SEAT Database Submission Form

1. Program Title:

2. Medical Area/Specialty: Which medical area will be most impacted by this activity?

3. Activity Type (Select the best fit from the list for activity type. You may select up to three choices. Please note: Activity type "physician engagement general or clinical" may be used for midwives and dentists.)

Business case or proposal (e.g. patient programs, hospital equipment)

Communication (e.g. new opportunities, methods or tools to share information or communicate with physicians or stakeholders)

Cultural Safety & Indigenous Health (e.g. First Nations community outreach & member engagement, partnerships, committees, strategies, events, learning)

Equity, Diversity and Inclusion (e.g. committees, strategies, events, learning)

Health authority collaboration (e.g. meetings, planning, projects with HA leadership, admin and/or allied/program staff)

Leadership development (e.g. workshops, conferences)

MSA / Phys Society / FE activities (e.g. planning, governance, WG meetings, funds)

Networking (e.g. social and speaking events, opportunities for physician connections)

Physician engagement clinical/medical (e.g. collaborative activities and solutions specific to patient care)

Physician engagement general (e.g. involvement in discussions, decisions, workplace improvements, feedback, priority-setting, building physician community)

Physician recruitment (e.g. recruitment strategies, activities)

Physician wellness (e.g. activities that specifically address burnout, support physician health)

Planetary Health (e.g. committees, strategies, policy development, sustainable practices, events, learning)

Quality improvements (e.g. activity to improve patient care: delivery, quality, safety, access, or effectiveness - not the PQI Initiative)

Redeveloping space or building (e.g. unit, clinic, new hospital, lounge)

Regional/ community/ provincial/ partner collaboration or outreach (e.g. physicians at different sites, Divisions of FP)

Research, review or study (e.g. clinical program or patient needs assessment, data collection)

Technology (e.g. electronic information systems, virtual care, two-way text messaging)

Training, education, coaching (e.g. SIM, workshop, conference, teaching, orientation)

4. Health System Impacts (Select the best fit from the list for Health System Areas of Impact. You can select multiple options.)

5. Was Health Authority Input Received?

In Progress, working on receiving input

N/A

No, input not received

Yes, collaborative activity with Health Authority

Yes, input received

Please Indicate if/how the health authority was informed by the activity team of project information before activities began, consulted by the activity team to obtain feedback on key decisions related to the project, involved in the decision making processes related to the activity, collaborated with the activity team by providing advice and leadership (minimum 150 characters and maximum 1,500 characters).

6. Is the Lead Contactable?

Yes

No

7. Share Physician Lead's Name?

Yes

No

8. Full Name of Physician Lead:

9. Progress and Next Steps: Indicate what progress you have made on achieving your objectives and list your next steps. Maximum 1,500 characters (Minimum 150 characters required)

10. Results/Impact of Activity: If the project/activity is complete, provide a high level summary of the results and how the project/activity impacted engagement. Maximum1,500 characters (Minimum 150 characters required)

RH MSA SEAT Database Submission Form