Exit Doctors Nova Scotia Skills and Attributes Matrix for Board Chair Position 1. Doctors Nova Scotia Skills and Attributes Matrix for Board Chair Position For the Board Chair position, the information gathered from this skills and attributes survey serves two purposes:1. To assess the diversity of member representation on the Board: All candidates are asked to complete a skills and attributes survey when expressing an interest in an appointed position on the Board of Directors. The information gathered allows the Nominating Committee to assess the current mix of skills and attributes of those on the Board and will highlight gaps that may need to be filled. 2. To assess whether candidates meet the criteria for the position (see the ‘Board Chair Criteria' found on the Nomination Form). *The information gathered will be kept confidential and only shared with the selection committee* Question Title * Full name Question Title * Email address Question Title * Specialty Question Title * Practice Location Question Title * Payment model: Question Title * Contact numbers Primary Alternate Question Title * Perspective/Background: (Please tick the boxes that apply). BIPOC Indigenous status 2SIALGBTQ+ Disability Family medicine specialist Royal College specialist International medical graduate Early career (less than 10 years in practice) Late career (less than 10 years until retirement) Retired Question Title * How do you identify? Female Male Gender diverse Other: Question Title * Board Chair Experience/Knowledge/Skills (Please check the number that you feel best represents your experience, knowledge or skills in the specified area). 1 (none) 2 (low) 3 (moderate) 4 (high) Experience serving on boards Experience serving on boards 1 (none) Experience serving on boards 2 (low) Experience serving on boards 3 (moderate) Experience serving on boards 4 (high) Experience chairing meetings Experience chairing meetings 1 (none) Experience chairing meetings 2 (low) Experience chairing meetings 3 (moderate) Experience chairing meetings 4 (high) Knowledge and understanding of rules of order/parliamentary procedures Knowledge and understanding of rules of order/parliamentary procedures 1 (none) Knowledge and understanding of rules of order/parliamentary procedures 2 (low) Knowledge and understanding of rules of order/parliamentary procedures 3 (moderate) Knowledge and understanding of rules of order/parliamentary procedures 4 (high) Knowledge of governance practices/improvements Knowledge of governance practices/improvements 1 (none) Knowledge of governance practices/improvements 2 (low) Knowledge of governance practices/improvements 3 (moderate) Knowledge of governance practices/improvements 4 (high) Communication and facilitation skills Communication and facilitation skills 1 (none) Communication and facilitation skills 2 (low) Communication and facilitation skills 3 (moderate) Communication and facilitation skills 4 (high) Conflict resolution skills Conflict resolution skills 1 (none) Conflict resolution skills 2 (low) Conflict resolution skills 3 (moderate) Conflict resolution skills 4 (high) Question Title * General Experience/Knowledge/Skills(Please check the number that you feel best represents your experience, knowledge or skills in the specified area). 1 (none) 2 (low) 3 (moderate) 4 (high) Cultural Competence/Equity Issues Cultural Competence/Equity Issues 1 (none) Cultural Competence/Equity Issues 2 (low) Cultural Competence/Equity Issues 3 (moderate) Cultural Competence/Equity Issues 4 (high) eHealth/Technology eHealth/Technology 1 (none) eHealth/Technology 2 (low) eHealth/Technology 3 (moderate) eHealth/Technology 4 (high) Financial Acumen Financial Acumen 1 (none) Financial Acumen 2 (low) Financial Acumen 3 (moderate) Financial Acumen 4 (high) Government Relations Government Relations 1 (none) Government Relations 2 (low) Government Relations 3 (moderate) Government Relations 4 (high) Health Policy Health Policy 1 (none) Health Policy 2 (low) Health Policy 3 (moderate) Health Policy 4 (high) Leadership Leadership 1 (none) Leadership 2 (low) Leadership 3 (moderate) Leadership 4 (high) Question Title * Comments This matrix and the supporting documents (Board and Committee Diversity Policy and Guidelines for Diversifying the Board and Committees) were developed in collaboration with the Governance Committee, the internal DNS EDI Committee and physician members of equity-deserving groups. If you have any questions or require assistance completing this form, please contact Sonia Abi-Ajab at sonia.abiajab@doctorsns.com. Done