APPLY TO NOURISH
We're delighted you are applying to Nourish:- the future of food in health care!
Please complete this form and include supporting letters by October 1, 2016. Please have the lead applicant complete this form once, including the information of the supporting applicant and endorsing CEO or senior leadership team member.
If two members from the same organization are applying for two positions in the cohort, please have them complete a separate application which outlines the rationale for selecting two applicants from the same organization.
Responses will be kept confidential within the selection committee.
As needed, interviews will be conducted during the month of October 2016.
Successful applicants will be notified by November 1, 2016.
CONTACT INFORMATION
1a. Name of Lead Applicant *
1b. Organization of Lead Applicant *
1c. Position (role) of Lead Applicant *
1d. Contact Number of Lead Applicant *
1e. Email Address of Lead Applicant *
1f. Full Organizational Mailing Address of Lead Applicant *
2a. Name of Supporting Applicant *
2b. Organization name and full mailing address of supporting applicant *
2c. Position (role) of Supporting Applicant *
2d. Contact Number of Supporting Applicant *
2e. Email Address of Supporting Applicant *
3a. Name of Endorsing CEO or Senior Leadership Team member *
3b. Organization name and full mailing address of supporting applicant Endorsing CEO or Senior Leadership Team member *
3c. Position (role) of Endorsing CEO or Senior Leadership Team member *
3d. Contact Number of Endorsing CEO or Senior Leadership Team member *
3e. Email Address of Endorsing CEO or Senior Leadership Team member *
4. In your personal life, what role does food play? What does food mean to you?
(300 words or less)
5. Describe your institution's food service. (Is it outsourced or run in-house? Who does purchasing? Member of GPO (which one)? Broadline distributor? Other suppliers? What is the cooking set-up?)
6. How many patients do you feed or how many meals do you serve? What is your annual food service budget?
7. What is the current culture of food in your institution? What do you think it could be?
(300 words or less)
8. What other food initiatives exist at your institution? (e.g. healthy food environment policy, on-site gardens, food security programs)
(300 words or less, Word count: 0)
MOTIVATION TO ADHERE TO NOURISH
9. Why are you interested in participating in Nourish? What do you want to learn?
(300 words or less)
10. What value would your organization get out of participating in Nourish?
(300 words or less)
11. What skills, strengths, or experiences could you share with the national Nourish cohort?
(300 words or less)
12. What are the current priorities of your institution?
(300 words or less)
13. How do the current priorities of your organization relate to food?
(300 words or less)
14. Please describe the population your institution primarily serves. How does this influence your food service?
(300 words or less)
15. What key performance indicators or measures of success are you accountable to? What other indicators or KPIs in your organization are/or could be affected by your food service?
(300 words or less)
16. Who are your (current or ideal) key allies in your organization, to develop a culture of food enhancing health in your organization?
(300 words or less, Word count: 0)
PRIORITIES
17a. Please rank your personal interest in the following topics (1 = top priority, 10 = lowest priority):
· Writing more strategic RFPs.
· Developing new menus that feature more sustainable, nourishing foods that promote healing and comfort.
· Shifting purchasing towards more local sustainable food sourcing.
· Engaging patients, families and staff in decision making and food education.
· Developing institutional policy that supports a culture of food for health.
· Influencing public policy and regulation that affects food in health care.
· Producing evidence of the benefits of a food for health approach.
· Reframing ‘best value’ and related criteria in RFPs.
· Addressing environmental concerns related to food choices.
· Addressing social determinants of health.
· If you have other priorities not mentioned in this list, please mention them here and give them a rating from 1 to 10 (1 = top priority, 10 = lowest priority) (300 words or less)
18a. Please rank the relevance of the following topics to your institution: (1 = top priority, 10 = lowest priority):
· Writing more strategic RFPs.
· Developing new menus that feature more sustainable, nourishing foods that promote healing and comfort.
· Shifting purchasing towards more local sustainable food sourcing.
· Engaging patients, families and staff in decision making and food education.
· Developing institutional policy that supports a culture of food for health.
· Influencing public policy and regulation that affects food in health care.
· Producing evidence of the benefits of a food for health approach.
· Reframing ‘best value’ and related criteria in RFPs.
· Addressing environmental concerns related to food choices.
· Addressing social determinants of health.
· If your institution has other priorities not mentioned in this list, please mention them here and give them a rating from 1 to 10 (1 = top priority, 10 = lowest priority) (300 words or less)
19. Describe an initiative or project that you would like to undertake at your institution. (300 words or less)
OPPORTUNITIES
20. Do you have any food sourcing or food service management contracts coming up for renewal, or other events that would make your participation in Nourish timely? If so please describe.
(300 words or less)
21. Are there other institutions in your region that might be interested in this program? Please describe them briefly and your existing relationship, or how will you reach out to them. We encourage applicants to reach out to other institutions in their region to apply to the cohort. Preference will be given to clusters of applications that come from the same region.
(300 words or less)
COMMITMENTS & SUPPORT
22a. The Nourish program is valued at $20,000 per participant. The J.W. McConnell Family Foundation will subsidize participation such that the cost to selected applicants will be between $3,000 to $5,000 for the two-year program. Program participation costs covered by Nourish include travel and accommodation for two national retreats. Please propose the amount your facility is committed to paying, and explain. Cost should not be a barrier to participating in Nourish. If your institution is requesting a full or partial scholarship, please use this space to outline the basis for the request.
Amount your facility is committed to paying ($)
22b. Explanation
(300 words or less, Word count: 0)
23a. Do you have access to a webcam for an interview?
23b. Can you have access to a webcam for the duration of the program to participate in video conference calls?
24a. Please attach a Letter of Support from your Senior Leadership Team endorsing your participation in Nourish and outlining the institution’s alignment with the program mission to the Nourish application from. Strong letters of support will describe how the senior leadership team from your institution will support the applicant to Nourish and show clear mission alignment between the Nourish mission and your organization’s strategic priorities. *
Please use the following naming convention for your attached files: Organization Name_Senior Leadership Letter of Support
24b. Optional: Attach any additional letter(s) of support for your participation (from peers, supply chain partners, community partners, or other relevant supporters) to the Nourish application form.
Please use the following naming convention for your attached files: Organization Name_Additional Letter of Support
24c. Optional: Please indicate any other institutions in your region that might be interested in or applying to Nourish. Please describe the status of your conversation with them, if any – or if you would like us to follow up with a particular contact.
______
If you have further questions, please contact Hayley Lapalme to discuss: mailto:.