ACUTE CARE FOR ELDERS (ACE)
12-MONTH QUALITY IMPROVEMENT
COLLABORATIVE
EXPRESSION OF COMMITMENT
EXPRESSION OF COMMITMENT DEADLINE:
FEBRUARY 1, 2016
The ACE collaborative is a partnership between the Canadian Foundation for Healthcare
Improvement and the Technology Evaluation in the Elderly Network.
The Canadian Foundation for Healthcare Improvement (CFHI) identifies proven innovations and accelerates their spread
across Canada by supporting healthcare organizations to adapt, implement and measure improvements in patient care,
population health and value-for-money. CFHI is a not-for-profit organization funded through an agreement with the
Government of Canada. The views expressed herein do not necessarily represent the views of the Government of Canada.
Technology Evaluation in the Elderly Network (TVN) is Canada’s network for frail elderly and late-life care solutions. We
support original research, and train the next generation of health care professionals and scientists to improve outcomes for
elderly Canadians across all settings of care. Recognizing they may be nearing the end of life, TVN is dedicated to improving
advance care planning and end-of-life care.
Expression of Commitment
Acute Care for Elders (ACE) 12-Month Quality Improvement Collaborative
This Expression of Commitment constitutes a team application to participate in the Acute Care for Elders
(ACE) collaborative focused on implementing and evaluating elder-friendly interventions across acute care
hospitals in Canada and internationally. Please refer to the Prospectus for detailed information before filling
out the application form.
By completing the Expression of Commitment, the organization and team members confirm that they have
reviewed and understood CFHI’s Conflict of Interest Policy, including the rules regarding the eligibility of
foundation employees, directors and agents. Organizations from which any members of the CFHI’s Board of
Directors, or foundation agents or employees receive remuneration are eligible to apply to this competition.
Applicants must fully disclose any relationship with sitting CFHI board members.
Please Note
 Expressions of Commitment will be reviewed and screened in February and readiness interviews
conducted, as needed. The deadline for submission of the expression of commitment is February 1,
2016. Teams are advised to hold February 19, 22 and 23 as potential dates for readiness interviews.
 CFHI plans to limit enrollment in the collaborative to up to 15 organizations.
 Teams will be selected by CFHI and advisors based on the strength of their applications as aligned with
characteristics described within the Prospectus and on CFHI considerations of overall composition of the
cohort of teams in terms of diversity of setting and context.
 Decisions will be communicated to applicants by February 26.
 All applicants will receive summary feedback from the reviewers.
 Memorandums of Understanding (MOUs) from each team must be signed by March 11.
 The maximum page limit for Sections A to C of the expression of commitment is 7 pages. All applications
must be on letter-sized paper (8 ½ by 11), single space, with use of the margins and Calibri 11-point font
that has been preset into the form.
Application Instructions
Please submit (by e-mail only) this Expression of Commitment and
 Abbreviated curriculum vitae (1 page or less) for each team member.
 Declaration of any potential conflict of interest as per CFHI policy.
Email completed applications to Lucie Matthews at Lucie.matthews@cfhi-fcass.ca
If you would like to speak with someone about the application, please email or call Claudia Amar, Senior
Improvement Lead at Claudia.amar@cfhi-fcass.ca or 613-728-2238 (292).
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A: Organizational Commitment
Executive endorsement and support – must be made by the CEO or person of highest accountability in the
organization (e.g., accountable to the board of directors) as well as a member of senior management
(including a clinical or administrative lead).
CEO (or person of highest accountability in the organization)
Mr./Mrs./Ms./Dr.
Name
Title/Department
Organization
Mailing Address
City
Province
Telephone
Fax
E-mail
Original Signature1
Postal Code
Member of Senior Management (including a clinical or administrative lead)
Mr./Mrs./Ms./Dr.
Name
Title/Department
Organization
Mailing Address
City
Province
Postal Code
Telephone
Fax
E-mail
Original Signature1
1. Explain how implementing elder-friendly care practices is aligned with your organization’s strategic priorities.
2. Explain how you will ensure adequate time and resources are allocated to implementing and evaluating
the success of the initiative.
1
Signature on the application form confirms the organization’s commitment to:
The development, implementation, evaluation and potential sustainability of the initiative. During the collaborative, the CEO (or
most senior leader in the organization) will ensure the improvement team has: Regularly scheduled access to the senior
executive team; protected time for the work; and support for, and active engagement in, the organizational or policy change
dimensions. Senior management (including a clinical or administrative lead) will support and be accountable for the overall
direction, implementation, and management of the initiative.

Signing an agreement with CFHI, confirming mutual commitments, by March 11 should the application be successful.

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B: Organizational Overview
1. Your organization is located in an area that is:
□ Rural
□
Remote
□
Urban
2. Provide a brief overview of your organization, including a description of the elder-friendly services it
currently provides and your successes and challenges to date in advancing elder-friendly care within your
organization.
3. Please provide a description of the older population your organization is serving, e.g., percentage of
people aged 65 years and over and aspects that characterize this patient population as well as the
challenges inherent in meeting their particular needs.
4. Please provide a brief overview of the severity of the problem you are looking to address e.g., what
metrics are you trying to improve with the establishment of more elder-friendly practices? (E.g.,
reductions in readmission rates within 30 days of admission to the hospital, reductions in patients’ total
lengths of stay, improvements in patient and family experience, etc. . .)
5. Please indicate which of the following services you are currently providing in your organization, if any:
Mount Sinai Hospital Acute Care for Elders (ACE) Strategy Components
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Emergency Department Components
High-Risk Screening for Elders
Geriatric Emergency Management (GEM) Nurses Model
Geri-EM Emergency Department (ED) Staff Educational Program
Inpatient Care Components
Elder-Friendly Order Sets
Use of Provincial/National Nursing Best Practice Guidelines
Nurse Rounding Model
Acute Care for Elders (ACE) Medical Unit
Integrated Orthogeriatrics Hip Fracture Service
Hospital Elder Life Program (HELP)
Nurses Improving Care for Healthsystem Elders (NICHE)
ACE Tracker
Inpatient Behavioural Management Strategies to Promote Patient and
Staff Safety
Urinary Catheter Use Reduction Initiatives
Our Organization Does
This
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
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Transitional and Community-based Care Components
14. Care Transitions Interventions
15. Home-Based Primary/ Specialty Care Model
16. Nurse-Led Outreach Team to Long-Term Care Homes
17. Community Paramedicine Program for Frequent Emergency Services
Users
18. Intensive Care Management Program for High-Risk Older Patients
Other(s), if applicable:
☐
☐
☐
☐
☐
6. Please provide a brief description of each of the elder-friendly components that have been implemented
in your organization and their impacts.
C: Organizational Readiness
1. Please describe your goals for this initiative and how you will adapt and implement the Mount Sinai’s
four ACE Strategy Principles (see below) to your context.
1) Redesigns or establishes new sustainable approaches that seek to enhance and improve upon
current service models.
2) Requires a shift in traditional thinking that currently underpins the administration and culture of
most traditional care organizations.
3) Is not averse to identifying risk factors and needs and intervening early to maintain independence.
4) Requires a relentless focus on monitoring and evaluating its outcomes to support continuous quality
improvement.
2. Provide an example of how your organization has implemented and measured quality improvement
initiatives to date.
3. Please indicate if your organization is involved in any of the following capacity-building initiatives related
to the care of your older patients.
1. Nurses for Improving the Care of Healthsystem Elders (NICHE) Hospital
2. Registered Nurses’ Association of Ontario (RNAO) Best Practice Spotlight Organization (BPSO)/or Use
of Provincial/National Nursing Best Practice Guidelines
3. Regional Geriatric Program (RGP) of Ontario Senior Friendly Hospital Advanced Leadership Training
Program
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4. Please indicate which of the following measures you are currently tracking, if any:
Quality
Dimensions
Access and
Efficiency
Measures
We Are
Tracking
This
Measure
☐
☐
☐
1. Expected Length of Stay/ Average Length of Stay Ratio
2. Average Length of Stay
3. Alternate Level of Care (ALC) Days as % of total days (ALC
rates)
4. Return to Pre-admission Destination (%)
☐
Additional access and efficiency measures you are tracking, if applicable:
5. Readmission Within 30 Days
6. Rate of Delirium
7. Prevalence Hospital-Acquired Pressure Ulcers (Stage 2 and
Above)
8. Falls Resulting in Injury
9. Catheter Associated Urinary Tract Infection Rate
10. Medication Reconciliation on Admission for Targeted
Patients (%)
Additional quality and safety measures you are tracking, if applicable:
☐
☐
☐
Experience of 11. Patient Satisfaction: Overall Care Received
Care
12. Patient Satisfaction: Communication Around Discharge
13. Patient Satisfaction: Did Everything To Control Pain
14. Total Care Environment Score (NICHE Geriatric Institutional
Assessment Profile) Staff Satisfaction Measure
Additional experience of care measures you are tracking, if applicable:
☐
☐
☐
☐
Quality &
Safety
Financial
Health
15. Average Total Cost Per Case
16. Average Total Cost Per Weighted Case
Additional financial health measures you are tracking, if applicable:
☐
☐
☐
☐
☐
5. Please indicate if you are tracking other measures and if so, please elaborate.
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6. Briefly describe other resources or processes that are in place in your organization that will support
implementation and evaluation of the intervention (e.g., quality improvement committee, patient
advisory committee, information technology systems, tools, etc. . .).
7. Please describe if your organization has developed any connections or collaborations with community
and primary care providers that can help avoid hospital use (ED visits, unplanned readmissions) after an
acute care hospitalization.
D. Ethics
1. Is ethics approval required prior to commencement? Yes
□ No □ Need more information □
Although this initiative is not a research project, expectations for ethics approval vary by location and
organization. Applicants should investigate at the application stage what form of ethics approval this
initiative may require (e.g., full ethics approval or approval to conduct a quality improvement initiative).
It is expected that successful teams will begin the process of gaining ethics approval as soon as they are
advised of the success of their application.
E. External Partnerships or Sponsors
1. Do you have any external partnerships or sponsorship agreements in place that will support
implementation and evaluation of the intervention? If yes, please describe.
F. Budget
1. How does your organization anticipate spending the seed funding (of up to $40,000) to support
implementation and evaluation of the initiative? (e.g., for time release of front-line providers; education
costs; project manager; travel for educational purposes; etc. . .). *Note that final development of a
budget will be informed by answers to this question.
Please complete the budget summary below using the eligible and ineligible expense information
provided in Appendix 1.
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Budget Summary
Category
Personnel
Travel
Equipment
Supplies and Service
Description
Amount
Total
Budget Justification: The appropriateness of the proposed budget will be assessed by the reviewers.
Please provide a detailed breakdown of each budget category by line item below.
G: The Team
Your team must include the following members:

Team Lead: who will be the key coordinator and motivator, ensure milestones are met, and who will
serve as a main point of contact for CFHI. This individual will plan for and provide overall guidance and
oversight for the spread and will be primarily accountable for the design, implementation, and
evaluation of the initiative. This person will lead and coordinate necessary engagement with staff.

Evaluation and Measurement Lead: who will be accountable for the evaluation of the innovation;
support or coordinate/supervise data analysis; regularly communicate results to healthcare teams via
brief quarterly reports and through meetings with management, physicians, and the larger multidisciplinary staff; participate in all activities related to process and outcome measurement (e.g.,
webinars with evaluation and measurement leaders from other teams).

Physician Champion(s): who will work with the Team Lead and provide necessary clinical support to
staff. Multiple Physician Champions can be included (e.g., geriatrician, primary care physician, etc. . .).

Nurse Champion(s): who will work with the Team Lead and Physician Champion(s) on implementing
elder-friendly practices. Multiple Nurse Champions can be included (e.g., registered nurse, advanced
practice nurse, etc. . .).

Patient and Family Caregiver Advisor: who has experience and expertise as a service-user within the
healthcare organization and who will advise the team on patient-centred approaches to care.
This team will be responsible for ensuring that:
1) There are established structures for advancing the initiative;
2) The initiative is a recognized organizational priority;
3) That the appropriate amount of time, resources, and accountability is in place to promote performance
measurement and overall success.
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Note that there is no limit to the number of team members and a single person can play multiple roles (e.g.,
the Evaluation and Measurement Lead might also be the Team Lead). You may elect to include, for example,
senior medical, nursing, and pharmacy leadership; and a quality improvement leader.
Please list all members of your team and complete the information below:
Team Lead
Mr./Mrs./Ms./Dr.
Title/Department
Organization
Mailing Address
City
Telephone
E-mail
Original Signature
CV one-pager attached
Name
Province
Fax
Yes
□
Evaluation and Measurement Lead
Mr./Mrs./Ms./Dr.
Title/Department
Organization
Mailing Address
City
Telephone
E-mail
Original Signature
CV one-pager attached
Yes
□
Physician Champion(s)
Mr./Mrs./Ms./Dr.
Title/Department
Organization
Mailing Address
City
Telephone
E-mail
Original Signature
CV one-pager attached
Postal Code
Language of
Correspondence
English
□
French
□
Name
Province
Postal Code
Fax
Language of
Correspondence
English
□
French
□
Name
Province
Postal Code
Fax
Yes
□
Language of
Correspondence
English
□
French
□
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Nurse Champion(s)
Mr./Mrs./Ms./Dr.
Title/Department
Organization
Mailing Address
City
Telephone
E-mail
Original Signature
CV one-pager attached
Name
Province
Yes
Language of
Correspondence
□
Patient and Family Caregiver Advisor
Mr./Mrs./Ms./Dr.
Title/Department
Organization
Mailing Address
City
Telephone
E-mail
Original Signature
CV one-pager attached
Postal Code
Fax
Yes
English
□
French
□
Name
Province
Postal Code
Fax
Language of
Correspondence
□
English
□
French
□
Other Team Members
Please copy and paste as many team member boxes as you require — all other contact information for team
members must be provided on their CV one-pager.
Team Member Name
Affiliation
Original Signature
CV one-pager attached
Yes
□
Yes
□
Team Member Name
Affiliation
Original Signature
CV one-pager attached
Team Member Name
Affiliation
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Original Signature
CV one-pager attached
Yes
□
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APPENDIX 1: ELIGIBLE AND INELIGIBLE BUDGET EXPENSES
CATEGORY
Personnel
(up to 100% of
eligible
expenses)*
ELIGIBLE
 release time for team members whose
regular job description will be amended to
allow them to work on the quality
improvement initiative or funds to hire
additional staff to backfill the jobs of team
members who are being released to work on
the quality improvement initiative
 salary replacement costs to allow providers
to participate in the quality improvement
initiative (not including delivery of services)
INELIGIBLE**
 eligible release time charged
at rates above existing salary
 service delivery costs
 release time related to the
financial administration of
collaborative funds
Travel for
Educational
Purposes
(up to 10% of
eligible
expenses)*



travel costs for team members between
quality improvement initiative site(s)
travel, accommodation and meals for team
members required to attend meetings,
including the collaborative in-person
workshop in fall 2016

Equipment**
Supplies and
Services
(up to 10% of
eligible
expenses)*
travel costs not directly
related to the conduct of the
quality improvement
initiative


cost of producing materials required for the
quality improvement initiative (photocopies,
printing, office supplies, etc. . .)
costs relating to communication of the
quality improvement initiative results, such
as meetings and videoconferences
computer and other capital
purchases
 cost of equipment directly
required for the quality
improvement initiative
 cost of supplies and services
not directly related to the
conduct of the quality
improvement initiative
* Use as a guide
** Under usual circumstances, items listed here will be deemed ineligible. CFHI recognizes, however, that
exceptional situations exist. Please contact CFHI staff for clarification and interpretation.
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