SUBGRANT AGREEMENT RE SCALE WITH INSTITUTE FOR HEALTHCARE IMPROVEMENT.PDF

Institute for
Healthcare
Improvement
SUBGRANT AGREEMENT
between
Institute for Healthcare Improvement and
IViaricopa County Department of Public Health
On behalf of Health Improvement Partnership of Maricopa County
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 Health Department. As a SCALE
community subgrantee you should read this carefully; your signature on this form constitutes
your acceptance of all the teems and conditions. As used in this form, the term "subgrant"
includes any income you derive from the subgrant.
Sub-Awardee: Maricopa County Department of Public Health
On behalf of Health Improvement Partnership of Maricopa County
I.D.: 72316 Robert Wood Johnson Foundation Reference)
Amount: $71,000.00 (includes $9,000,00 for travel)
Purpose: Develop community capacity to accelerate improvement and spread of
bright spots in support of creating a culture of health through a formative
evaluation, capacity building and learning approach.
Project Information: Subgrant Period: May 1, 2015 through December 31, 2016
Maricopa County Department of Public Health: Kane Johnson,
Grants/Contracts Administrator, KallaJohnson@mail.maricopa.gov
IHI Project Director: Somava Saha Stout, MD, MS, 617-301-4813
(sstout@lhi.org )
IHI Project Director: Gareth John Parry, MSc, PhD, 617-301-4974
parrv@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 l 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.IH I may approve changes to the schedule from time to
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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.
Spreading Community Accelerators through Learning and Evaluation (SCALE) Initiative
generously supported by the Robert Wood Johnson Foundation and designed to establish systems
for learning and evaluation to spread community efforts toward a Culture of Health and a goal
of.100 million healthier lives. SCALE includes a 20-month intensive "learning and doing" program
for 20 pacesetter communities who are paired with an improvement coach and 4 mentor
communities, The aim is to support local leaders at every level of a community to be successful and
to multiply their effectiveness in achieving their existing vision and goals and facilitate and learn
what it takes to create spread of great approaches between communities to accelerate the pace of
improvement.
An interdisciplinary partnership of the Institute for Healthcare Improvement (IHI), Community
Solutions, Col laborative Health Network (CHN), and Communities Joined in Action (CJA) has
been convened to facilitate the spread of solutions that generate improved community health
outcomes by developing an "Intercommunity learning system at scale' Through a formative
evaluation, the initiative will learn what it takes to create this spread of solutions among
communities; develop a change and capacity building process that builds community capability
to envision, act on, and sustain results-oriented change; and create a support system for
intercommunity learning that continuously adapts and improves the systems needed to
facilitate spread and actively supports communities in their change process.
Pacesetter 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 community health improvement for a local
Improvement advisor;
• intensive support from an improvement coach who will help communities meet their
community-specific health improvement goals;
• Peer-to-peer learning, support and trouble-shooting with other pacesetter communities;
• 'Mentor community" coaches;
• Support in identifying community-specific metrics for the community's health improvement
plan;
• Partnership with a collaborative and supporting evaluation team throughout the 20 months
of SCALE, that will provide timely feedback to accelerate community health improvement;
• Access to a peer learning and knowledge sharing technology platform;
• Support and tools from the broader 100 Million Healthier Lives initiative;
• Travel expenses covered for a local cohort of up to two community leaders, including a local
improvement advisor for a site visit to learn with and from a "best practice" program or
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community; and
$62,000 (plus $9,000 for travel) over 20 months to support your SCALE community health
improvement effort and travel of key leaders and the improvement advisor to attend
required leadership development sessions. The funding cycle begins May 1, 2015 and ends
December 31, 2016.
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.
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)(I ) 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 subgrarit 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
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 IH I 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 11 hereof, you shall
repay within thirty (30) days all 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, 2016 through January 14, 2017 ("Year 2") must first be approved
by IHI if subgrantee seeks to enter into such contract before January 14, 2016.
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 (11) 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
available at www.rwif,org/files/guidelinesforoollsandsurveys.pdf).
It On or before December 1, 2015, representatives of IHI and the Foundation will meet to
discuss the project funded- by the subgrant and whether the Foundation will continue to
provide funding for Year 2. Subgrantee acknowledges and agrees that the decision whether to
fund Year 2 rests with the Foundation in its sole and absolute discretion and that the
Foundation may elect not to fund Year 2 for no or any reason. An election by the Foundation
not to fund Year 2 must be communicated to IHI in writing (in electronic or hardcopy form) on
or before January 14, 2016. IHI will inform subgrantee in writing (in electronic or hardcopy
form) on or before January 18, 2016 or two business days after the Foundation has
communicated to IHI. The.termination right set forth in this Section 2.H is in addition to the
termination rights set forth in Section 11 below.
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.rwif.org/grantees/instructionslistisp) (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
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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
I Hi with copies of such documents upon IHI's request and to make your books and records
available for inspection by the Foundation or 1HI 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 Foundation. 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
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. IF-fl will discuss potential communications activities with you related to this subgrant,
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including the issuing of press releases. Please do not issue press releases or any public
announcements without consulting with 1H1 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,
B. 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)(3), You shall
immediately give written notice to II-II if you cease to be exempt from federal income
taxation as an organization described in Section 501 (c)(3), or your status as not a private
foundation under Section 509(a) and not a Type 111 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)(11) 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 CF. 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.
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 .5,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 H1PAA
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
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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(6(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(2)(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 S u bg rant 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 wider 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,
14. NONTRANSFERABILITY; NO JOINT VENTURE.This subgrant 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 taws,
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: Carol Carol Beasley Date
Title: Vice-President, Business Development
Maricopa County Department of Public Health
Name: Date
Title:
Organization: Maricopa County Department of Public Health
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Institute for Healthcare Improvement C-86-
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:
Deputy Attorney for Maricopa County
Date

Attachment 1:
Scope of Wok
As part of this Agreement, Maricopa County Health Department will:
Please check below if you are a Pacesetter Community
Li A Pacesetter Community is expected to:
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 regularly report how SCALE funds have been spent;
3. Work across sectors (e.g., health care, education, public health, etc,);
4. Work to implement change in your community;
5. Share the good, the bad, and the ugly with transparency;
6. Adopt an improvement approach (e.g., a learning attitude, willingness to try things and test
changes, and use data for improvement);
7. Address equity as part of their health improvement goals;
8. Attend all core SCALE activities including but not limited to the Community Health
Improvement and Leadership Academies (CHIA);
9. Secure a local improvement advisor dedicated to SCALE activities and participating in all
Community Health improvement and Leadership Academies (CHILA), Each community needs
to have, at a minimum, a half-time local improvement advisor dedicated to SCALE for 20
months. (SCALE funds can be used to pay for the improvement advisor. If a community
already has an improvement advisor, funds can be used to engage partners to help
accelerate local improvement efforts.);
10. Sustain community health improvement efforts and the local improvement advisor after
SCALE;
11. Complete a readiness assessment as well as a needs and assets community assessment,
leveraging work you may have already completed as part of a community health needs
assessment;
12. Develop a theory of change and a detailed plan for improving the health of your community,
including a measurable aim, a set of metrics, and a set of ideas to test and implement;
13, Report and share data monthly;
14, Submit and participate in regular formative evaluation requests on your activities, metrics,
and learning;
15. Participate in a peer mentoring process;
16. Participate in monthly peer group calls;
17. Participate in monthly individual coaching calls with a selected person from a mentor
community;
18. Mentor communities earlier in the journey; and
19. Participate in at least one site visit to a "bright spot' community.
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Attachment 2:
Funding Disbursement and Reporting Schedule for Pacesetter Communities
NI will pay Maricopa County Health Department according to the following payment schedule;
' f*Oil0i.it: •• . - - ,. yPayMent.jaMOunt '
Yl. (May 1 2015 —January 31, 2016); $27,500.00
Upon execution of the agreement (Plus $6,000,00 for travel)
Total = $33,500.00
Y2 (February 1, 2016 — December 2016); $34,500.00
Upon submission of annual financial and narrative report (Plus $3,000.00 for travel)
Total $37,500,00
Total over the 20 months (May 1, 2015— December 31, 2016) $71,000.00,— Includes
mentoring stipend and $9,000
for travel
Maricopa County Health Department will provide MI regular financial reports according to the following
reporting schedule:
Report .,,::i -,:':':- :Dile pate . . .
Y1 Financial Report (May 1, 2015— August 30, 2015) September 15, 2015
Y1 Financial Report (September 1, 2015- January 31, 2016) February 15, 2016
,
Y2 Financial Report (February 1, , 2016 — April 30, 2016) May 15, 2016
Y2 Financial Report (May 1, 2015— August 30, 2016) September 15, 2016 •
Y2 Financial Report (September 1, 2016— December 31, 2016) January 15, 2017
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