SCI 2015 AGM Summary Report

SCI SickKids-Caribbean Initiative Enhancing Capacity for Care in Paediatric Cancer and Blood DisordersAnnual General Meeting 2015 April 13-14, Toronto, Canada SUMMARY REPORT

Message from the Co-Chairs and Report SummaryDear Colleagues,Thank you all for joining us in Toronto for the SickKids-Caribbean Initiative (SCI) 2015 AnnualGeneral Meeting (AGM). Marking the start of our third year of operations, this meeting was anopportunity for SCI members in Canada and the Caribbean to come together and think criticallyabout measuring success and working towards sustainability in the course of the five-year initiative.We believe that this year‟s AGM enabled us to strengthen the collaboration within and across the sixparticipating SCI countries and define a strategic path to achieve our collective goal.There are many achievements to date for us to celebrate. We are extremely pleased with theprogress that has been made within each participating country in the Caribbean. Within the firsttwo years of the initiative, we have unveiled all planned telemedicine facilities, provided second -opinion consultative services for dozens of complex cases, begun data collection at allCaribbean sites on new cases and developed a process for providing diagnostic services fornew leukemia cases. In addition, we have unveiled a guidance document that addressesscholarly output from the SCI. The funding target of CAD $8 million has been achieved, whichspeaks to our strong partnership with SickKids Foundation and its respective donors.In the meeting, we discussed the key components for project sustainability. These include:strong respectful partnerships; a shared value proposition; the need for continued local politicalsupport; and finally, taking an active approach to encourage country-level ownership, asappropriate. Demonstrating the impact of the initiative in these first five years is an essentialrequirement for long-term sustainability. Much progress has already been achieved and wecommend all of you – at SickKids and in the Caribbean - for your hard work and dedication tothis initiative.The success and sustainability of this initiative is grounded by the commitment inherent in th epartnerships and collaborations involved. We look forward to continued collaboration across theCaribbean towards our goal of enhancing capacity for care in paediatric cancer and blooddisorders.Sincerely,Victor Blanchette, FRCP(C), FRCP Upton Allen, MBBS, MSc, FAAP, FRCPCMcCaig Magee Family Medical Director and Co-ChairCo-Chair SickKids-Caribbean Initiative (SCI)SickKids-Caribbean Initiative (SCI) Professor of Pediatrics, University of TorontoProfessor of Pediatrics, University of Toronto Chief, Division of Infectious DiseasesStaff Hematologist, Division of The Hospital for Sick Children (SickKids),Hematology/Oncology Toronto, CanadaThe Hospital for Sick Children (SickKids),Toronto, Canada Page 2 of 15

Table of ContentsMessage from the Co-Chairs and Report Summary .................................................................................... 2Table of Contents............................................................................................................................................. 3List of Attendees .............................................................................................................................................. 41.0 AGM Proceedings: Day 1..................................................................................................................... 6 1.1 Meeting Goals, Introductions and Expectations………………………............................................ 6 1.2 Country Updates ............................................................................................................................ 6 1.3 Fundraising Achievements............................................................................................................. 8 1.4 Financial Overview ......................................................................................................................... 8 1.5 Review of Operational Achievements ............................................................................................ 9 1.6 Nursing Practice: Education, Roles & Sustaining Change ............................................................ 9 1.7 Evaluation and Sustainability ......................................................................................................... 9 1.8 Summary of Day 1........................................................................................................................ 102.0 AGM Proceedings: Day 2................................................................................................................... 11 2.1 Summary of Day 1 and Day 2 Goals ........................................................................................... 11 2.2 Group Decisions........................................................................................................................... 11 2.3 Sustainability of Working Group Deliverables.............................................................................. 11 2.3.1 Sustainability of Working Group Deliverables..................................................................12 2.4 Summary and Closing.................................................................................................................. 123.0 Appendices ......................................................................................................................................... 13 3.1 AGM Agenda................................................................................................................................ 13 3.2 SustainabilityFactors .................................................................................................................... 15 Page 3 of 15

List of AttendeesMeeting Facilitator: Mrs. Cindy Bruce-Barrett, SickKids International Affairs, The Hospital for SickChildren (SickKids), Toronto, CanadaEvaluation Specialist: Dr. Hana Saab, SickKids Learning Institute, The Hospital for Sick Children(SickKids), Toronto, CanadaEllie Adler Lisa CharlesSickKids Centre for Global Child Health Ministry of HealthThe Hospital for Sick Children Castries, St. LuciaToronto, Canada Stephanie de YoungCheryl Alexis SickKids Centre for Global Child HealthUniversity of the West Indies The Hospital for Sick ChildrenCavehill, Barbados Toronto, CanadaZulaika Ali Bonnie Fleming-CarrollDepartment of Clinical Medical Sciences Collaborative for Professional PracticeFaculty of Medical Sciences The Hospital for Sick ChildrenUWI, St Augustine Campus Lawrence S. Bloomberg Faculty of Nursing,Trinidad and Tobago University of Toronto Toronto, CanadaUpton AllenDepartment of Paediatrics, University of Toronto Ted GarrardDivision of Infectious Diseases SickKids FoundationThe Hospital for Sick Children Toronto, CanadaToronto, Canada Tracey GibsonCassandra Bick University Hospital of the West IndiesSickKids Centre for Global Child Health Kingston, JamaicaThe Hospital for Sick ChildrenToronto, Canada Sumit Gupta Department of Paediatrics, University of TorontoVictor Blanchette Division of Hematology/OncologySickKids Centre for Global Child Health The Hospital for Sick ChildrenThe Hospital for Sick Children Toronto, CanadaToronto, Canada Patricia Ingram-MartinCurt Bodkyn Bustamante Hospital for ChildrenDepartment of Clinical Medical Sciences Kingston, JamaicaFaculty of Medical SciencesUWI, St Augustine Campus Denise Israel-RichardsonTrinidad and Tobago University of the West Indies School of Nursing St. Augustine, TrinidadRosemary BoyleMilton Cato Memorial HospitalSt. Vincent and the GrenadinesKingstown, St. Vincent and the Grenadines Page 4 of 15

Melanie Kirby-Allen Stan ReadDepartment of Paediatrics, University of Toronto Department of Paediatrics, University of TorontoDivision of Hematology/Oncology Division of Infectious DiseasesThe Hospital for Sick Children The Hospital for Sick ChildrenToronto, Canada Toronto, CanadaJennifer Knight-Madden Michelle Reece-MillsTropical Medicine Research Institute University Hospital of the West IndiesKingston, Jamaica Kingston, JamaicaMargaret Manley Tanya ReidSickKids Centre for Global Child Health SickKids Centre for Global Child HealthThe Hospital for Sick Children The Hospital for Sick ChildrenToronto, Canada Toronto, CanadaSharon McLean-Salmon Corrine Sin QueeBustamante Hospital for Children University of the West IndiesKingston, Jamaica School of Clinical Medicine & ResearchDepartment of Paediatrics, University of Toronto Princess Margaret HospitalDivision of Haematology/Oncology, Nassau, The BahamasThe Hospital for Sick ChildrenToronto, Canada Brian Smith SickKids Centre for Global Child HealthNatalie McNeil-Beecher The Hospital for Sick ChildrenBustamante Hospital for Children Toronto, CanadaKingston, Jamaica Hillete WarnerIsaac Odame SickKids Centre for Global Child HealthSickKids Centre for Global Child Health The Hospital for Sick ChildrenThe Hospital for Sick Children Toronto, CanadaToronto, Canada Sheila WeitzmanMichelle-Ann Richards-Dawson The Hospital for Sick ChildrenBustamante Hospital for Children Toronto, CanadaKingston, Jamaica Karla WentzelJanet Seo The Hospital for Sick ChildrenThe Hospital for Sick Children Toronto, CanadaToronto, Canada Stan ZlotkinClaudia Schauer SickKids Centre for Global Child HealthSickKids Centre for Global Child Health The Hospital for Sick ChildrenThe Hospital for Sick Children Toronto, CanadaToronto, Canada Page 5 of 15

1.0 AGM Proceedings: Day 1The complete agenda for the AGM can be found in the Appendix in Section 3.1.1.1 Meeting Goals, Introductions and ExpectationsAfter being welcomed by the host, V. Blanchette, C. Bruce-Barrett reviewed meeting goals: (1) Review pastyear‟s progress against established milestones and deliverables; (2) Establish evaluation metrics and logicmodel for the program by developing indicators in working group areas; and (3) Discuss and developstrategy for sustainability.During a roundtable of introductions, individual expectations for the AGM were raised. These expectationshave been organized in the following three categories: 1. Working Group Focus Areas  Review achievements to date, updates and progress  Share information and learning  Identify opportunities for improvement 2. Capacity Building, Collaboration and Impact  Measure and articulate project impacts  Clarify our objectives and the „way forward‟  Integrate project and working group outcomes to better coordinate efforts  Identify „where we are at‟ and „where we are going‟  Continue focus on building capacity and overcoming current and future challenges 3. Operations and Sustainability  Set ambitious but achievable goals  Reach agreement on a logic model and evaluation for the program  Develop strategies to achieve measurable outcomes and work towards sustainability  Identify and engage stakeholders to advocate for sustainability1.2 Country UpdatesEach country-lead provided a high-level description of the impact that has been realized to date in theirrespective country. Z. Ali provided an update on the UWI Telehealth Programme as the future SCItelemedicine hub.Overall, key themes noted project impacts to-date on:  standards of care  improved patient care management  enhanced diagnostic capacity and turnaround times  continued focus on specialized education and training  telemedicine capacity enabling sharing of information and access to expert opinion  increased awareness and interest from government  strong support in building capacity and continued movement forwardThe Bahamas: Dr. Corrine SinQuee-Brown Immunophenotyping SOP was a significant addition to the project Need to discuss sourcing for medications in reference to standard of care protocols Continued focus on nursing education is key moving forward National health insurance will include maternal and child radiation oncology Page 6 of 15

Jamaica: Drs. Michelle-Ann Richards-Dawson/ Michelle Reece-Mills The project has helped to raise political awareness for paediatric cancer and there is now keen interest and attention by government on areas for improvement Telemedicine, availability of flow cytometry and timely pathology results have been huge achievements Haemophilia training has brought increased awareness and has served to build capacity for care Physician training is helping reach potential; continued focus on nursing education will be a major support ensuring success SCI has encouraged a more streamlined system of care Significant improvement in the care of children; greater standardization of care Increased awareness as a result of the project Timing of Telemedicine rounds has been an issue in terms of participation Opportunity to increase focus on neuro-oncology Nursing training will have a big impact and need to identify who should be trainedBarbados: Dr. Cheryl Alexis Major achievement was obtaining buy-in from hospital administration and UWI Telemedicine centre opened in 2013 with new, updated equipment Case consultations have been good and it has been very beneficial having access to expert opinion for patient management Have extended review round attendance to broader team; overall participation could be enhanced Diagnostics have improved with immunophenotyping Profile of project has stimulated donor interest and funding Haemophilia training was timely in terms of need and increased awareness Sickle Cell Disease awareness needs to be improved/better communicated locallySt. Vincent and the Grenadines: Dr. Rosemary Boyle More focused, standardized management of children with cancer Knowledge translation and management plans have been instrumental in increasing capacity to manage the children in St. Vincent and the Grenadines The project has encouraged better coordination with the nurses and nursing participation in rounds Establishment of a telemedicine unit is a key milestone Access to expert consultation has been an invaluable result of the project Good collaboration with colleagues across the Caribbean; a feeling of openness and comfort as a result of being part of the project Diagnostic turnaround has been a huge achievement; previously took up to 2 weeks; now it takes 2 days! Biggest challenge is funding with being a poor country Training is also a challenge, as most trained professionals don‟t stay or return to St. VincentSt. Lucia: Lisa Charles Redcap training was significant and data input will now begin 85-90% heel prick capture for Sickle Cell Disease screening Telemedicine has been a good accomplishment Having a second pathologist has enhanced our capacity and reduced turnaround time Coordination and capacity remain a concern particularly with chemotherapy preparation/ delivery and storage (coordinating with pharmacy etc) Page 7 of 15

Trinidad and Tobago: Curt Bodkyn Case consultations have enabled improved care by direct referral and improving care management; neuroblastoma case presentations from other sites changed/ improved management Caribbean based tumour board meetings and creation of a „hub‟ will be key to ongoing sustainability Hiring excellent candidate to take on role of Research Nurse; funding for this position made possible by SCI Evaluation of protocols and focus on outcomes is a priority going forward Nursing education, specifically paediatric nursing, is needed and extremely important Need for increased profile with the government to move things forwardUWI Telehealth Programme: Zulaika Ali Longstanding relationship with SickKids, now in its 11th year of collaboration SCI has enabled upgrades of the system and has established capacity across the islands well beyond the original site in Trinidad Major challenges will be sustainability of system functionality from a technical perspective1.3 Fundraising AchievementsT. Garrard summarized the fundraising achievements of SickKids Foundation for SCI. Fundraising milestones o When the fundraising campaign launched in 2013 SickKids Foundation raised CAD $2 million towards the goal of CAD $8 million o February 2014: CAD $6.8 million raised o March 2015: CAD $8 million goal achieved o 80% of the funding has come from 6 donors; funding supports initiatives spanning all countries Next steps will focus on donor stewardship and meeting donor expectations that include: o an accurate timeline of deliverables o measurable outcomes for each component of the Initiative (Telemedicine, Training, Registry) o annual impact reports on the progress of the Initiative o opportunities to participate in celebrating milestones o access to our partners in the Caribbean (corporate) o an impact on paediatric health in the Caribbean Upcoming articles in local Caribbean newspapers will highlight project achievements to date and bring the campaign to a successful close Subsequent phases of the project will be entirely dependent on outcomes of Phase 1, hence the need for focus and attention on evaluation and sustainability1.4 Financial OverviewB. Smith provided an overview of project finances and expenditures to date, as follows: The project overall is tracking close to plan and is currently over budget by $13K A significant amount of in-country activities needs to occur in order to ensure we do not see a significant financial variance Hiring of local resources dedicated to supporting the project objectives needs to be a top priority Detailed budgets for implementation of the Sickle Cell Disease and Diagnostic Services workplans need to be developed to ensure that the financial resources are sufficient and accurately allocated. Page 8 of 15

1.5 Review of Operational AchievementsEach Working Group presented an update on: (1) 2014/2015 Achievements to Date; (2) Objectives for2015/2016; and (3) Potential Barriers to Sustainability. The working group presentations were are follows: 1. Project Management: Claudia Schauer and Ellie Adler 2. Local Oncology Databases: Sumit Gupta and Tracey Gibson 3. Clinical Care: Victor Blanchette, Corrine Sin Quee and Curt Bodkyn 4. Diagnostic Services: Stan Read 5. Sickle Cell Disease: Isaac Odame and Jennifer Knight-Madden 6. Research and Scholarly Activities: Upton Allen 7. Nursing: Bonnie Fleming-Carroll and Patricia Ingram-Martin1.6 Nursing Practice: Education, Roles & Sustaining ChangeThe Nursing team provided an overview of the nursing education program planned for implementation atUWISoN (St. Augustine). After a brief presentation, attendees were invited to break-out for small groupdiscussions and provide feedback on the following questions: A. Care: How do you envision care to look differently to improve outcomes? B. Nursing roles: In order to achieve this vision, what new skills and knowledge do nurses need to practice differently? What would this look like? C. Integration into the setting: What are enablers/facilitators or strategies to help nurses integrate new knowledge and skills into care settings? How do you see the physician‟s role in facilitating integration? Attendees highlighted areas where enhanced nursing knowledge and practice would improve outcomes including: pain management; patient assessment; interprofessional communication including participation in interdisciplinary rounds; and patient education. Strategies to support integration of trained nurses into the care setting, include: decreased rotation to other wards; physician support; and opportunities for continuous learning.1.7 Evaluation and SustainabilityC. Schauer provided an overview stressing the importance of early planning for evaluation and the role ofprogram logic models for implementation and assessing impact. She shared a draft logic model that hasbeen developed for the program highlighting the working groups, their respective activities, outputs,expected outcomes (immediate and intermediate) as well as the overarching goal of the project. H. Saabthen engaged the attendees in developing indicators based on the four (4) immediate outcomes for theproject: 1. Increased utilization of specialized knowledge and skills in patient management 2. Increased use of data to improve clinical care and decision-making 3. Increased availability and access to diagnostic services 4. Increased knowledge translation and dissemination of evidence-based practiceH. Saab gave a short presentation on the importance of all stakeholders in a program, coming to anagreement on what constitutes program success as a key component to evaluation planning. A key exercisein assessing program effectiveness is developing indicators that would provide evidence of the condition orresult that the partners are measuring.Process indicators reflect the extent to which the various elements of the initiative are being implemented.For example, a process indicator for outcome (2) Increase use of data to improve clinical care and decision-making is “Application of guidelines in entering data into registry”. Examples of outcome indicators are: (a)alignment of treatment with diagnosis, (b) number of patients who receive treatment that is timely, and (c)number of patients who receive treatment that is appropriate. Page 9 of 15

While process indicators could include qualitative measures, outcome indicators generally include bothqualitative information such as patient satisfaction and quantitative or numeric measures. Numeric indicatorsoften provide the most useful and understandable information to decision-makers.All attendees were divided into four groups, cross-cutting across each of the six working groups. Each groupbrainstormed on process and outcome indicators for the four SCI immediate outcomes outlined above. Eachgroup then rotated across each outcome to add their contributions. In this manner, members of the sixworking groups all contributed to developing the indicators for the overall SCI program. A draft summary ofthe process and outcome indicators for each of the program outcomes was circulated to all attendees. Theplan is to continue refining the content of these tables and use them as planning tools for the evaluation ofthe SCI program.The interactive workshop also created an opportunity for participants to highlight key issues they need toconsider and be cognizant of as the program progresses. For example, the increased capacity for diagnosisof patients with SCD, leukemia, and other illnesses is a desired outcome of the initiative. However in theshort-term the health systems in the Caribbean countries might not be sufficiently developed to assess,diagnose, and treat these cases. Similarly, the increased awareness by the public of these services couldpotentially increase the number of presenting cases when there is still limited capacity to address theirneeds.These considerations were an important segue into the discussion and presentation around sustainability onDay 2.1.8 Summary of Day 1To close the first day of the AGM, C. Bruce-Barrett reviewed the items captured throughout the day andadded to a list of Parking Lot items for later follow-up. Final closing remarks were given by V. Blanchette. Page 10 of 15

2.0 AGM Proceedings: Day 22.1 Summary of Day 1 and Day 2 GoalsTo open the second day of the AGM, C. Bruce-Barrett welcomed attendees and provided a summary of Day1, which included opportunity for participants to report and reflect on project achievements to date and totable outstanding operational barriers and challenges. The group exercise to identify potential indicators andthe introduction to evaluation helped set the stage for sustainability planning and continued momentum intoyear 3 of the project.C. Bruce-Barrett summarized the goals of Day 2 and provided an outline of the agenda which includedbreak-out discussions to determine actions, timelines, and accountabilities to sustain 2014 accomplishmentsand support achievement of 2015 objectives.2.2 Group DecisionsDr. V. Blanchette requested time on the agenda to bring forward key items that were tabled during Day1. The items were reviewed by the group and their decision and endorsement sought as a collective.The items are summarized below.ASPHO membership The group agreed to pursue renewal of membership.Clinician validation process The group agreed that each Country lead (or delegate) wouldSite visit observations assume responsibility for validation of data in registry for their respective country with a turnaround time of 1 week The group agreed that the Clinical Working group will develop action plans in response to observations made at the site visitsCaribbean consortium The group agreed to explore feasibility and process for establishing a paediatric consortiumFormal scope management process The group agreed that the Project Management Team willProcess for feedback on develop a formal process for vetting and deciding on changes toguidelines/Protocols project scopeEngagement of Ministry of Health incommunication specific to Nursing The group agreed that the Clinical Working group will develop thePractice process for review and feedback on protocols and guidelines The group agreed that the Nursing Working group will explore development of a communication strategy with the MOH and/ or body responsible for nursing within the specific country2.3 Sustainability of Working Group DeliverablesC. Schauer presented a framework around the key factors that are important for the sustainability of aninitiative which are: (a) funding stability, (b) political support, (c) partnerships, (d) organizational capacity, (e)program adaptation, (f) communications, (g) strategic planning, (h) public health impacts, and (i) programevaluation (Schell, S. F. et al., 2013) (see the Appendix in Section 3.2 for definitions of each element of theframework). She stressed the importance of early planning for sustainability and developing a strategy forlong-term impact.H. Saab discussed the various ways sustainability is defined and recognized in the literature (Scheirer, M.A., 2013), which include: Normalization  Institutionalization Routinization  Continuation Durability  Maintenance Page 11 of 15

She emphasized how each term relates to a different aspect of the SCI. For example, institutionalizationrefers to SOPs becoming adopted and implemented across all healthcare organizations in the Caribbeancountries. However, this does not imply the sustainability of practices expected from these SOPs. This iswhen another feature of sustainability that needs to be paid attention to: routinization and normalization. Forexample, the extent to which proper line care is being practiced by nursing staff across organizations in aconsistent way following the SOP. Durability refers to the fact that erosion of practices does not happenwhen there is a change in leadership because there were champions in place to ensure continuity.2.3.1 Sustainability of Working Group DeliverablesParticipants broke out into their respective working groups to focus discussion on the actions, timelines, andaccountabilities required to address the identified barriers, sustain the 2014 accomplishments and supportdevelopment of work plans to achieve the 2015 objectives. To help guide the discussion, each workinggroup was given a worksheet (see Appendix) that summarized the following, specific to their area of focus:  Activities  Outputs  2014/15 Achievements  2015/16 Objectives  BarriersEach working group provided a report back to the larger group highlighting the key action items as well asoutstanding areas of concern that would need to be discussed further in follow-up to the AGM.2.4 Summary and ClosingTo close the second and final day of the AGM, Dr. V. Blanchette provided a very brief, high-level summaryand thanked participants for attending and for sharing their thoughts to help move the project forward. Healso acknowledged the work that was done over the weekend prior to the AGM to develop protocols.Dr. S. Zlotkin provided closing remarks and shared the following key messages emphasizing the importanceof a shared value proposition between partners as well as the need to advocate for continued politicalsupport and funding to help sustain project outcomes:  Measure the impact of the current pilot phase of the project and to be able to articulate the results broadly  Be proactive in developing a sustainability action plan that will enable an effective transition from project to operations  When planning, participants need to consider identifying key champions in each country who will be able to identify and understand the impact and then be actively involved in moving issues forward in order to support a second phase of the project.C. Bruce-Barrett closed the meeting advising the group as to next steps in developing work plans for2015/16. She emphasized that the information drawn from each of the group discussions during the twodays should serve as a foundation for planning the work plans for the upcoming year with a particular focuson managing barriers, measuring impact, achieving objectives and planning for longer term sustainabilityafter the project closes. Page 12 of 15

3.0 Appendices3.1 AGM AgendaAGENDA Monday April 13, 201507:30 Breakfast Served08:00 – 08:10 Host Welcome ……….…………………………………………..………………………..……….….... Dr. Victor Blanchette08:10 – 08:20 Meeting Goals, Etiquette and Parking Lot.….…………….……………………….…...….. Cindy Bruce-Barrett08:20 – 08:30 Introductions ………………………………………………………………………………………..….….. Cindy Bruce-Barrett08:30 – 09:00 Country Updates: Roundtable ……………………………………………………………….…………..……………..…… All09:00 – 09:10 Fundraising Achievements ……………………………………….……………………..………………….…... Ted Garrard09:10 – 09:30 Financial Overview …………………………………………..….………..……………………………..…….……. Brian Smith09:30 – 10:00 Review of 2014 Operational Achievements 09:30 – 09:45 Project Management ………………..………………….……. Claudia Schauer and Ellie Adler 09:45 – 10:00 Local Oncology Databases ……………………….… Drs. Sumit Gupta and Tracey Gibson10:00 – 10:15 Coffee Break10:15 – 10:20 Review of 2014 Operational Achievements (con’t) 10:15 - 10:30 Clinical Care ….… Drs. Victor Blanchette, Corrine SinQuee-Brown and Curt Bodkyn 10:30 – 10:45 Diagnostic Services ……………….……………………………………….……………… Dr. Stan Read 10:45 - 11:00 Sickle Cell Disease ……………………… Drs. Isaac Odame and Jennifer Knight-Madden 11:00 –11:15 Research & Scholarly Activities ……….…………….…………………..…..….. Dr. Upton Allen 11:15 – 11:30 Nursing Education ………………. Bonnie Fleming-Carroll and Patricia Ingram-Martin11:30 – 12:30 Lunch Served12:30 – 14:00 Nursing Practice: Education, Roles & Sustaining Change ……………..…………..………….. Nursing Team14:00 - 14:30 Introduction to Sustainability and Program Evaluation ……………………….……..……. Claudia Schauer14:30 – 14:45 Coffee Break14:45 – 16:15 Program Evaluation Workshop: Part I …….…………..…………………………………..…….…..… Dr. Hana Saab16:15 – 16:45 Parking Lot Review ………………………………………………………..……………………………… Cindy Bruce-Barrett16:55 – 17:00 Summary and Closing Remarks …………………………………………………………………… Dr. Victor Blanchette19:45 Group Dinner Page 13 of 15

AGENDA Tuesday April 14, 201507:30 Breakfast Served08:00 - 08:15 Summary of Day 1 and Day 2 Goals ……….………………………….……………….……….. Cindy Bruce-Barrett08:15 – 10:00 Program Evaluation Workshop: Part II ……….………..……………….….……….………….…..… Dr. Hana Saab10:00 – 10:15 Coffee Break10:15 - 10:30 Sustainability of Working Group Deliverables ……..……..................…………...……………… Brian Smith10:30 - 12:15 Sustainability Workshop ……..……..................................... Dr. Hana Saab and Cindy Bruce-Barrett12:15 - 12:30 Summary and Closing Remarks ……………………………..………………..…….…………… Dr. Victor Blanchette13:00 – 14:30 Group Lunch15:00 – 16:00 Optional Hospital Tour.....…………….……………………………………………………………………….….…… Janet Seo16:00 – 17:00 Nursing Working Group Meeting …………………………………….…………………………..….……. Nursing Team18:00 – 20:00 SickKids Foundation Reception Page 14 of 15

3.2 Sustainability FactorsSource: Schell, S. F. et al. (2013). Public health program capacity for sustainability: A new framework.Implementation Science, 8, 15, p. 7. Page 15 of 15