Request for Harpa Designation Approval

Request for Harpa Designation Approval

REQUEST FOR DESIGNATION UNDER

THE HEALING ARTS RADIATION ACT (HARPA)

TO INSTALL AND OPERATE CT SCANNER / EQUIPMENT

BUSINESS CASE TEMPLATE

Hospital Name: ______

Mailing Address: ______

______

Contact Name/Phone/E-mail: ______

______

LHIN: ______

CT scanner/equipment (new or replacement?) ______

Will this equipment be located in a regional cancer centre? ______

1. Overview & Current Status

______

ITEM / RESPONSE / COMMENTS
Purpose / Rationale / Reason
Brief Environmental Scan
  1. List the individual CT scanners / equipment currently operating at each hospital site. Include:
Name of device
Date installed
Number of slices (ie – 8, 16, 32, 64, if relevant)
Total number of CT scanners / equipment per hospital site
**For each scanner, please also indicate whether:
Research
Clinical
Hybrid (eg – SPECT-CT)
Dental
(A separate list may be attached to this document)
  1. Attach a statement from the hospital which includes the following confirmation:
The number of base hours of operation for the new/replacement CT equipment
That the hospital will have a balanced budget (or plan to balance) in that same fiscal year
That there will be no additional base budget implications with respect to the purchase and operation of this new CT simulator/scanner
That the CT equipment will be purchased with previously secured funds (ie – donation, etc)
  1. Include a brief description of the sponsoring hospital, including programs/services available, overall bed numbers, catchment area, etc.

  1. Identify any “unique” factors that would make this proposal critical for the community / stakeholders.

  1. Strategic Analysis

ITEM / RESPONSE / COMMENTS
  1. Provide impact analysis for both hospital and LHIN to verify that CT implementation is consistent with service provision goals outlined in LHIN’s Integrated Health Services Plan (IHSP)

  1. Explain the goals of the proposal and how it relates to Hospital Strategic Plan, and Wait Time Strategy.

  1. Provide an analysis of the strengths, weaknesses, opportunities, and threats of current CT request/proposal.

  1. Describe all alternative options and the rationale for the recommended option.

  1. List key assumptions and any dependencies which exist with other projects or initiatives.

  1. Describe target benefits, future success measures, and dates for achievement, critical deliverables.

  1. Describe the impact on and communication plan with stakeholders.

  1. Describe any infrastructure work (ie – renovations or new construction) which will be required to accommodate the CT scanner/equipment.

  1. Describe the proposed “reach” of CT services to other communities within the district, county, and/or region.

3. Resource Analysis

ITEM / RESPONSE / COMMENTS
  1. List all start-up, one-time capital, and annual operating costs.

  1. Conduct a cost-benefit analysis which includes a multi-year financial plan addressing the sources of funding for both capital and operating costs. For operating costs, this should describe the hospital’s current financial position, sustainability of resources, and the ability to maintain a balanced budget position as per the Hospital Service Accountability Agreement (H-SAA).

  1. Include an analysis of the health human resources impact, impact on other services, and utilization management strategy.

4. Capital Component

ITEM / RESPONSE / COMMENTS
  1. The hospital must clearly confirm that the following four conditions will be met:
That the equipment and any required construction and/or renovations will be fully funded by the hospital;
That the construction and/or renovations will be related solely to the installation of the equipment and its operation, and that there will be no additional program, service or structural changes resulting from the installation;
That the CT installation proposal will not change the hospital’s Master Plan options and/or Site Plan. Or, if the HSP does not have a current Master Plan / Master Program, that the HSP (along with its Health Care Facility Designers and relevant Health Care Facility Stakeholders) will verify that the project will not have a negative impact on the Vision for the facility and its site(s). The ministry’s Master Planning Guide specifies that a Master Plan must provide for optimum flexibility to adapt to changes in community needs as well as changes in health care delivery. P1 of 11, Version 1, June 9, 2007; and
That if the hospital is in the planning or construction phase of an approved major project,the CT installation, (a) will not have an impact on this pre-existing project if it is located at the same site of the hospital, and (b) will not negatively impact the hospital’s Master Local Share plan.

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