidelines/care algorithms many health organisations are moving toward a paperless practice environment. Guidelines/care algorithms are incorporated into electronic medical records, documenting the provision of care, the referral process and form part of the client’s record. Outsource vendor products incorporate data tools into the practice guidelines/care algorithms that allow for outcome indicators being generated by the use of the electronic practice guidelines/care algorithms.
1.3 Estimated Value
The total value of any contract (s) resulting from this SOW shall not exceed $673,200.00 CAD, including travel and living expenses, other expenses and all applicable taxes.
1.4 Objectives of the Requirement
The objectives of the project are as follows:
Specifically the contractor will perform the following activities:
1. Conduct a detailed review of the current CPGs identifying required updating of clinical content based on current evidenced informed best practices, introducing symptom based algorithms for frequently seen conditions and regroup like CPGs based on diagnostic and treatment options
2. Develop a new format for the CPGs that is user friendly, can migrate to an electronic environment and incorporate in order set for diagnostic and treatment sections
3. Test a revised chapter of the CPGs and include the order sets for the health conditions identified in it
4. Update all chapters identified as required a review of the clinical content including the order sets
5. Provide a project summary report and presentation materials at the end of the contract
1.5 Background, Assumptions and Specific Scope of the Requirement
Background
The Clinical and Client Care program implemented the Clinical Practice Guidelines (CPG) as a key risk management tool to inform the clinical decisions of nurses delivering primary care services in First Nation communities. The CPGs must be reviewed on an ongoing basis in an effort to provide quality care. As new evidence is continuously integrated into primary care and nursing practice, and health research introduces ever increasing amounts of information, Health Canada is required to continuously maintain the CPGs. The rapid introduction of evidence is most observable in the clinical areas of investigations and treatment for any given heath conditions.
Order sets are sophisticated evidence-based best practice checklists that ensure physicians, nurses, pharmacists, and other clinicians have instant access to the most up-to-date evidence-based diagnostic and treatment information and checklists for every major clinical health condition. Order sets support the best practice/clinical approach investigation and treatment of patients once diagnosed. In addition, order sets have the potential to significantly reduce healthcare costs in primary care settings by streamlining treatment, focussing on the client receiving the right care, at the right time by the right provider.
The services of the contractor are required to update the clinical content and convert CPG entries to a new format that includes order set.
The contractor will have a proven track-record for undertaking a project of this scope and complexity by demonstrating: 1) advanced clinical understanding; 2) commitment to quality; 3) experience in developing and updating clinical practice guidelines; 4) experience in developing order sets; and 5) providing comprehensive services and support. In addition, the contractor will demonstrate successful partnerships with national and provincial healthcare providers and medical specialty associations.
RIFNC Facility and Nursing Profile
In the 49 Health Canada (HC) operated RIFNC there are 45 nursing stations and 4 health centres with treatment component. Primary health care is provided by approximately 214 full-time nurse equivalents (FTEs). The CPGs are utilized in all HC RIFNC by the nurses and may be used by nurses in the transferred RIFNC. The manner in which the CPGs are utilized varies from region to region, based on provincial legislation related to the nursing scope of practice. The CPGs may be used as an education/guidance tool in a region or as a mechanism to support a broader nursing scope of practice in others.
The nurses are responsible for providing the following services :
Access to primary care services 24 hours a day is provided 7 days a week in nursing stations (NS) and 5 days a week in health centers with treatment component.
Scope
The scope of this project includes all 385 Clinical practice guidelines, the revision and updating of all guidelines, develop symptom based algorithms for frequently seen conditions, a summary report and the development of a plan for ongoing updating and maintenance of the guidelines.
2.0 Requirements
The requirements for this project include the following:
2.1 Tasks, Activities, Deliverables and Milestones
Upon contract award, the Project Authority shall provide the contractor with documentation that is relevant to this project.
The process utilized by the contractor must be iterative in approach, taking into consideration regional variations in practice based on provincial legislation, drug formularies, and partner preferences.
2.1.1. Workplan and Methodology:
Within two (2) weeks of contract award, the contractor shall meet with the Project Authority to review the proposed methodology and detailed work plan for the review of the CPGs, development of the revised format, updating of the clinical content of the CPGS, testing of the first selected group of CPG, revisions based on feedback, completion of the remaining CPGs revisions and updating and a plan for the ongoing updating /maintenance of the revised CPGs. The contractor will provide a detailed Work Plan and schedule outlining the activities, associated budget and outputs for the contract. The Work Plan should stipulate the roles and responsibilities of all members of the proposed contract team and describe the approach methodology, potential risks and related mitigation strategies. The contractor will make adjustments to the work plan and methodology based on comments received from the Project Authority and submit a final detailed work plan and methodology for approval after a joint meeting.
2.1.2. Phase 1A: Discovery Phase – Review of all of the CPGs, obtain input from the advisory committee members as to the selection of first group of guidelines (or chapter) to be revised and developed in a new user friendly format that incorporates an order set.
This phase of the project involves working closely with the Project Authority and Advisory Committee to gain an understanding of work flow and working context.
A. The contractor will review background materials which may include information collected from multiple sources to compliment and further inform the discovery phase activities.
B. The contractor will gather input from the advisory committee members and if need be, collect information regarding the CPGs from front line nurses (maximum 10). The information to be gathered should at minimum focus on changes in format, structure, manner in which CPGs are used in practice and factors that would enhance their use. This information will assist the contractor is selecting the option(s) for the new format.
C. Based on the above the contractor will present the Advisory Committee potential formats for the CPGs that include an order set.
D. In consultation with the Project Authority and the Advisory Committee the contractor will finalize the new format for the CPGs to be tested. The Project Authority will consult E-Communications to ensure the new format is compliant with the Government of Canada Standard on Web Accessibility.
2.1.3 Phase 1B: The revision and updating of a chapter of the CPGs in preparation for testing
The contractor shall update and convert a chapter of the adult CPGs in preparation for validation. The Advisory Committee will review the revised CPG chapter and provide feedback. The Project Authority will consult E-Communications to ensure the new format is compliant with the Government of Canada Standard on Web Accessibility. The contractor should develop the plan to implement the test chapter and identify factors that would be evaluated during the validation period.
A maximum of three sites/facilities will be used to validate the revised CPG chapter. The selection of the sites/facilities is to be proposed by the Advisory Committee and is subject to review and final approval by the Project Authority.
The contractor shall provide a summary of the results of the testing to the Project Authority including suggested changes. The contractor shall modify the revised CPGs as agreed to with the Project Authority and/or Advisory Committee.
2.1.4 Phase 1C: Planning for the Revision of the remaining CPGs
The Project Authority and contractor shall review the work plan and methodology used for testing to identify any adjustments required according to the project's progress and results achieved. The contractor shall modify and submit the final work plan and methodology for the Project Authority's approval.
2 .1.5 Phase 1D: Revision and updating of CPGs
The Project Authority and the contractor shall review the final work plan and methodology for the revision and updating of the remaining CPGs. Upon approval by the Project Authority the contractor will proceed with the revisions, submitting the revised CPGs to the Project Authority and Advisory Committee for feedback on a scheduled basis as outlined in the work plan. It is expected that 150 CPGs out of 385 will be completed from the date the contract was awarded to March 31, 2015. This constitutes the final deliverable for year one (1) of the contract.
2.1.6 Phase 2A: Option year 1: Revision and updating of remaining CPGs
Upon approval by the Project Authority the contractor will proceed with the remaining 235 CPGs, submitting the revised CPGs to the Project Authority and Advisory Committee for feedback on a scheduled basis as outlined in the work plan. It is expected that up to 385 CPGs will be completed from the date the contract was awarded to March 31, 2016. This constitutes one of the deliverable for option year one (1) of the contract.
2.1.7 Phase 2C: Project summary report
Upon completion of the revisions of all the CPGs, the contractor shall submit a report that includes the results of the project to date as well as identification of conclusions and recommendations. The report shall also include a plan for ongoing updating and maintenance of the guidelines and be formatted to include an executive summary outlining key findings and recommendations.
The contractor shall develop a presentation (using MS PowerPoint) on the highlights of the report including major findings and key issues. The contractor shall submit this presentation to the Project Authority for review and approval. The contractor shall modify the presentation according to the Project Authority's comments and submit a final draft.
The contractor shall present the report, including major findings and key issues, in person to the Project Authority and Advisory Committee at FNIHB National Headquarters in Ottawa. This constitutes the second and final deliverable for the option year one (1) of the contract, due by March 31, 2016.
2.2 Specifications and Standards
The CPG deliverables should be produced in English and French, in MS Word, while the project summary report is to be provided in MS Word and MS Power Point format, submitted electronically as attachments.
Phase 1 of the project will be considered complete after the formal acceptance of 150 revised CPGs and/or by March 31, 2015. The Revised CPGs and the milestone report covering phases 2A and 2B of the project, will be delivered to the project authority, in accordiance with the “methods and sources of acceptance” as outlined in section 2.4 below. At the end of phase 2 (March 31st, 2016) and upon final approval by the project authority, the contractor must provide a CD ROM, containing all the updated CPGs, the report, and all templates developed for the project.
2.3 Technical, Operational and Organizational Environment
The work will be carried out on the premises of the contractor, although some meetings and interviews may require alternate sites (for example National Office meetings, presentations).
2.4 Method and Source of Acceptance
Material produced for this contract must meet the specified format, content and language requirements
The project summary report must follow the Health Canada approved formats and style (i.e. the documents will be submitted in MS Word and MS Powerpoint format) and contain all the required information. Progress reports will have a standard format which can be proposed by the contractor but which should be written in plain language and contain the following at a minimum:
Health Canada will provide feedback to the contract on workplans and reports within 7 working days. Feedback on clinical content, revised CPGs will be provided within 14 working days.
2.5 Reporting Requirements
A project Advisory Committee will be appointed to provide project oversight for this project and will provide ongoing feedback on the key phases and deliverables during the course of the project. The initial project meeting (regional committee members may attend either in person / and or by conference call) to be held in Ottawa, will include establishing terms of reference, reviewing project documents, project objectives, reaching consensus on the methodologies and processes for reaching final deliverables.
Following feedback from the Advisory Committee during phases 1 and 2, the final report and presentation materials will be prepared by the contractor as directed by the Project Authority.
2.5.1 Additional Meetings
The contractor will participate in bi-weekly progress meetings (in person and /or by phone) with the Project Authority and Advisory Committee. The Contractor will also submit a bi-weekly meeting report to the Project Authority outlining the accomplishments for the given period, open issues for discussion and decision and planned activities for the next meeting period. The Project Authority reserves the right to schedule additional face to face meetings, as deemed necessary, according to how the project is progressing.
2.6 Contractor Project Management Control Procedures
The Health Canada individual identified as the Project Authority will ensure that the deliverables, including progress reports, training, tools development testing and implementation, and reports are submitted on time and meet the requirements as defined in this Statement of Work. The Project Authority will provide timely input and feedback when needed, to ensure the project is on track and of acceptable quality. In the event that exceptional and /or unforseen circumstances occur, that have an impact on the project activities or outcomes, the Project Authority will work in close collaboration with the contractor to develop a appropriate and satisfactory solution. (i.e. submission of progress reports, system tests, etc.)
2.7 Change Management Procedures
Additional work: Health Canada reserves the right to request that the contractor complete additional work, according to the following procedure:
1. The Project Authority will send a written request to the contractor outlining the type of work required.
2. The contractor shall provide an estimate of the level of effort (in hours) and cost of completing the requested work.
3. The Project Authority will review the contractor's estimate and provide the contractor with written authorization to proceed with the requested work. The contractor shall not proceed with any of the work, in whole or in part, until such time as the Project Authority has provided written authorization to proceed.
4. Health Canada reserves the right not to proceed with any of the requested work.
This document does not oblige HC in any way to request that the contractor complete any additional work whatsoever.
2.8 Ownership of Intellectual Property
Under the Policy on Title to Intellectual Property Arising under Crown Procurement Contracts (Treasury Board of Canada Secretariat), the Crown will retain ownership of Intellectual Property arising from this Contract.
Crown Ownership is cited in Section 6.5 of the Policy “where the Foreground (Intellectual Property first conceived, developed, produced or reduced to practice as part of (this) ... Crown Procurement Contract) consists of material subject to copyright.”
3.0 Other Terms and Conditions of the SOW
3.1 Authorities
Department Representatives: Director Primary Care DivisionProject Management /Technical
Authority: Nurse Consulant, Clnical and Client Care(Main contact)
Contracting Authority: Procurement and Contracting Office:Internal Client Services
3.2 Health Canada’s Obligations
Health Canada will provide:
In addition Health Canada will provide:
provide comments on draft reports within seven (7) working days and 14 working days on clincial content
3.3 Contractor’s Obligations
The contractor will be required to complete all work and obligations in this Statement of Work. The contractor will inform the Project Authority of any exceptional and /or unforseen events that have an impact on project activities and outcomes. In such events, the contractor will collaborate with the Project Authority on appropriate alternate solutions.
o Provide the names of contact personnel , including sub-contractors;
o Work in close collaboration with the Project Authority; and
o Submit all information documents and deliverables before final payment is issued.
3.4 Location of Work, Work Site and Delivery Point
The contract will be interpreted and governed by the laws of the Province of Ontario.
The work will be carried out on the premises of the contractor , although some meetings and interviews with Health Canada personnel at departmental premises may required(for example National Office meetings, presentations ).
Due to existing workload and deadlines, all personnel assigned to any contract resulting from this SOW must be ready to work in close and frequent contact with the Project Authority and other departmental personnel.
3.5 Language of Work
Consistent with the requirements of the Official Languages Act , the contractor shall conduct the interviews in the official language chosen by FNIHB employees. English or French in bilingual regions. The following list is provided as a guide. However, the contractor must expect to be asked to conduct an interview in English or French in predominiantly French speaking or English Speaking regions
National Headquarters : English and French
Quebec region: French
Ontario region: English
Manitoba region: English
Alberta region: English
Saskatchwan : English
3.6 Special Requirements
The Contractor must certifiy that the personnel assigned to the project will be available to perform the tasks described in this Statement of Work within the alloted time frame. The contractor will have a working knowledge of Primary Health Care services, prrmary health care and remote and isolated First Nations communities
3.7 Security Requirements
As a visitor to a HC facility meetings and briefings, the contractor’s personnel will be subject to federal building and local security requirements and medical and public health issues that can vary from moment to moment. The contractor’s personnel may be faced with delay or refusal to certain areas at certain times although prior arrangements for access may have been made.
The contractor’s personnel are to confirm in advance of travelling to a site to ensure that they are expected and can obtain access. If access is unavailable, the contractor’s personnel are to adopt a work – around plan to perform other portions of the statement of work.
All of the contractor’s personnel who will be conducting interviews with the nursing staff will require security clearance to the level of reliability status.
3.8 Insurance Requirements
It is the sole responsibility of the Contractor to obtain and maintain an appropriate level of professional liability insurance coverage necessary for its own protection or fulfill its obligations under the contract and to ensure compliance with required federal, provincial and municiple law. Any such insurance shall be provided and maintained by the Contract at its own expense.
3.9 Travel and Living Expenses
Some travel is required for this project and will include trips to and from:
Payment for travel and living expenses must be made in accordance to the terms of payment and the Treasury Board Travel Directive.
4.0 Project Schedule
4.1 Expected Start and Completion Dates
The services of the Contractor will be required from contract award to March 31st, 2015. The expected completion date for phase 2 is March 31st , 2016.
A detailed schedule will be provided in the detailed Work Plan to be provided by the contractor and approved by the Project Authority as stipulated in Section 2.1
4.2 Schedule and Estimated Level of Effort (Work Breakdown Structure)
The contractor will have to obtain approval from the HC Project Authority prior to proceeding at the following points during the course of the project:
Approval of proposed work plan and methodology:
1. Finalized work plan, methodology and processes
Phase1A: Discovery
1. Approval of a new format
Phase 1B: Revision of the CPGs for testing
1. Approval of first draft of a revised CPG chapter
Phase 1C: Plan for the remainder of the CPGs
1. Approval of plan for the remainder of the CPGs
Phase 1D: Revision of remainder of CPGs
1. Approval of 150 revised CPGs
Phase 2A: Continued revision of remainder of CPGs
1. Approval of up to 235 revised CPGs
Phase 2B: Project summary report
1. Approval of report
4.3 Deliverables
The contractor will provide the CPG deliverables in an electronic, printable format, including a word processed format such as MS Word, in English and in French, for phases 1 & 2 of the project. All other deliverables will be provided in MS Word or MS Powerpoint.
All deliverables will be subject to review and acceptance by the Project Authority.
The following deliverables per phase of the project will be required from the contractor:
Phase1A: Discovery
1. A document outlining the approved new CPG format
Phase 1B: Revision of the CPGs for testing
1. A plan to test the chapter selected for revision
2. A summary document outlining the results of the testing
Phase 1C: Plan for the remainder of the CPGs
1. A final work plan and methodology to revise all the CPGs
Phase 1D: Revision of remainder of CPGs
1. 150 revised CPGs in an electronic format
Phase 2A: Continued revision of remainder of CPGs
1. Up to 235 revised CPGs in an electronic format
Phase 2B: Project summary report
1. A summary report and presentation materials of the project
5.0 Required Resources or Types of Roles to be performed
It is expected that the contractor, including any employees or subcontractors assigned to the performance of this contract will have prior experience in the development/revision of clinical practice guidelines for nurses and order sets including developing an approach, plan and tools to support CPGs development and use for health care organization and health care providers in Canada. Knowledge of nursing services, Primary Health care services, and the health care system in Canada, with particular reference to the context of health services delivery in remote and isolated First Nations communities is required. The contract team most include a primary care physician.
6.0 Applicable Documents and Glossary
6.1 Applicable Documents
The current CPGs can be found at the following links.
In English at: http://www.hc-sc.gc.ca/fniah-spnia/services/nurs-infi…
In French at: http://www.hc-sc.gc.ca/fniah-spnia/services/nurs-infi…
6.2 Relevant Terms, Acronyms and Glossaries
HC Health Canada
FNIHB First Nations and Inuit Health Branch
R/I Remote and Isolated
FN First Nations
IAPS Interprofessional Advisory and Program Support
PHC Primary Health Care
CDC Communicable Disease Control
NIHB Non-Insured Health Benefits
CCC Clinical and Client Care
CPG Clinical Practice Guideline
RIFNC Remote and Isolated First Nation Community
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