Quality Improvement (QI) in Clinics Application

Clinic Details

Which Cohort Are You Applying To?(Required)

Name of Clinic(Required)

Mailing Address of Clinic(Required)

Street Address City Province Postal Code

Team Details

QI in Clinics is designed to build capacity for quality improvement with a team working in a primary health care clinic. Teams should consist of a minimum one physician, a medical office assistant and/or office manager, who will lead a clinic-wide improvement project. Clinics may be eligible to have up to five members reimbursed for participating in the program. All team members are expected to take part in both the online course and the virtual workshops. Please see the QI in Clinics Program Guide for further details on team member composition, funding available, and associated program expectations.

Team Lead

The team lead is the individual who is responsible for leading the project team. This can be any individual on your project team, regardless of role. This person is also the primary contact for your team.

Name(Required)

First Last

Position Title(Required)

Phone Number(Required)

Email(Required)

Are you eligible for Mainpro+ credits?(Required)

Yes

No

Team Member 2

Name(Required)

First Last

Position Title(Required)

Phone Number(Required)

Email(Required)

Are you eligible for Mainpro+ credits?(Required)

Yes

No

Add Additional Team Members?

Team Member 3

Name(Required)

First Last

Position Title(Required)

Phone Number(Required)

Email(Required)

Are you eligible for Mainpro+ credits?(Required)

Yes

No

Team Member 4

Name(Required)

First Last

Position Title(Required)

Phone Number(Required)

Email(Required)

Are you eligible for Mainpro+ credits?(Required)

Yes

No

Team Member 5

Name(Required)

First Last

Position Title(Required)

Phone Number(Required)

Email(Required)

Are you eligible for Mainpro+ credits?(Required)

Yes

No

If you plan on involving more than five team members, please reach out to QIinClinics@hqc.sk.ca

Program Sponsor

QI projects within clinics are best supported with sponsorship from the clinic owner or manager. In most cases, this individual is in addition to the team members listed above. The Program Sponsor supports and enables participants to take part in the learning components of the program as well as implement their QI project work. The Sponsor removes barriers and supports project progress by championing and encouraging other clinic staff to take part in testing and implementing changes.

Please fill out the Program Sponsor Form and the Project Sponsor Form. You can attach your completed forms below.

Upload Your Completed Form(Required)

Submit your completed program and project sponsor forms here.

Drop files here or

Max. file size: 50 MB, Max. files: 2.

Project Details

Teams are required to apply their learning to a QI project within their clinic. QI projects may be focused on any area for improvement within the clinic, and may include a focus on:

Patient Outcomes
Patient Experience
Staff Experience/Wellbeing
Clinic Processes

Please tell us about the problem you are proposing to address through your participation in the QI in Clinics program. Describe how you know that this is a problem.(Required)

What would success look like in addressing this problem? For example, how would addressing this problem benefits patients and families, clinic staff or provider experience and wellbeing?(Required)

Please tell us what type of data you intend to use to better understand your problem.(Required)

Click submit below to finish your application

Thank you for applying! We will review your application and get back to you soon.