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Lorraine Muskwa, COO Bigstone Health Commission Main Office P.O. Box 1020 Wabasca, Alberta, T0G 2K0 Telephone: 780.891.2000 lorraine.muskwa@bigstonehealth.ca

Janice Willier, Project Coordinator Bigstone Health Commission Corporate Office 16310 – 100 Avenue Edmonton, Alberta, T5P 4X5 Telephone: 780.341.2777 janice.willier@bigstonehealth.ca

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• Bigstone Cree Nation History • Bigstone Health Commission History • Organization review 2009/10 • Project information • Information on Bigstone Health Commission

Report card

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‘Bigstone Cree Nation is committed to the

pursuit of the highest quality of life for all its

members’

Largest First Nation community in Treaty 8 Alberta territory, and third

largest in Alberta.

Has 7,200 members residing in multiple communities with the largest number of members living on and off

reserve in Wabasca, Alberta.

Located approximately 3.5 hours north of Edmonton

• Eighteen years ago in 1995 the Bigstone Health Commission embarked on a number of exciting and innovative approaches to the delivery of health services for their communities.

• A new program plan and facilities were needed to meet the needs of the First Nation that serves 6 communities separated by hundreds of miles.

• A major expansion to the facility was completed in 1998; a Professional Centre was built in Wabasca to accommodate a Pharmacy, along with Medical and Dental offices.

• A mobile dental treatment trailer was obtained from the Alberta rural dental program to serve the communities of Trout and Peerless Lake.

• Bigstone applied for and received authority to operate a Pilot Project within the Non Insured program areas that eventually was expanded to include all NIHB programs.

• An Elders Lodge was designed and constructed that added a much needed service component for the community of Wabasca

• A joint use facility was developed for Calling Lake in which the health department plays a major role.

Health Services play a vital role in any community. As an essential service provider to Wabasca/

Desmarais and surrounding area, we staff over 130 employees. Administrators, Health Professionals and

support staff are necessary in keeping the organization moving forward. Together we are able to enhance the quality of life for our members and

others living on Bigstone Traditional Lands.

Bigstone Health Commission Board of

Directors

Chief Executive Officer

The Bigstone Health Commission is overseen by a

governance board. Once a month the Chief Executive

officer updates the board on the activities and transactions

within the organization.

Organizational Structure

Chief Executive Officer

Director of Community & public Health

Manager of Elders Lodge

Manager of Client Care Services

Calling Lake Community Health Care

Manager of Maternal Child Health

Manager of Community Health Manager of Home Care

Under the direction of the CEO, the Director of Community Health is

responsible for six programs. These programs

are responsible for providing essential services to the community in which

we serve. Some departments may have

fifteen or more staff catering to the public.

Chief Executive Officer

Chief Operating Officer

Finance Controller NIHB

Medical Transportation/ Refferal Maintenance Manager

Fleet Maintenance Manager Human resources

Our Chief Operating Officer is responsible for six departments. Theses

departments are imperative to the daily operations of

the organization. They are the engine components that

keep our organization moving forward.

Chief Operating Officer

Business Administrator

Industrial Medical Services Apple Drugs

Dental Clinic Medical Clinic

Our Business Administrator plays a big role in ensuring

our profitable entities are running smoothly

and efficiently.

• Diabetes Education • Prenatal Nutrition • Community Health Representatives • Environmental Services • HIV Testing & Follow up • Maternal Health • Addictions Prevention

The Department of Community Health is

responsible for ensuring that clients have access to the

following services:

Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health.

Declaration of Rights: Article 24

We promote mental health and wellbeing for everyone in our

community. Our goal is to work with community members in healing emotional & substance abuse

concerns whenever possible. We strive to provide services that truly meet the needs of the community.

OUR PROFESSIONAL TEAM INCLUDES: • MENTAL HEALTH/ ADDICTIONS

COUNSELORS • REGISTERED CLINICAL

PSYCHOLOGIST • YOUTH COUNSELORS • RESOLUTION HEALTH SUPPORT

WORKERS

The goals and objectives of Bigstone Non-Insured Health Benefits are to

provide benefits to registered Bigstone Cree Nation membership in a

manner that:

Is appropriate to unique health needs;

Contributes to the achievement of an overall health status that is comparable to that of the Canadian population as a whole

Is sustainable from a fiscal and benefit management perspective; and will maintain health, prevent disease, facilitate early detection of disease, and management of illness, injury or disability.

We Provide assistance with medical transportation to clients who need

access to health services that are not accessible in the community of

residence With limited availably of

transportation in Northern Alberta, Bigstone Referral offers shuttle service between: Slave Lake, Edmonton and

Wabasca.

We offer safe, comfortable accommodation while encouraging a sense of respect, dignity,

and self worth for elders, who are able to remain independent with assistance from

community, based services.

To provide a home like atmosphere for our elders within the community a place

where they can experience carefree living, in a safe and secure environment.

We started in a trailer, 700 sq. ft., where the IMS Garage is today and moved into the Professional Centre 12 years ago. There we opened the second generation version, a 3500 sq. ft. modern Pharmacy that served our growing community

and businesses well.

March 22, 2012 marked another new beginning, with the opening of the third location.

On May 2nd, 2014 we opened our fourth location in

Slave Lake Alberta.

recognizing the support that our members and community have given to us, and in turn we want to

give back.

• Drivers medicals • Insurance forms (Eg. AISH) • Canada Pension Plan • Disabled Parking Plaque • Insurance and disability

claims • Patient Chart copies

Our goal is to provide excellent health care to all our patients.

• Check-ups, cleaning and treatment planning

• Oral Health Instruction

• Sealants

• Restorations

• Extractions

• Post – operative Instruction and necessary prescriptions

• Root Canals

• Crowns and Bridges

• Partial and Complete Dentures

• Bleaching kits and Sports mouth guards

• Referral to specialists

• Direct billing to all insurance companies through CDA Net.

Bigstone Dental and Orthodontic Ltd. Provides superior quality care to Wabasca and surrounding communities.

Bigstone has been providing industrial medical services to industry for over 7 years and has demonstrated providing high quality services. All units are fully equipped with each practitioner’s scope of practice in mind; we do not believe in operating units with minimum required equipment. The number of EMRs’/EMTs’ & Paramedics’ will depend on the hazard level of the site, the number of employee’s on site, as well as the distance and time from the nearest hospital.

The Edmonton Corporate office is located at 16310-100th Avenue and opened its doors June 2012

The following programs & Bigstone Cree Nation departments are available within the Edmonton Corporate Office:

• Bigstone Chief & Council • Business Development • Trust Administration • Health Administration • Alberta First Nations Information Government Centre • Medical Transportation\Referral Unit • Outreach Services and Staff Development • Non-Insured Health Benefits-Dental

There has been a recent expansion to the boardroom to further accommodate patrons. It is well equipped with state of the art Tele/Video Conference equipment and

the added convenience of Wi-Fi.

The Calling Lake location offers the same programs, and services that are available in the Wabasca Health Center. Staff from the Wabasca office travel to Calling

lake on a weekly basis to help with the coordination and execution of events and activities.

Such as Calling Lake, which is 100 km south of Wabasca. Working together with various Bigstone Cree Nation departments our integrated approach to health

service delivery is enhanced via this cooperation.

• Review major health problems and challenges in the community

• assess the capability of the health programs and services to meet the community health needs

• Review the strengths and areas for improvement • Reassess the mission/ purpose of the health

programs and services • Identify the things the organization did well to

be successful with the health service delivery; • Identify ways to measure how well our health

services are performing • Identify health-related business opportunities

within and outside Bigstone

IN 2009, The Bigstone Health Commission completed an organizational review. This was

an important step to review the major changes and challenges affecting the

organization, the community and its future

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After the original review was presented, we determined a need for our organization to

measure and evaluate not only the success, opportunities but also what we need to

improve on.

Background

The Bigstone Health Commission report card is an ongoing numerical summary of how well the Bigstone Health Commission (BHC) is carrying out its health services and business functions at a given point in time. The intent is to report how well BHC is meeting its mission and mandate: enhancing, maintaining and improving the social, physical, emotional/mental and spiritual well-being of Bigstone individuals, families and the community as a whole.

Methodology

• In 2010, the BHC initiated an organizational review

of the Bigstone Health Department. One of the outcomes of the review was the review was the recommendation for the development of a departmental report card.

• Fall 2011. One hundred and ninety-six (196) measures were proposed in the BHC Organization Review Final Report to the Council.

• Spring to Fall 2012. An introductory meeting on the report card was held with staff, measures were verified (e.g., were measures achievable? Appropriate?), primary data sources were identified. The report card was developed and presented to the Council.

• Winter 2012 t o Spring 2013. Data sources and frequency of data collection were verified.

• Summer 2013. Development of community survey, employee survey and ticket system to collect internal data.

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In total, seven core performance indicators were identified: • Service delivery of the BHC:

businesses or services are delivered for enhancing, maintaining and improving the social, physical, emotional/mental and spiritual well-being of Bigstone individuals, families and the community as a whole.

• Service delivery elements: (governance & management, community relations, human resources/ workforce, finances, information technology, buildings and equipment). Measure the support and administrative activities that allow BHC to meet the needs of its population.

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• Indicators included in the report card and the meaning of each indicator

• Summary groupings and measures included under each indicator

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1. Core service delivery of the BHC. This is derived from Bigstone’s vision: To Revive, strengthen, and protect members Treaty right to health. And to enhance the quality of life of members and others living in Bigstone traditional lands Bigstone’s Service Delivery can be stated as: enhancing, maintaining and improving the social, physical, emotional/mental and spiritual well-being of Bigstone individuals, families and the community as a whole. Core performance indicators: • Population health status • Population health outputs..

2. Support Elements of the BHC. Service delivery elements refer to the businesses or services delivered by the BHC that support the work of the health department. They are just as important to the success of the health department as the service delivery. Bigstone needs to be able to hire and keep competent employees, maintain a solid financial standing, use IT to work more efficiently, etc. Bigstone’s Service delivery elements can be stated as: governance & management, community relations, human resources/ workforce, finances, information technology, buildings and equipment (infrastructure). Support performance indicators: • leadership & accountability • community engagement • workforce development • financial sustainability and systems & infrastructure

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The Performance report card focuses on two types of performance

This diagram illustrates the seven indicators that make up the foundation of the report card: • Core performance indicator:

• Population health status • Population health service outputs

• Support performance indicators: • Leadership & accountability • Community engagement • Workforce development • Financial sustainability • Systems & infrastructure.

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To help determine how well BHC is doing in the seven indicators: • 196 measures were proposed in the Fall 2011.

• 174 measures were verified and created in August 2013.

The chart below shows how indicators, summary groupings, measures and Summary measures relate to one another: a hierarchy with multiple measures falling under each summary grouping and

multiple summary groupings falling under each indicator.

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Indicators 7 Summary Groupings 41 Measures 174

The following slides describe each of the seven indicators, their purpose, and the summary groupings and measures contained in each…

Population health status refers to the health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development and health services.

Health indicators are a wide range of measures used to assess and monitor the health of populations as well as inequalities among groups within the population. Health indicators are measures of health and of the factors that affect health. They are numbers and statistics for measuring, monitoring, and comparing important factors that influence the health of people. Note: population health status is long-term slow-changing measure, with changes taking 5 to 10 years to become noticeable. Even as changes occur it is difficult to attribute them to any one intervention.

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• Education • Employment & Income • Environmental Health • Family Composition • Health – Chronic • Conditions • Health – Communicable

diseases • Health – Mental • Health – Behaviors • Housing

Population health outputs. The quality and quantity of the health department’s programs and services are important to building and maintaining a healthy population and to helping those with chronic conditions live as independently as possible. The outputs represent the work that is conducted by the BHC on an annual basis and reflects current targets and program priorities.

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• Children and youth- awareness/ Education • Children and youth- Service/ support • Chronic Disease Control-

Awareness/Education • Chronic Disease Control- Service/ Supports • Communicable Disease Control-

Education/Awareness • Immunization • Mental Health and Addictions- Awareness/

Education • Mental Health and Service/Supports

Community Engagement: a process that enables participation of community members in assessing, planning, implementing, and evaluating solutions to health problems that affect them. Community members are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change. The goals of community engagement for BHC are: • To build capacity in the Bigstone community

and within the BHC organization • To partner in the development of a healthy

Bigstone community • To build trust and credibility with the Bigstone

community • To contribute to better health outcomes for the

people served by the BHC • To support BHC accountability to the Bigstone

community

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• Community Participation • Community Satisfaction • Complaints Resolution

Leadership: processes involved in guiding and motivating people in performing their jobs to accomplish specific objectives in moving towards the shared vision. Leadership 15 involves: • Taking health services in the direction of a

clearly articulated and shared vision with clearly defined standards of excellence.

• Providing resources and strategies necessary for attaining the standards of excellence.

• Consensus-building, promotion of intrasectoral and intersectoral collaboration, issue resolution, communication, reward and recognition of excellence.

Accountability: refers to the mutual obligation to demonstrate and take responsibility for performance in light of agreed expectations. These expectations are part of the Accountability Framework which: • Outlines roles and responsibilities. • Ensures visibility and transparency in decision-

making throughout the health system. • Improves information collection, resulting in

better data being available to support evidence-based decision-making.

• Improves the quality of service delivery to First Nation communities.

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Accountability: • Assessing and Reporting on Performance • Organization and policy development Leadership: • Assessing Needs and Responding • Monitoring and Evaluation Process in place • Policies and Procedures in place

Workforce development : processes to enhance knowledge and skills development, on-the-job training and work experience and long-term employment opportunities. The overall objective of BHC workforce development is to develop a workforce that has the required qualifications and confidence to carry out their work roles and responsibilities effectively. Workforce development also addresses BHC employment recruitment and retention, employee satisfaction, reward and recognition programs. Workforce development aims to assist in the retention of BHC managers and employees and to build supportive working environments.

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• Employee Development • Employee Retention • Employee Satisfaction • Performance appraisals • Succession Planning

Financial sustainability: BHC organizational capacity to obtain funding in response to health needs, in order to sustain effective health programs and services at a steady or growing rate to meet the health needs of the Bigstone population on an ongoing basis. Financial sustainability is important at the project, program or organizational level.

Financial sustainability requires: • Financial and strategic planning • Income diversification • Sound administration and finance • Own income generation

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• Administration and Finance • Financial Planning • Income Diversification • Strategic Planning

Systems & infrastructure: BHC organizational capacity to develop, maintain, protect and sustain physical assets and technological systems and structures to enable, support and sustain effective and efficient functioning and delivery of health programs and services to the Bigstone population. Infrastructure refers to the hard physical assets such as buildings, equipment and vehicles owned by the BHC and used to support the delivery of health programs and services to the Bigstone population, as well as the policies and procedures that guide the operation and use of the assets. Systems refers to the technological assets, both hardware and software, owned and used by the BHC to enable and support the functioning and delivery of health programs and services to the Bigstone population as well as the policies and procedures that guide the operation and use of the technological systems.

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• Maintenance of Physical assets • Systems structures • Systems and usefulness and reliability

The following section outlines: • Who should be using the report card • The process of using and analyzing the report card • Assumptions made in the creation and analysis of the report card

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Who should make changes to the report card?

The Administrator is responsible and accountable for the master copy of the report card. Responsibilities include: version control, reporting requests, delegating data entry, reviewing the entered data and accuracy of the final report. The individuals who have delegated responsibility to add data elements, measures and targets, or remove measures and targets should have extensive knowledge of MS Excel, including: the ability to propagate and modify formulas, delete rows and columns, add sheets, rename tabs, and password protect previous years of data. Adjustments to the report card are ultimately the responsibility of the Chief Executive Officer and Senior Management Team.

Who should use the report card?

The report card contains approximately 174 measures across seven individual reports (Population Health Status, Leadership & Accountability, Workforce Development, Financial Sustainability, Systems & Infrastructure and Community Engagement), but not all measures are applicable to everyone. This report is intended for the information and use of the BHC Board. However, Managers may find the information contained within the summary useful in analyzing the information within their specific unit.

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The following section outlines the data that is used to generate the BHC report card including: measures, indicators, summary groupings, responsibilities, frequency of collection, measure logic and measure

priority.

Who is responsible for measure? This column identifies the individual who is responsible for: • Double checking the validity of the continual

use of the measure • Updating the measure and target information

at the frequency stipulated • Confirming the behaviour of the measure

(should the BHC figures be ideally higher or lower than the target)

• Confirming the priority level of the measure based on BHC priorities

Measure. This column describes the measure used to generate the report card, as confirmed by BHC. Indicator. This column shows which of the seven overarching indicators (one core performance indicator, one output indicator, and five support business indicators) the measure belong to. Summary Grouping. This column shows a summary grouping the measure belongs to. Summary groupings are used in the report card to aggregate the related measures.

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• Frequency of measure collection. The report card has the capacity to collect measures monthly and summarize them quarterly and annually. However, it is not feasible (or necessary) to repopulate all the measures within the report card on a monthly, quarterly or even yearly basis. The majority of measures will be collected every year. However, long term population outcomes are often collected only once every three years. When using this information, the individual responsible for the measure will want to check when the target and measure information was last updated. If the time frame requires an update of the measure, the individual should do so.

• Do we want to be higher/lower than target. The logic within the report card needs to be told whether the BHC should be higher or lower than the target. For example, the rate of high school graduation ideally should be higher than provincial average but the rate of chronic diseases ideally should be lower. The intent of the column is to reflect an ideal situation. Even if the BHC is not currently performing better than the target, the ideal future would have them perform better. Therefore, you would choose “higher”.

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• What is the priority level of this measure? The priority levels aid BHC in measuring performance against areas of focus for the BHC. For example, although employment income and education affect the health of Bigstone members, these health indicators do not directly relate to the work done by the BHC. Consequently, each measure is weighed on a user-inputted ranking system from 0 (no measure - do not include in the analysis) to 5 (most important). The person identified as responsible for the measure is also responsible for confirming BHC priorities and subsequently the priority of each the measure they are responsible for.

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BHC Data Source refers to the source of information used when identifying BHC’s performance for a certain month, quarter or year.

Nearly a quarter of the data included in the report card was found in publically available materials. Additionally, discussions with Health Canada have resulted in externally collected unpublished data being released to BHC (i.e.., Regional Health Survey statistics). Where available, data from internal databases and forms (CBRT) has also been collected. In total, six data sources make up the majority of the measures in the report card: • Aboriginal Affairs & Northern Development (INAC) - housing data • Health Co-Management Secretariat & Health Canada - health data • Community Based Reporting Template (CBRT) (completed quarterly

for Health Canada by BHC) - health outputs • Internal data from BHC databases

The following chart illustrates the sources of data included in the report card as a proportion of all measures.

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Internal database

CBRT

Health Canada

Health Co-Management

Secretariat

INAC

Regional Health Survey

Target Data Source. This column describes where data for the Target measure may be found. The column identifies existing sources of data. A number of targets reflect BHC baseline information or best practices for an organization. If baseline data is not available, the first time that data for the report card is collected, the first year’s data will be considered “baseline” for future report card’s. Note: if administration decides on a future direction that may impact a measure, they may choose to modify the “baseline” figure and/or add other measures and targets. For example, if administration places a greater focus on expanding the IT department, they may wish to modify the baseline target and/or add other measures and targets to better reflect their goal.

Note: Health Status targets are based on averages for the general Alberta population. Although FN communities tend to lag behind Alberta’s population health targets, Bigstone has historically exceeded the performance of other First Nations. Consequently, the targets in the report card are viewed as “stretch” targets. As such, it is expected that progress will occur on an incremental basis.

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BHC Data includes data for each measure as defined by the Bigstone Data Source.

Target Data. The target data column contains the comparison measure to the Bigstone data measure.

Note: The report card has the capacity to conduct quarterly analysis. However, data included in any of the BHC month must have related target data in the same month of the target columns (e.g., if BHC data is included in January, the target data should be included in the January month of the same month). Note: • Data in the BHC Data column should be entered in the same format as

data in the Target Data column. • There can be no blank spaces between rows of data • DO NOT DELETE ROWS within the template.

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• The following section outlines how data is analyzed by the report card to generate scores and assumptions within the report card data calculations.

• The BHC score is an automatic calculation conducted by the report card. The calculation considers BHC data for a month, quarter, or year against Target data for the same month, quarter or year.

• Two calculations are used: – Is the BHC data equal to a “yes” or “no”; if so,

compare text of the target. – If text is not present, either calculate (based on the

higher/lower distinction): • BHC Data divided by Target Data or • Target Data divided by BHC Data

• One way to think about the measure is, what percentage

of the target has BHC achieved. Summary Grouping Measure Higher/lower

than target? BHC Data

Target Data

BHC Score

Summary Grouping 1 Measure 1 Higher 70 100 70%

Summary Grouping 1 Measure 2 Lower 70 100 143%

Summary Grouping 1 Measure 3 Higher 100 70 143%

Summary Grouping 1 Measure 4 Lower 100 70 70%

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The logic within the report card needs to be told whether the BHC should be higher or lower than the target. For example, the rate of high school graduation ideally should be higher than provincial average; however, the rate of chronic diseases ideally should be lower. The following table shows the effect of the “Higher/Lower” distinction on the calculation of the BHC score. Although Measure 1 and Measure 2 have the same data in the BHC Data and Target Data columns, the scores differ depending on whether the ideal situation is the

Summary Grouping Measure Priority BHC Score

(no rank) BHC Score

Ranked Summary Grouping 1 Measure 1 0 60% 0%

Summary Grouping 1 Measure 2 1 70% 6%

Summary Grouping 1 Measure 3 2 80% 13%

Summary Grouping 1 Measure 4 4 90% 30%

Summary Grouping 1 Measure 5 5 100% 42%

Total Rank points: 12

Gross Avg.:80%

Rank Avg.: 91%

• Note: if all measures in a summary grouping are ranked the same (whether that be 1, 2, 3, 4, or 5) they will be weighed the same in the summary grouping.

• Note: The rank of all indicators is the same. The Rank average (91% in the example) is combined to provide a summary for the summary grouping measure. Individual summary groupings are weighted the same when being consolidated into an indicator. The scoring system is set as follows: • A is 85 to 100% of the target is achieved • B is 65 to 85% of the target is achieved • C is 45% to 65% of the target is achieved • D is 44% or below of the target is achieved

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The intent of the ranking system is to aide Managers in BHC in measuring performance against areas of focus for the BHC. For example, although employment income and education are important and affect the health of Bigstone members, these health indicators do not directly relate to the work done by the BHC. Each indicator is broken down into multiple summary groupings. The summary groupings each contain multiple measures. Each measure is weighed on a user-inputted ranking system (6 ranks, from 0 (No m measure, do not include in the analysis) to 5 (most important). Measures for each summary grouping are weighed by their rank prior to a final score being analyzed for a summary grouping or a indicator. For example:

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The following section outlines the Report generated by the report card and how it may be used.

On clicking the “Generate Report” button on the “Report Tab” of the Excel workbook, a Reporting Form pops up. In the Reporting form, the user may choose the primary year (usually the most current year) for which to run the analysis. The user may then choose up to two additional years to complete an analysis for.

• Generate Report Button

• Reporting Form

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The introduction to the report card is intended to provide an overview of the intent of the report card, how the report card summarizes data to generate scores (i.e., the number of indicators, summary groupings and measures) and provides the assumptions for scores.

• Intent of the Report Card

• Overview of Report Card calculation function

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Table 1.0 illustrates summary scores for seven indicators using colour-coded summaries, as per the introduction section. Population health status is the ultimate outcome of BHC interventions and is therefore highlighted. Chart 1.0 provides a visual representation of Table 1.0. The scores are drawn with each of the seven indicators serving as a “spoke” to the wheel. The further from the centre the score is, the higher the rating.

• Table 1.0 Seven Indicator Annual Summary and Comparison.

• Chart 1.0 Seven Indicator Annual Summary

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Table 2.0 shows the summary scores calculated for each of the 41 summary groupings. Information on the current yearly to date, and up to two previous annual scores is provided. As the number of summary groupings is large, the user may choose to browse the groupings by one of the seven indicators, by clicking on the indicator of interest on the left, the remaining scores will update automatically.

• Summary Grouping Score Introduction

• Table 2.0 Summary Grouping Annual Summary by Indicator

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Based on the indicator chosen in Table 2.0, a general description of the indicator will be provided in the Indicator Description. The description does not provide an analysis of the indicator. However, Chart 3.0 does illustrate how the indicator is doing as compared to previous years (up to two years). The bar chart uses percentages instead of the A, B, C and D rating, allowing for better analysis of more granular changes.

• Indicator Description [based on indicator chosen in Table 2.0]

• Chart 3.0 Summary Grouping Annual Summary [based on indicator chosen in Table 2.0]

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