AGMT RE LEARN EVAL WITH INST FOR HLTH IMPRVMNT.PDF

SUBGRANT AGREEMENT
between
Institute for Healthcare Improvement and
Maricopa County by and through its Department of Public Health on behalf of Health Improvement
Partnership of Maricopa County (HIPMC)
For bridge funding for the SCALE Initiative funded by the Robert Wood Johnson Foundation
Following are the terms and conditions applying to a subgrant made by the Institute of
Healthcare Improvement (“IHI”) to Maricopa County Department of Public Health. As a SCALE
community subgrantee you should read this carefully; your signature on this form constitutes
your acceptance of all the terms and conditions. As used in this form, the term "subgrant"
includes any income you derive from the subgrant.
Sub-Awardee: Maricopa County by and through its Department of Public Health
On behalf of Health Improvement Partnership of Maricopa County (HIPMC)
I.D.: 74280 (Robert Wood Johnson Foundation Reference)
Amount: $5,000
Purpose: Providing bridge funding for the Spreading Community Accelerators
through Learning and Evaluation (SCALE) Initiative
Project Information: Subgrant Period: January 15, 2017 – April 14, 2017
Maricopa County Department of Public Health: Seth Fritsch, Strategic Initiatives
Coordinator, (sethfritsch@mail.maricopa.gov)
IHI Project Director: Somava Saha Stout, MD, MS, 617-301-4813
(sstout@ihi.org)
1. PURPOSE AND ADMINISTRATION. You will directly administer the project or program
being supported by the subgrant and agree that no subgrant funds shall be used in any way
other than as specifically set forth in this Agreement and the final budget and related documents
(Attachments 1 and 2), all as approved by IHI (the "Approved Subgrant Documents") without
IHI's prior written consent. IHI will disburse funds according to the Payment Schedule
(Attachment 2) and, where specified, contingent on subgrantee’s completion of the applicable
target, milestone, or reporting deliverable. IHI may approve changes to the schedule from time to
time, and will confirm any such changes in writing. You further agree that no subgrant funds shall
be disbursed to any organization or entity, whether or not formed by you, except as specifically
set forth in the Approved Subgrant Documents.
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Spreading Community Accelerators through Learning and Evaluation (SCALE) Initiative
generously supported by the Robert Wood Johnson Foundation has supported 24 experienced
community collaborations to develop the skills and capacity necessary to enable local health and
health equity and has expanded to 43 community collaborations earlier in the journey. Relatedly,
the ongoing formative SCALE evaluation enables improvement of the initiative. This grant period will
harvest insights, disseminate information to the field, and refine the approach to supporting
communities earlier in the journey to a Culture of Health and plan for the next phase of work.
Deliverables include contributing to the bright spot library by sharing SCALE stories, synthesis
reports, plan for a capacity building program and curriculum for community collaborative based on
the SCALE experience.
SCALE Bridge Communities will receive the following support system:
 Access to an intensive world-class “learning and doing” program that assists community
representatives in expanding skills and capabilities specific to change management, process
improvement, and implementation;
 Extensive capacity development training in sharing their story;
 Intensive support from an improvement coach who will help communities develop and share
their stories;
 Support in entering data and metrics on Measure What Matters platform;
 Peer-to-peer learning, support and trouble-shooting with other SCALE Bridge communities;
 Access to a peer learning and knowledge sharing technology platform;
 Partnership with a collaborative and supporting evaluation team throughout the 3 months of
SCALE Bridge, that will provide timely feedback to accelerate community health
improvement;
 Support and tools from the broader 100 Million Healthier Lives initiative;
 $5,000 over 3 months to support your SCALE community health improvement effort. The
funding cycle begins January 15, 2017 and ends April 14, 2017.
No changes may be made to the nature or scope of the program or project being supported by
this subgrant without the express written consent of IHI.
2. USE OF SUBGRANT FUNDS.
A. No part of the subgrant shall be used to carry on propaganda or otherwise attempt
to influence legislation within the meaning of Section 4945(d)(l ) of the Internal Revenue
Code.
B. No part of the subgrant shall be used to attempt to influence the outcome of any
specific public election or to carry on, directly or indirectly, any voter registration drive
within the meaning of Section 4945( d)(2) of the Internal Revenue Code.
C. No part of the subgrant shall be used to provide a subgrant to an individual for travel,
study, or similar purpose within the meaning of Section 4945(d)(3) of the Internal Revenue
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Code, without prior written approval of IHI. Payments of salaries, other compensation, or
expense reimbursement to your employees within the scope of their employment do not
constitute subgrants for these purposes and are not subject to these restrictions.
D. No part of the subgrant shall be used for purposes other than religious, charitable,
scientific, literary, or educational purposes or the prevention of cruelty to children or animals
within the meaning of Section 170(c)(2)(B) of the Internal Revenue Code. If any portion of the
subgrant is used for purposes other than those described in Section 170(c)(2)(B) of the Internal
Revenue Code, you shall repay to IHI that portion of the subgrant and any additional amount in
excess of such portion necessary to effect a correction under Section 4945 of the Internal
Revenue Code.
E. You promptly shall repay any portion of the subgrant which for any reason is not used
exclusively for the purposes of the subgrant. You shall repay to IHI any portion of the subgrant
which is not used exclusively for the purposes described in Section 1 hereof by the expiration
of the subgrant period or within any approved extension within thirty (30) days. In addition, if
the Foundation or IHI terminates the subgrant pursuant to Sections 2 .H or 1 1 hereof, you shall
repay within thirty (30) days al l subgrant funds unexpended as of the effective date of
termination and all subgrant funds expensed for purposes or items allocable to the period of
time after the effective date of termination less any Non-cancelable Expenses. As used in this
Section 2.E, the term "Non-cancelable Expenses" means expenses subgrantee legally is
obligated to pay pursuant to the terms of a written contract (approved by IHI as noted below, if
applicable) that cannot be terminated by subgrantee; provided, however, that if a contract is
terminable by subgrantee upon the payment of a termination fee (or other form of liquidated
damages) and that fee is less than the expenses that otherwise would be treated as Non-
cancelable Expenses, subgrantee will terminate the contract in question and the resulting
termination fee will be treated as a Non-cancelable Expense for purposes of this Section 2.E;
provided further, that any contract to be funded under this subgrant that covers any portion of
the period from January 15, 2017 through April 14, 2017 must first be approved by IHI if
subgrantee seeks to enter into such contract before January 14, 2017.
F. If you are directly or indirectly controlled by IHI or by one or more "disqualified persons"
(within the meaning of Section 4946 of the Internal Revenue Code) with respect to IHI , you
agree (i) to expend all of the subgrant prior to the close of your first annual accounting period
following the taxable year in which you receive a subgrant payment, as qualifying distributions
within the meaning of Section 4942(g)(3) and (h); and (ii) to submit to IHI promptly after the
close of your annual accounting period a full and complete written report signed by an
appropriate officer, director, or trustee showing that the qualifying distribution has been made,
the name and address of the recipient or recipients, the amounts received by each, and that all
the distributions are treated as distributions out of corpus under Section 4942(g)(3) and (h).
G. Subgrantee agrees that any polls or surveys funded as part of this subgrant, if any, shall
comply fully with the RWJF Guidelines for Funding and Releasing Polls and Surveys (which are
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available at www.rwjf.org/files/guidelinesforpollsandsurveys.pdf).
3. BUDGET. The subgrant budget and any revisions thereto shall comply with the attached
budget guidelines which are incompliance with the Foundation Budget Preparation Guidelines
and Budget Revision Guidelines (which are available at
www.rwjf.org/grantees/instructionslist.jsp) (collectively the "Budget Guidelines"). Such Budget
Guidelines, as they may be modified by the Foundation from time to time, are part of the terms
and conditions of your subgrant. Expenditures of subgrant funds must adhere to the specific
line items in your approved subgrant budget.
4. ACCOUNTING AND AUDIT. You shall indicate the subgrant separately on your books of
account. You shall maintain a systematic accounting record of the receipt and disbursement of
funds and expenditures incurred under the terms of the subgrant and shall retain the
substantiating documents such as bills, invoices, cancelled checks and receipts in your files for
at least four (4) years after expiration of the subgrant period. You agree promptly to furnish
IHI with copies of such documents upon IHI's request and to make your books and records
available for inspection by the Foundation or IHI at reasonable times.
At our expense, the Foundation or IHI may audit or have audited your subgrant-related books
and records, and you shall provide all necessary assistance in connection therewith.
5. REPORTS. You shall furnish financial reports to IHI for each budget period of the subgrant and
upon expiration, repayment (pursuant to Section 2E) or termination of the subgrant (pursuant
to Section 11). The financial report shall show actual expenditures reported as of the date of the
report against the approved line item budget. You shall furnish annual narrative reports and the
final narrative report to IHI which shall include a report on the progress you made toward
achieving the subgrant purposes and any problems or obstacles encountered in the effort to
achieve the subgrant purposes. All such reports shall be furnished to IHI within fifteen (15) days
after the close of the period for which such reports are made. You shall retain all such reports in
your files for at least four (4) years after expiration of the subgrant period.
At our expense, the Foundation or IHI may monitor and conduct an evaluation of operations
under the subgrant, which may include visits by our representatives to observe your program
procedures and operations and to discuss the program with your personnel.
6. COPYRIGHT; FOUNDATION USE OF DATA; PUBLIC USE DATA SETS. All copyright interests
in materials produced as a result of this subgrant are owned by the subgrantee. You grant to
the Foundation and IHI a nonexclusive, irrevocable, perpetual, royalty-free license to
reproduce, publish, republish, summarize, excerpt or otherwise use and license others to use,
in print or electronic form, including in electronic databases or in any future form not yet
discovered or implemented, any and all such materials produced in connection with this
subgrant.
You represent and warrant that the material produced by you under this subgrant will be
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original and not infringe upon any copyright or any other right of any other person, and has not
previously been published.
If one of the deliverables described in Section 1 is a public use data set for inclusion in the
Foundation's Health and Medical Care Archive, you shall, at no additional cost to the
Foundation and IHI, cause public use data files to be constructed (with appropriate
adjustments to assure individual privacy) in accordance with the specifications of the Inter-
University Consortium for Political and Social Research , University of Michigan, including the
full documentation outlined in the Consortium's current data preparation manual.
7. PUBLIC REPORTING. The Foundation or IHI will report this subgrant, if made, in its next annual
report. IHI will discuss potential communications activities with you related to this subgrant,
including the issuing of press releases. Please do not issue press releases or any public
announcements without consulting with IHI prior to these activities. In addition, we may publish
reports on the project or program, briefly describing its accomplishments and results, which we
may also use to respond to inquiries.
You shall send to IHI copies of all papers, manuscripts and other materials which you produce
that are related to this subgrant.
In all public statements concerning the Foundation, you should refer to the Foundation by its
full name: Robert Wood Johnson Foundation.
8. SUBGRANTEE TAX STATUS. You represent that you are currently either (i) a tax-exempt
organization described in Section 501(c)(3) of the Internal Revenue Code and either (a) are
not a private foundation and are not a Type III supporting organization described in Section
509(a)(3)(B)(iii) ; or (b) are an exempt operating foundation described in Section 4940(d)(2);
or (ii) an organization described in Section 170(c)(1 ) or Section 511(a)(2)(B). You shall
immediately give written notice to IHI if you cease to be exempt from federal income
taxation as an organization described in Section 50 I (c)(3), or your status as not a private
foundation under Section 509(a) and not a Type III supporting organization under Section
509(a)(3)(B)(iii), as an exempt operating foundation described in Section 4940(d)(2) or as a
Section 1 7 0 (c)(1l ) or Section 511 (a)(2)(B) organization is materially changed.
9. CERTIFICATION REQUIRED WHEN SUBGRANT MAY BE USED FOR RESEARCH INVOLVING
HUMAN SUBJECTS. If the subgrant is to be used in whole or in part for research involving
human subjects, you hereby certify that you will conduct the research in compliance with the
ethical standards and the criteria for approval and conduct of research set forth in United
States Department of Health and Human Services policy for the protection of human research
subjects (45 C.F.R. Part 46 and related guidance, as amended from time to time) and all other
federal and state laws applicable to the research project. Such requirements may include, but
are not limited to, obtaining and maintaining institutional review board (IRB) approval and
obtaining informed consent of participating research subjects.
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10. PRIVACY AND SECURITY OF HEALTH INFORMATION. You represent and warrant that any
individually identifiable health information used or disclosed in connection with the subgrant
will be used and disclosed in compliance with applicable federal and state statutes and
regulations regarding the privacy and security of such information including, but not limited
to, the Health Insurance Portability and Accountability Act of 1996, 42 U .S.C. Section 201 et
seq., as amended, and its applicable implementing regulations, 45 C.F.R. Part 164 (HIPAA).
Any health information reported to IHI will be de-identified within the meaning of the HIPAA
privacy rule or will be consistent with the research subject's signed HIPAA authorization or
will be otherwise permissible under law.
11. SUBGRANT TERMINATION. It is expressly agreed that any use by you of the subgrant
proceeds for any purposes other than those specified in Section 170(c)(2)(B) of the Internal
Revenue Code will terminate our obligation to make further payments under the subgrant.
At our sole option, we may terminate the subgrant at any time if (i) you cease to be exempt
from federal income taxation as an organization described in Section 501 (c)(3) of the Internal
Revenue Code; (ii) your status as not a private foundation under Section 509(a), as not a Type
III supporting organization under Section 509(a)(3)(B)(iii), or as an exempt operating
foundation under Section 4940(d)(2), or as a Section 170(c)(1) or Section 511(a)(2)(B)
organization is materially altered; or (iii) in our sole judgment, you become unable to carry
out the purposes of the subgrant, cease to be an appropriate means of accomplishing the
purposes of the subgrant or fail to comply with any of the conditions hereof.
If the subgrant is terminated prior to the scheduled completion date, upon our request, you
shall provide IHI a full accounting of the receipt and disbursement of funds and expenditures
incurred under the subgrant as of the effective date of termination.
12. LIMITATION; CHANGES; SEVERABILITY. You acknowledge and agree that we have no
obligation to provide other or additional support to you for purposes of this project or any
other purposes. Any changes, additions or deletions to (i) the terms and conditions of the
subgrant; or (ii) the Approved Subgrant Documents must be made in writing only and must be
jointly approved by IHI and you. The invalidity in whole or in part of any term or condition of
this subgrant shall not affect the validity of the other terms and conditions.
13. CHANGED CIRCUMSTANCES; REGULATORY ACTION. You shall promptly notify IHI in writing if
there is any change in circumstances that might affect your ability to carry out the subgrant;
you undergo a merger, division or other corporate reorganization; you become subject to a
proceeding under the Bankruptcy Code or other law relating to insolvency or make an
assignment for the benefit of creditors; you become subject to an investigation or proceeding
brought by the Attorney General or any other regulatory agency; or you receive notice of any
litigation or other legal action relating to the subgrant or are served with a subpoena or other
legal process seeking to compel production of or obtain access to any data related to the
subgrant.
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14. NONTRANSFERABILITY; NO JOINT VENTURE. This grant is not transferable. Nothing contained
herein shall be construed in any manner to imply or create a relationship between the Foundation
and you as partners, joint venturers or agent. You shall not act in any manner as our agent or
representative.
15. AUTHORITY; COMPLIANCE WITH APPLICABLE LAW. You represent and warrant that you have
full power and authority to enter into this agreement , and that all activities conducted hereunder
shall be in full compliance with the requirements of all applicable federal , state and local laws,
regulations and ordinances.
All the terms and conditions above are hereby accepted and agreed to as of the date indicated.
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Institute for Healthcare Improvement
Name: Amy Hosford-Swan Date
Title: Chief Financial Officer, Finance
Maricopa County Department of Public Health and Health Improvement Partnership of Maricopa
County (HIPMC)
IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date
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Name: Date
Title:
Organization: Health Improvement Partnership of Maricopa County
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Attachment 1:
Scope of Work
As part of this Agreement, Maricopa County Department of Public Health will:
1. Have a 501(c)(3) or municipality organization that is willing and able to receive SCALE funds;
2. Provide a local SCALE budget and final report how SCALE funds have been spent;
3. Attend all core SCALE activities including but not limited to
Complete any outstanding Priorities from SCALE 1.0:
a. Enter your data into Measure What Matters platform
b. Re-administer (or administer for the first time) the well-being survey in
accordance with your SCALE work plan.
c. Update your sustainability plans and post on HealthDoers.
d. Complete your Action Labs.
Share your SCALE experience through IMAPP and LiveStories:
a. Use IMAPP to share a specific innovation/program/initiative, ideally all have
measurable outcomes, that you have done/are doing that others in 100M Lives
could learn about and adapt for their own communities.
b. Use LiveStories to share and swap a story of your SCALE journey.
Contribute to the Synthesis Reports:
Identify someone from your team who will participate in writing groups and contribute to
the Synthesis Reports that are capturing our collective experience during SCALE.
Contribute to Planning SCALE 2.0:
Identify someone from your team who will participate in SCALE 2.0 virtual planning and/or
design meetings.
Attend the following upcoming sessions:
a. LiveStories Introductory Session: Thursday, January 26th (3:30 – 4:30 PM ET)
b. LiveStories Training: Monday, February 13, 2017 (1:00 – 2:00 PM ET)
c. Additional LiveStories trainings and technical assistance support sessions as
needed
d. Monthly SCALE Update Sessions
i. Thursday, January 26 (3:00 – 3:30 PM ET)
ii. Thursday, February 9th (3:00-3:30 PM ET)
iii. Thursday, March 9th (3:00 – 3:30 PM ET)
iv. Thursday, April 13th (3:00 – 3:30 PM ET)
v. Additional SCALE Update Sessions as needed
e. 100M Lives Momentum Call on the first Thursday of every month at 3:00 PM ET.
i. Thursday, February 2nd (3:00 –4:30 PM ET)
ii. Thursday, March 2nd (3:00 – 4:00 PM ET)
iii. Thursday, April 6th (3:00 – 4:00 PM ET)
f. One of the Measure What Matters office hours to learn about new updates and
answer your questions.
i. Friday, January, 20th (2:00 – 3:00 PM ET)
ii. Thursday, January 26th (11:30 – 12:30 PM ET)
iii. Friday, January 27th (11:30 –12:30 PM ET)
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iv. Additional Sessions as needed
4. Participate in regular formative evaluation requests on your activities, metrics, and learning;
5. Participate in coaching calls with SCALE coach as needed.
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Attachment 2:
Funding Disbursement and Reporting Schedule for SCALE Bridge Communities
IHI will pay Maricopa County Department of Public Health according to the following payment schedule:
Payment Payment amount
Grant Period: January 15, 2017 – April 15, 2017 $5,000
Upon execution of the agreement
Maricopa County Department of Public Health will provide IHI regular financial reports according to the
following reporting schedule:
Report Due Date
Grant Period: January 15, 2017 – April 15, 2017 April 30, 2017
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SCALE Bridge Budget Form
Grant Period: January 15, 2017 - April 14, 2017
COALITION NAME Health Improvement Partnership of Maricopa County
CITY/TOWN OR COUNTY Phoenix
STATE AZ
Category Column1 Amount Salary % FTE Budget Narrative
PERSONNEL
(Please specify) $ - $ - 0%
(If Additional Staff, please specify) $ - 0%
(If Additional Staff, please specify) $ -
Subtotal $ -
Fringe 0% $ - Please describe benefits here
Personnel Total $ -
OTHER DIRECT COSTS
Momentum Lab Meeting Venue $ 500.00 Venue rental for the conclusion meeting of the Action Lab process.
(2) Laptop computers used to support HIPMC daily functioning activities/Quarterly Partner &
Equipment $ 3,400.00 Steering Committee meetings
Office and meeting supplies $ 564.29 Supplies to support HIPMC quarterly and Steering committee meetings.
Other Total $ 4,464.29
Please edit formula for any faculty/consultants as these need be at 4% indirect. See the
INDIRECT - (refer to budget guidelines) 12% $ 535.71 Budget Guidelines
TOTAL $ 5,000.00 not to exceed $5,000.00
FOR IHI USE ONLY
Approved by: Notes:
Date Approved:
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