WCMICS Funding Program 2017/18

Expression of Interest (EOI)

Instructions for Submission: Please contact Kathy Quade at r on 03 8344 9171 to discuss your EOI prior to submission. Please utilise the funding guidelines including the selection criteria when completing this EOI.

All Expressions of Interest are due for submission by 5pm on Friday, 25 August 2017 to

Project Criteria:

Project Title (less than 25 words)

Please list hospital/s to be included in this project:

☐ / Melbourne Health
☐ / Royal Women’s Hospital
☐ / St Vincent’s Health Melbourne
☐ / Peter MacCallum Cancer Centre
☐ / Western Health
☐ / Werribee Mercy
☐ / Djerriwarrh Health Services

Please list additional organisations to be involved in this project:

Please list tumour group/s to be included in this project:

☐ / Breast / ☐ / Central Nervous Systems
☐ / Colorectal / ☐ / Genitourinary
☐ / Gynaecology / ☐ / Haematology
☐ / Head & Neck / ☐ / Lung
☐ / Skin/Melanoma / ☐ / Upper GI
☐ / All

Please tick which OCP step/s is being addressed:

☐ /
  1. Prevention and early detection

☐ /
  1. Presentation, initial investigations and referral

☐ /
  1. Diagnosis, staging and treatment planning

☐ /
  1. Treatment: Establish intent of treatment

☐ /
  1. Care after initial treatment and recovery

☐ /
  1. Managing recurrent, residual and metastatic disease

☐ /
  1. End-of-life care

Please list which areas of the National Safety and Quality Health Service (NSQHS) Standards this project will address:

☐ / Governance for Safety and Quality in Health Service Organisations / ☐ / Clinical Handover
☐ / Partnering with Consumers / ☐ / Blood and Blood Products
☐ / Preventing and Controlling Healthcare Associated Infections / ☐ / Preventing and Managing Pressure Injuries
☐ / Medication Safety / ☐ / Recognising and Responding to Clinical Deterioration in Acute Health Care
☐ / Patient Identification and Procedure Matching / ☐ / Preventing Falls and Harm from Falls
☐ / All

Please indicate which WCMICS Strategic Goal/s being addressed by this project:

☐ / Consumer Partnerships: To further enhance the partnership of consumers in the WCMICS work program.
☐ / Transition: To ensure efficient and effective access into and transition out of WCMICS health services for cancer care
☐ / Care Coordination: To facilitate the continued improvement in coordination, quality and consistency of care for cancer patients in WCMICS health services
☐ / Information: To facilitate WCMICS health services to provide timely, useful and culturally sensitive information for cancer patients

Please indicate if this project is addressing any of the priority area as set by the WCMICS Funding Guidelines 2017/18 page’s 7 & 8:

3.1:Oesophagogastric (OG) Optimal Care Pathway (OCP) focus areas:

☐ / 3.1.1 / Improving the timeliness of care, from referral to health services to treatment
☐ / 3.1.2 / Improve coordination of care for OG patients
☐ / 3.1.3 / Improving access to MDMs for all OG patients – particularly improving regional access and establishing regional links
☐ / 3.1.4 / Improving the timeliness of referrals to palliative care.

3.2:Prostate OCP Focus areas:

☐ / 3.2.1 / Improve supportive care for men with prostate cancer, to improve experience and quality of life
☐ / 3.2.2 / Improve contribution to the Prostate Cancer Outcomes Registry (PCOR) promoting collaboration through data sharing
☐ / 3.2.3 / Improving access to MDMs for all prostate cancer patients – particularly improving links for regional patients
☐ / 3.2.4 / Facilitate earlier diagnosis and management of localised prostate cancer by improving community awareness and GP implementation of the NHMRC PSA testing guidelines.

3.3: Improve outcomes & experience for CALD & vulnerable groups

☐ / 3.3.1 / Improving outcomes and experience of care for CALD and Vulnerable groups
☐ / 3.3.2 / Improve access to cancer services for CALD and vulnerable groups

3.4: Other tumour streams / innovative ideas

☐ / 3.4.1 / Innovative approach to improving patient experience / patient outcomes / treatment modalities / access to care and waiting times.

Project Plan Overview:

Project Objective (less than 75 words):

Total Funding Requested (inc GST)

Funding from WCMICS
Additional funding from another source Name of organisation / $

Brief Project Overview (less than 300 words)

Health Service Initial Endorsement:

Applicant’s Manager

I fully support this Expression of Interest.
Name:
Position:
Organisation:
Signature: / Date:

Additional Funding Organisation

I fully support this Expression of Interest.
Name:
Position:
Organisation:
Signature: / Date:

Applicant’s Declaration

I certify that the information in this Expression of Interest is accurate and has been compiled in accordance with the WCMICS Funding Program Guidelines 2017/18.
-The EOI has been discussed with relevant stakeholders and has been submitted for prioritisation by the lead healthservice.
-If the project is piloting a service change which requires ongoing support from the organisation this has been agreed in principle for theEOI.
Name:
Position:
Organisation:
Signature: / Date:

Director of Cancer Services (or nominated representative) Declaration

I certify that this Expression Of Interest has organisational support and has been prioritised against other EOIs submitted by this health service for the WCMICS Funding Program 2017/18.
Name:
Position:
Organisation:
Signature: / Date:
Project priority ranking: #