Advancing Teams Program Application

Introduction to the Advancing Teams in Community Health Program

Thank you for your interest in the Advancing Teams in Community Health Program. This 10-month Program is designed to build leadership, teams, and improvement capacity at community health centers in Massachusetts.

Please complete the application below and submit the required letter(s) of support by Wednesday, August 31st.

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* 1. Community Health Center

Name

Address

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* 2. Leadership Sponsor(s)

Your Leadership Sponsor(s) should be your Executive Director, Chief Medical Officer or other leadership team member who can help support your team over the course of the next 10 months. This person will be required to attend a half-day orientation meeting in October, and several other events throughout the program period.

Name, title, email address

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* 3. Day-to-Day Leader
This is the lead point-person between your team and the Advancing Teams Program faculty.

Name

Title

Email address

Phone number

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* 4. Please describe your CHC’s patient demographics.

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* 5. Do you currently involve patients in your improvement projects? Do you anticipate involving a patient partner on your team? Please describe.

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* 6. What types of trainees are currently involved at your CHC?

Residents

Medical school students

Nursing students

Dental students

Behavioral health practicum students

Others (please specify)

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* 7. Please state your reason for participating in this program.

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* 8. The Advancing Teams Program design requires that CHCs select an improvement project upon which to focus and apply their learning over the course of the project. Please choose from one of the recommended focus areas below or identify another focus area for your improvement work.

Behavioral Health Integration

Oral Health Integration

Use of patient navigators/community health workers to improve care for patients with complex care needs

Other (please specify)

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* 9. Please state how your selected project aligns with your organization’s strategic plan.

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* 10. Please state how the selected project aligns with your community’s health priorities.

In addition, please email the letter(s) of support outlined below to Ceara_OSullivan@hms.harvard.edu:

(Mandatory) A letter of support from your CHC’s Leadership Sponsor that outlines engagement and commitment to program time and resources
(Optional) A letter(s) of support for trainee engagement from the affiliated training program(s)

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* 1. Community Health Center

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* 3. Day-to-Day Leader This is the lead point-person between your team and the Advancing Teams Program faculty.

Question Title

* 4. Please describe your CHC’s patient demographics.

Question Title

* 5. Do you currently involve patients in your improvement projects? Do you anticipate involving a patient partner on your team? Please describe.

Question Title

* 6. What types of trainees are currently involved at your CHC?

Question Title

* 7. Please state your reason for participating in this program.

Question Title

* 8. The Advancing Teams Program design requires that CHCs select an improvement project upon which to focus and apply their learning over the course of the project. Please choose from one of the recommended focus areas below or identify another focus area for your improvement work.

Question Title

* 9. Please state how your selected project aligns with your organization’s strategic plan.

Question Title

* 10. Please state how the selected project aligns with your community’s health priorities.

* 3. Day-to-Day Leader
This is the lead point-person between your team and the Advancing Teams Program faculty.