North West Local Health Integration Network
North West LHIN Project Management Office: Charter V1.4
Proposed Facilitated and Negotiated
Integration
Project Charter
<Enter Proposed Facilitated and Negotiated Integration Project Name
Here>
Author:
<Enter first & last name, organization>
Status:
<Enter status>
Version Number:
Version Date:
V <Enter version number. 1.0 first approved>
<yyyy-mm-dd>
The information contained in this document is confidential. Unauthorized distribution or use of this document or the information
contained herein is strictly prohibited.
Version No:
Version Date:
Project Charter
<n.n>
<yyyy-mm-dd>
Revision History
Revision
Date
Status
Author
Reviewed By
Summary of Changes
V0.1
Draft
Created first draft
V1.0
Approved
Updated as the approved first version
by Sponsor.
Document Approval List
Version
Approved By
Signature
Date
V1.0
Document Distribution List
Name of Receiver / Group
Date
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Project Charter
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Table of Contents
Purpose Statement ...................................................................................................................................... 4
Project Scope .............................................................................................................................................. 4
Goals, Objectives & Performance Measures................................................................................................ 5
Strategic Alignment with and Impact on Provincial & LHIN Priorities ............................................................ 5
Project Benefits ........................................................................................................................................... 5
Project Timelines ......................................................................................................................................... 6
Funding Sources ......................................................................................................................................... 7
Project Governance ..................................................................................................................................... 7
Project Team ............................................................................................................................................... 7
Project Stakeholders.................................................................................................................................... 9
People & Organization Change Impacts .................................................................................................... 12
Policy / Legal / Privacy & Security / Standards Considerations .................................................................. 12
High-level Project Resource/Solution Procurement Strategy ..................................................................... 12
Community Engagement ........................................................................................................................... 14
Project Communications ............................................................................................................................ 15
Project Risks.............................................................................................................................................. 15
Critical Success Factors ............................................................................................................................ 16
Assumptions & Constraints ........................................................................................................................ 16
Sign-Off ..................................................................................................................................................... 16
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Project Name
Project ID
Project Sponsor
Target Project Completion Date
Project Manager
Version No.
n.n
Version Date
Purpose Statement
Explain the purpose of this project by describing, at a high-level, the background necessary to understand why the
project was started, what will be done. What is this project aiming to achieve? What is its vision? What need or
opportunity will it address? What problem will it solve?
Overview (max. 250 words)
Project Scope
Summarize the scope of this project. Then describe ‘what is’ and ‘what is not’ included as part of the work to be
performed on this project. Consider specific features, functions, quality needs or other “must have” requirements and
place them in the “IN” scope section. Spell out any exclusion, i.e. work that will not be performed, in the “OUT” of
scope section.
“IN” Scope
“OUT” of Scope
Describe specific items that WILL be included as part of
the work performed by this project.
Describe specific items that WILL NOT be included as part
of the work performed by this project.
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Strategic Alignment with and Impact on Provincial & LHIN Priorities
Describe the project’s strategic relevance i.e. how it supports the province’s health care priorities.
(max 250 words)
Project Benefits
Identify specific results-based benefits that can be expected as a result of completing this project
(max 250 words)
Goals, Objectives & Performance Measures
Provide the details of what this project aims to accomplish by listing its specific goals, objectives and deliverables.
State the goals in terms of high-level outcomes to be achieved. Identify specific objectives and deliverables for each
goal listed. (They should be the same as those identified in your Business Case.)
Goals
List all goals to be achieved by
the project – ensure alignment
with project purpose.
Objectives/Deliverables
Performance Measures
For each goal, list specific objectives
and/or deliverables that will signify
achievement of goal when finished.
For each objective/deliverable, list the
measures that will be used to evaluate
success of results achieved.
OBJECTIVE: Open/relocate seniors
services along public transportation
routes
PERFORMANCE MEASURE: 25%
increase in the number of seniors
services relocated within 100m of
public transportation stop
EXAMPLE
GOAL: Improved
accessibility of quality
health care services within
2 years
1.
DELIVERABLE: Seniors
rehabilitation services located closer
to public transportation stop
A.

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Goals, Objectives & Performance Measures
2.

A.
Project Timelines
Indicate when the project will take place. Provide a preliminary estimate for the duration of the project by documenting
the target completion dates for high-level project milestones. Milestones are significant project events that usually
signify completion of project phases or major deliverables.
High-Level Milestones
Target Completion Dates
List key milestones below. State milestones in past tense to signify achievement
and completion. Include target dates for project kick-off and project end. The
following headings are provided to help you start your list of milestones.
Provide preliminary estimates.
Use ‘Month, Year’ format.

Project Costs
Indicate how much it will cost to complete the project. Provide a preliminary estimate of the project’s budget by listing
key expense categories and providing target cost figures. Indicate the fiscal years during which these costs will be
incurred. Adjust budget categories to match the needs of your project. Note: benefits and other direct operating
expenses (ODOE) are expressed as an estimated percentage of salaries and wages.
Project Budget
Category
Fiscal Year 1
Fiscal Year 2
Fiscal Year 3
TOTAL
Salaries and Wages
Benefits (% of S&W)
ODOE (% of S&W)
Materials/Equipment
Office Space/Facilities
Training/Development
Consultants
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Project Costs
Totals
Funding Sources
Identify source of funding for this project. Indicate whether project costs will be absorbed by an existing organization or
if separate source of funding is required. Where known identify any alternate or non-traditional sources of funding (i.e.
cost recovery, special initiative funding, etc.).
Project Governance
Identify the Project Sponsor, Executive Lead or Executive Sponsor, and Project Lead or Project Manager.
Provide the expected Governance Structure, including the composition of a Steering Committee if the project will have
such a body, and any other related governing bodies associated with the project. You may include a Governance
Structure Organization Chart in this section, or attach as an appendix to the completed Project Charter.
Project Team
Identify who is needed on the core project team to complete project deliverables and achieve its goals and objectives.
What skills, knowledge and experiences are required? Consider the need for special expertise to deal with people and
organization change challenges. Use table below to indicate who will be part of the core project team and who will be
brought-in as required. Include resources from partnering organizations as appropriate. Please consider policy,
architecture, and privacy and security domains for resource requirements.
Team Member,
Organization
Provide titles of core project
team members.
Required Involvement
Role on the Project
Describe the role & responsibility of
each core project team member.
Estimated Duration
Level of Effort
Indicate target dates or
no. of weeks /months
Indicate F/T or days
per week/month
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Project Partners
Is this project carried out in partnership with other groups/organizations? Indicate who else, in addition to those listed
above, committed to contributing to this project. Partners are individuals, groups or organizations who work together
towards joint interests to achieve common goals. Identify shared, mutually beneficial objectives below and the
contributions of each partner. Details of each partnership are typically provided in a separate document, such as a
Memorandum of Understanding or a Service Level Agreement.
Partners
Identify your partners. List names,
groups, or organizations.
Common Interests & Priorities
State shared objectives and identify
priorities for each partner listed.
Roles & Responsibilities
List roles. What commitments
have been made? Have MOUs or
SLAs been signed?
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No:
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Date:
Project Charter
<n.n>
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Project Stakeholders
Stakeholders are individuals or organizations that have a vested interest in the initiative. They are either affected by, or can have an effect on, the
project. Anyone whose interests may be positively or negatively impacted by the project, or anyone that may exert influence over the project or its results
is considered a project stakeholder. All stakeholders must be identified and managed appropriately.
Also identify the impacts this project will have on both the people and structures of the affected organizations. Who will be impacted (both positively and
negatively) as a result of or during the execution of this project? List the management strategies that will be adopted on this project to minimize the
negative and maximize the positive change impacts of this project.
Stakeholder
Level of Outcomes
Impact and
Relationship to Project
None*, Low, Mod,
High, Unknown
Postive?
Negative?
Level of Influence
on outcomes
None*, Low, Mod,
High, Unknown
Level of Concern
or Interest
None*, Low, Mod,
High, Unknown
Issue of greatest concern or
opportunity
to stakeholder
How can stakeholder
Contribute?
Help define the issue?
Contribute data?
Help to establish decision criteria?
Help to develop options?
Help to evaluate options?
Make recommendations or decisions?
Level of involvement recommended
Educate/Inform (i.e. provide balanced
and objective information to assist with
understanding the problem, alternatives,
opportunities and/or solutions)
Consult ( i.e. obtain feedback on
analysis, alternatives
and/or decisions)
Involve (i.e. work directly throughout the
project
to ensure that concerns and aspirations
are consistently understood and
considered)
Collaborate (i.e. partner in the decision
process including the development of
alternatives and identification of
preferred solutions)
Empower (i.e. to allow final decisionmaking)
1.
2.
3.
4.
5.
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Project Stakeholders
6.
7.
*NB – “none” may still result in a plan to educate communities relative to the purpose of the project and how they are affected by outcomes.
Contents within are based on the best available information at the time of planning.
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People & Organization Change Impacts
Identify the impacts this project will have on both the people and structures of the affected organizations. Who will be
impacted (both positively and negatively) as a result of or during the execution of this project? Are there any security,
legal or privacy implications that need to be considered? What will the project do to ensure end-user/client uptake of
the new product, service or solution?
Description of Impact
Impact Management Strategies
List the people and organization change impacts this
project will have. Identify who/what will be impacted and
provide a description of that impact.
List the strategies that will be adopted on this project to
minimize the negative and maximize the positive change
impacts of this project.


Policy / Legal / Privacy & Security / Standards Considerations
Describe the policy approach and activities to identify and analyze options to enable the recommended course of
action including stakeholder impact(s) and any legislative/regulatory changes. Clarify whether policy under
consideration is provincial, federal or the jurisdiction of a stakeholder organization.
Identify the key issues involved in handling personal health information resulting from the implementation and postimplementation of the new product or service. How are the project team and responsible organization(s) complying
with PHIPA legislation?
High-level Project Resource/Solution Procurement Strategy
Describe how project personnel and other resources (equipment, etc) will be obtained for the project. Include a brief
description of how any new IT solution will be procured.
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Community Engagement
If required describe the community engagement required for the project. If community engagement is required the NW LHIN Community Engagement
guidelines, strategies and planning documents need to be reviewed and followed by the project team.
How will the success of the engagement activities be evaluated? Evaluation should reflect success relative to identified success factors for process,
outcomes, and impact of engagement. Process measures will look at whether the method(s) used were the most appropriate to gain the involvement of
the community stakeholder. Outcomes measures will look at whether the engagement activity achieved its desired outcome. Impact measures will look
at how the outputs of the engagement activity contributed to the final results. (How will contributors to this process see themselves reflected in the project
plan or decision?) Supporting templates for engagement sessions can be found as outlined below:
L:\3 LHIN ACTIVITIES\Community Engagement\Community Engagement Activity Report\Evaluation Forms\templates
**Once evaluations are completed and summarized, please submit with your monthly community engagement report.**
Community Engagement Description:
Evaluation:
Stakeholder
Engagement
Method
Key
Objective
Process
Measures
What are the
factors for
success?
Process
Evaluation
How will you
assess your
success?
Outcomes
Measures
What are the
factors for
success?
Outcomes
Evaluation
How will you
assess your
success?
Impact Measures
What are the
factors for
success?
Impact Evaluation
How will you assess your
success?
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Project Communications
Identify information needs of steering committee, project sponsor, project manager, team members, working
groups, partners, stakeholders and others. List strategies for ensuring that right information is provided to right
audience in most suitable and timely manner. Be sure to identify format and frequency of communication between
the project manager and project sponsor regarding project status, performance, risks, issues, etc.
Also include the project performance reporting required by the LHIN, the provincial government or other
key stakeholders
Audience
Information Needs
Format & Timing
Responsible
To Whom? List
recipients of the
information.
What? State what information
will be communicated.
How? When? How often?
Explain method &
frequency.
Who? Identify who
will provide
information.




Project Risks
Consider what if… Document high-level project risks apparent at this point that could either positively or negatively
impact the achievement of project goals and objectives. Indicate initial likelihood and impact. Focus on risks that are
likely to happen and have significant affect on project success. Be sure to consider risks associated with people &
organization change, knowledge management and transition to operations.
Risk
List high-level risk events that
pose threats or opportunities to
the project.
Likelihood
Indicate Low/
Moderate/High
Impact
Indicate Low/
Moderate/High
Risk Response
Explain what will be done to avoid,
transfer, mitigate or accept risks listed.

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Critical Success Factors
Define key factors that are critical to success of the project. These conditions must be satisfied to enable successful
completion of project objectives and deliverables. Include significant events or decisions that need to take place.
Assumptions & Constraints
Assumptions are external factors that, at the time of writing the charter, are considered true, real or certain for
purposes of planning. Certain unverified or unknown aspects that are likely to happen must be assumed as facts to
proceed. Constraints are factors that are outside the control of the project team, that restrict or regulate the project.
They limit available options and affect performance of the project.
Assumptions
List the assumptions made to date. What did you
have to assume to be true to complete the charter?
Constraints
List project constraints. Consider time, budget, scope,
quality, availability/skills of resources, priorities, etc.

Sign-Off
Project Charter must be approved & signed-off by project sponsor before Definition Phase can be completed.
Project manager and/or director also sign-off the charter. Once completed & signed-off, the charter forms the basis
for detailed planning and future decision-making. It cannot be modified without securing the sponsor’s approval. Any
changes to information contained in the charter must be documented using a formal Project Change Request and
the associated process.
Executive Sponsor / Project Sponsor
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Sign-off by Executive / Project Sponsor signifies that there is clear commitment on behalf of the sponsor to provide
guidance & support and contribute necessary resources to complete project goals & objectives as outlined in the
charter. By approving the project charter, the sponsor has understood what will be delivered and is in agreement
with performance measures and success factors identified.
Name & Organization
Signature
Date
Project Manager
Sign-off by Project Manager signifies that there is clear commitment to adhere to the terms of the charter and
ensure that the project proceeds to meet the objectives defined in it.
Name & Organization
Signature
Date
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