ࡱ> 5@ Wbjbj22 7XXM     ppp8d(l z2"yyyyyyy$;{R}vyp!"!!y  y"""!L 8py"!y".",#J.r\Xpu r/-$!@tBtxy0 zt~<"~u    u~p\wh$J"n<yyd"" CitiStat for Performance Management Relevance for NHS QIS 1. Introduction 1.1 The Scottish Executive is strongly encouraging public sector organisations to adopt the CitiStat model for performance management. Kevin Woods wrote to Board Chairs on the 11th October 2006 about adapting and adopting CitiStat principles. They commissioned research to evaluate four CitiStat pilots in Scotland. The full evaluation is available if required. The results of this evaluation have been used to assess the value of adapting this approach to NHS QIS. In this document, key points from the evaluation are highlighted and their relevance for NHS QIS is explored. Sections of this paper are taken directly from the evaluation report. 1.2 NHS QIS has already agreed to implement a system of performance management and, if deemed appropriate, perceived benefits of CitiStat should be integrated with the system already under development. 2. Background to CitiStat 2.1 CitiStat originated in the USA and uses recent operational data on key performance indicators as the basis for discussions between the leader of an organisation and service directors in a panel setting. In the original application, CitiStat meetings are intensive and formal; service directors are asked to account for their Department's performance and offered support to improve performance where necessary. CitiStat is used to foster a culture of accountability throughout the organisation. 2.2 CitiStat brings a number of distinctive elements to performance management. It is clear that there is no single element of this approach that by itself is key to success but rather, it is the combination of elements linking review and enhanced use of data with the accountability process that is key. The evaluation of the pilots shows that there are five key elements to the process: ( Leadership ( Data Quality and Analysis ( Ownership and Actions Dual Approach: Hot Spots and Whole System Working Cultural and Organisational Change 2.3 Whilst these elements are common to most performance management systems, and indeed are intended for the NHS QIS system, there are aspects of the CitiStat approach which are unique, specifically the panel process. 2.3 From the SEHD commissioned evaluation, there was consensus that the Scottish pilots had largely been a success and that participants would wish to retain most of the elements of the model. Particular elements that worked well include: The flexibility of the model to fit into existing governance and accountability structures and be structured in ways to suit different organisational contexts. The high level involvement of Chief Executives and senior non-Executives. The challenge process of the CitiStat Panel, including praise and recognition of achievements. Enhanced data quality and analysis. Stronger links between the data, performance and agreed actions and the focus on generating action and change. Dialogue between key stakeholders that enhances mutual understanding and communication. The use of CitiStat as a driver for organisational and cultural change. 3. How the process worked 3.1 CitiStat Panel Process: The confrontational approach of the USA CitiStat model was not adopted in the case studies. CitiStat sessions were still challenging, but have not been particularly adversarial. Some participants would like them to be more adversarial and find this element of the model useful. Most found that a strict CitiStat approach was artificial and was generally felt not to sit well within the existing culture, leadership and organisational style of the case study agencies. However, the challenge of the process has been welcomed by most participants. 3.2 The process gives senior executives the opportunity to improve their understanding of operations and the challenges in terms of barriers and resources. At the same time, it has allowed operational managers to understand the corporate priorities and drivers for organisational change and provided the impetus for communication across the wider organisation. At best, the Panel process has seeded a new culture and rules of engagement which combine respect with an ability to ask 'difficult questions' through a clear focus on scrutiny of data, accountability, and performance improvement 3.3 Operational managers explain their performance and identify the action they propose to take to address poor performance. This has been most effective where staff have ownership of the indicators and targets as the process itself gives them the opportunity to refine these and make them work better for service priorities and management. The panel process also has educational benefits. The following diagram shows how the pilot sites implemented the panel system.  3.4 The make up of an NHS QIS panel would be vital to the success of this approach. Indeed the Chairman is keen to be involved, and suggestions have been made that the non-executive directors who chair the NHS QIS committees should also be on the panel. The aim should be that Directors and relevant supporting managers are held accountable for a range of appropriate performance indicators, with challenges set by the panel and responded to by appropriate staff. 3.6 Clearly the work of NHS QIS is less immediate than that of territorial boards providing direct patient care. The type and number of performance indicators would reflect this. It should also be reflected in the frequency of panel meetings. 3.7 In addition, the NHS QIS Executive Team has developed a set of terms of reference for its own functions to give clarity around roles and responsibilities. These terms of reference also propose formalising the Directorate Management Team meetings and an organisation wide business meeting of senior staff, who will also have defined terms of reference. This should, in effect, be the performance management working group who will meet monthly and prepare the responses for the panel. 3.8 The SEHD evaluation identified several benefits to the panel process and these are highlighted in the following sections. 3.9 Clarity of roles and responsibilities: The Panel process enabled clarity of roles and responsibilities to be articulated. CitiStat appears to have driven an improved adherence to existing policies and procedures. This dialogue and face to face exchange between key stakeholders coming together with the common aim of driving performance improvements has been a vital element of CitiStat. Scrutiny and governance were felt to be enhanced by the process through the ability to identify failing plans earlier on and submit new plans. 3.10 Focus on generating action and change: The model's focus on generating action and change has been significant and refreshing for Panel members. It has retained a focus on the key issues and avoided lengthy explanations and excuses. It has significantly speeded up the process for generating ideas, driving improvements and achieving results. 3.11 Challenge to the pace of decision-making: This speeding up of the pace does bring some tensions where decision-making through committees tends to be much slower. CitiStat does challenge this pace of decision-making through the frequency of meetings and use of more recent data. 3.12 High-level involvement: The involvement of Chief Executives and non-Executive Board members on the Panel was crucial. This senior level buy-in to the process has been empowering at middle management level, by promoting faster change and the possibility to influence future changes towards improvement. It is seen to generate behavioural and cultural change over time and vital in preventing managers falling back into the 'comfort zone' and usual ways of working. High level expectations of continuity of attendance each time were also seen as important. This developed a stronger corporate memory, continuity and improved the operation of the model. 3.13 Recognition of achievements: Another important element of the value of high level involvement which was perhaps unanticipated from the Baltimore experience has been praise and public recognition of particular achievements or improvements. It was acknowledged that to sustain the model in the longer term, behavioural change was required, so that Panel members ' almost work ourselves out of a job' as managers start to scrutinise performance on a more routine basis and self-scrutiny, accountability, bringing solutions and improvements come to be seen as the norm. 4. How data has contributed to improving performance 4.1 The data analysis process has been shown to be crucial to the effectiveness of the CitiStat Panel. The panels have provided the impetus and identification of priority areas for change. The model has been used both to tackle 'hot spots', or areas where there are agreed localised issues or problems that require urgent action; and to develop a longer term, collaborative whole system perspective that looks at wider issues and connectedness between different parts of the system in which the service is located. These approaches are not mutually exclusive. The act of identifying hot spots and then tackling them collaboratively across the wider system provides both focus and promotes integrated actions to tackle wider causes of trends. 4.2 Evidence about the contribution of data to performance improvement shows that the very act of scrutinising available data in this way can expose issues of poor performance; however, it also shows the limitations of focusing on narrow targets that may, on the face of it, appear to have been achieved, at the expense of the bigger picture. Data that appear to demonstrate good performance in terms of 'hitting the target' may in fact be masking a number of issues that might merit investigation if performance is to be maintained, and may also be contributing to other problems elsewhere in the wider system. The process has highlighted this tension between data designed for performance reporting rather than for driving forward continuous performance improvement. 4.3 What has been achieved to date is that the process has exposed significant weakness in the knowledge base and has begun to develop process improvements to ways of working both within and across organisations. In the longer term, there is an expectation that this process will improve outputs and ultimately lead to performance improvements in measures that demonstrate outcomes. 4.4 This is of importance to NHS QIS as we develop our strategic direction and consider more fruitful linkages across pre-existing and new strands of work. It is an opportunity for NHS QIS to consider how it maximises its impact on the wider NHS. A key outcome measure could be the inclusion of measurable indicators within products to give a way of demonstrating contribution over time. 4.5 The pilot evaluation showed that some of the most significant developments have taken place by using the CitiStat process to develop actionable data, rather than available data and to develop indicators that are meaningful for service managers rather than simply to meet reporting requirements. In all the case studies CitiStat facilitated a review of existing performance indicators and data sources within the participating services. The process often improved the consistency and accuracy of the data. It also refined the indicators to more accurately reflect different elements of the issue they are measuring; for example, sickness absence has been a common issue and been broken down to the component parts, separating out short and long term absence. 4.6 This led to the design of a new, more relevant and meaningful set of indicators and targets in which participants have been involved; this enhances the effectiveness of that data and makes it more suited to effective performance management. 4.7 The model as developed has also been seen as biased in favour of quantitative measures and this may foster a perception that CitiStat is not suitable for smaller and rural authorities that don't have the same volume of data as larger, urban authorities or health boards. However, a focus on quantitative rather than qualitative indicators is not necessarily an inherent feature of the CitiStat model. The experience of the case studies shows that qualitative data is also essential to develop a fuller understanding of the management issues and may also help to validate the significance of 'exceptions' or statistical outliers. NHS Tayside now plans to incorporate qualitative data including tracking a few patients to map the process of delayed discharge and get a fuller picture of what is happening at local level. It also plans to use information from public and patient involvement events to influence CitiStat improvement indicators and targets. 4.8 As NHS QIS does not have a pre-existing performance management system, this gives us a good opportunity to consider carefully what information would be of most use and to build information systems appropriately. It should also be possible to incorporate some appropriate qualitative measures. Some examples of appropriate indicators for QIS could be: Possible Performance Indicators for NHS QISQuantitative Sickness absence by unit with Directorate summary Established posts & vacancies whole time equivalent by unit summarised to Directorate Financial position by project, summarised to unit and Directorate Manpower utilisation needs further definition Project deadlines achieved by unitQualitative Progress with EQIA by unit Post Project Evaluation feedback by unit5. Opportunities for and barriers to the effective implementation of CitiStat 5.1 Flexibility and diversity: The Pilot has shown the potential diversity and value of the model where it has been allowed to evolve to suit local circumstances and priorities and crucially, reflect local governance, accountability and partnership arrangements. The CitiStat model appears to be flexible as it can fit into existing structures and be organised in different ways. 5.2 Respective roles of executives and non-executives: Experience from the Pilot suggests that the CitiStat meetings have provided a useful forum where executives can seek the support of non-executives and the Chief Executive for actions which require their backing. NHS Tayside has seen more active involvement from non-executive Board members and this has helped them to be better informed about the work of the Board and has supported scrutiny and governance. 5.3 Governance and accountability arrangements: CitiStat has raised issues about the understanding and clarity of accountability across departmental, corporate and partnership responsibilities. The process has shown the need for greater clarity of responsibilities for action, especially where service managers are held accountable for performance and where other departments are expected to provide data or other information. 5.4 Resources for the CitiStat process: Effective data analysis and clear briefing of the Panel was an indispensable element of the CitiStat process and in the process of ongoing adaptation. In large organisations this was very resource intensive both in terms of the data analysis and briefing process, attendance at meetings by large numbers of staff and the high level input from Panel members and is one of the clear barriers to effective implementation of the CitiStat process. Key Principles of CitiStat and their Relevance to NHS QIS 6.1 The following table highlights the key principles of CitiStat and the implications for NHS QIS. Core PrincipleEvaluation CommentRelevance to NHS QISLeadership The high level involvement of Chief Executives and senior non-Executives focuses the agenda on improvement, scrutiny and accountability and gives a clear sense of organisational and partnership priorities. The challenge process is an important driver and gives service managers confidence to implement required changes. It influences behaviours by highlighting respective responsibilities as managers for the implementation of policies.The QIS Board and Executive team have already agreed proposals to implement a performance management system. Using the CitiStat model will allow these principles to be rapidly accepted and integrated into the workings of the organisation, reinforced by involvement of the most senior staff.Data Quality and Analysis Enhanced data quality and analysis are key to the process and set it apart from existing performance management models. CitiStat provides a focus on actionable data, rather than available data. It facilitates a review of existing performance indicators and data sources to enhance the accuracy, validity, quality and utility of data. The use of real-time data brings a new immediacy to the process and provides quicker feedback on actions. The analytical approach supports the more effective process of accountability through the Panel. The process has highlighted this tension between data designed for performance reporting rather than for driving forward continuous performance improvement.Work has already begun to identify relevant and actionable performance indicators for NHS QIS. Recognising that the organisation differs from a front line service provider it will be vital to develop a portfolio of meaningful indicators. Investment is being made in our management information infrastructure to enable this to happen. The Panel may also have views on the information it would like to see. Ownership and Actions Review of the data used for performance management enhances ownership of the indicators. CitiStat strengthens the links between the data, performance and agreed actions and whilst challenging, provides a strong and broadly welcome focus on taking action which has been empowering for some managers. Promoting ownership and action will be key in any CitiStat activity that QIS undertakes. Historically there appears to be little or no concerted action against some key indicators such as perpetual financial underspends and underestablishment. A cultural change is required in order to make a success of this new approach. The Panel will have a key role in promoting such change.Dual Approach: Hot Spots and Whole System Working CitiStat creates a dialogue that enhances mutual understanding and communication between participants. It is applicable both to the identification, analysis and action around hot spots and also to a whole system approach. These are not mutually exclusive approaches. There is scope for using the leverage of CitiStat to develop a long term and wider perspective, rather than simply focusing on 'quick fixes'. CitiStat can be a tool to promote closer working within and between departments, agencies and partnership structures.Identification of key indicators and culture change are again important here. A mature response will be required from all involved.Cultural and Organisational Change CitiStat can be a driver for organisational and cultural change. It challenges established cultures and ways of working in the public sector.NHS QIS needs to become more business like and more accountable for its activities. CitiStat is a reasonable vehicle through which to create change. Conclusions and Recommendations 7.1 Given that NHS QIS is in the early stages of development of a performance management system, it would be good timing and a good opportunity to take on board the positive aspects of CitiStat and use that to embed the new system into the culture of the organisation. The panel process would be a good opportunity to take this forward at a senior level. There are several issues that would need to be developed or resolved before a CitiStat model could be implemented. Most notably, performance management information must be developed and performance indicators identified and discussion is required on the make up of the panel.  What Do We Measure and Why?: An Evaluation of the CitiStat Model of Performance Management and its Applicability to the Scottish Public Sector. Cathy Sharp, Jocelyn Jones and Alison M. Smith, Research for Real. This evaluation explores the experience of the CitiStat pilot in Scotland. CitiStat has been piloted by City of Edinburgh Council, Aberdeen City Council and NHS Tayside between September 2005 and February 2006 and NHS Ayrshire and Arran Health Board between November 2005 and March 2006. PAGE  PAGE 8 Paper C Appendix 1  &;<MQ^g @ E Z [ h m   ( 0 Ǽwrrmm^h 8CJOJQJ\^JaJ hJ\5 h}k5hp0iCJOJQJ\^JaJ h45jh2+0J5Uhl/hl/5H* hl/5 h2+5 h 85 hp0i5 hp0ihp0ihp0ih 8CJaJh.hCJaJhJ\CJaJhp0ih2+CJaJhh dCJaJ*jhh dCJUaJmHnHsH tH u$&<M 0>ZtgdJ\ & FgdM 0^`0gdM ^`gdM0dd[$\$^`0gdp0i0dd@&[$\$^`0gdp0i dd@&[$\$gd?[$dd@&[$\$a$gdp0iUWWW % E s z V W _ h k *./013=>?@YZ[\]^stַx jhM5 hM5hMhp0i5hMhM5]hMhp0i5] hM5] jhM5] h_|;5h_|;h_|;5 h?[5hkDhkD5 h2+5 hkD5 h5)5 h45 hJ\5hkDh?[5 hp0i5hp0ih?[\ hp0i\/./4IKorzlʷsis_sisisRshS h" OJQJ^Jh" OJQJ^JhJ\OJQJ^Jh2h" OJQJ^J"h2h" 0J5OJQJ\^Jh" 0J5OJQJ\^J*hkTh" 0J5CJOJQJ\^JaJ$h" 0J5CJOJQJ\^JaJh" h" 5 h5)5 hJ\5 h" 5h" hJ\5 h?45] hJ\5]hJ\hM5 4t/mcW> 0^`0gd5)`gd" 0^`0gdJ\ 0^`0gd" gd"  & Fdd[$\$gd" 0dd[$\$^`0gd" 0^`0gdJ\lmq|@ABcfgǺ캎|i`SSIh0OJQJ^Jh2h" OJQJ^Jh" 0J5\$jh2h" OJQJU\^J"hJ\h" 0J5OJQJ\^J"hJ\hJ\0J5OJQJ\^JhJ\h" OJQJ^JhJ\h0OJQJ^JhJ\hJ\OJQJ^JhJ\hJ\5OJQJ^Jh2hJ\OJQJ^JhHOJQJ^JhJ\OJQJ^Jh" OJQJ^JgxyTUV[flt-89CDG_=>AFNߴn\"hkTh" 0J56OJQJ^J"h/h/0J56OJQJ^Jh5)0J6OJQJ^JhH0J6OJQJ^Jh" 0J6OJQJ^JhkTh5)OJQJ^Jh2h5)OJQJ^Jh5)OJQJ^Jhl/OJQJ^JhJ\OJQJ^JhHOJQJ^Jh" OJQJ^Jh2h" OJQJ^J$>!/#K$&)K)1,2/07215'69G;s; $IfgdWx 0^`0gdQgdQ 0^`0gd" 0^`0gd5)?!`!!!!!!!!!"/#0#3#4#5#\#^#H$I$J$K$L$ѺzhѣVhLLh/OJQJ^J"h5)h5)0J56OJQJ^J"hkTh" 0J56OJQJ^Jh/0J56OJQJ^Jh5)0J6OJQJ^JhH0J6OJQJ^Jh" 0J6OJQJ^Jh5)OJQJ^Jh0h0OJQJ^Jhl/OJQJ^JhkTh" OJQJ^JhkThJ\0J6OJQJ^J"hkThJ\0J56OJQJ^JL$M$O$P$f$h$$$$$}%%%%& &&&&&&&&''J(m())J)K)O)öösbXhQOJQJ^J h\hQCJOJQJ^JaJ*h\hQ0J5CJOJQJ\^JaJhkTh" 0JOJQJ^Jh" OJQJ^Jh/OJQJ^Jhl/OJQJ^JhkTh" OJQJ^Jh" 0J6OJQJ^J"hkTh" 0J56OJQJ^JhH0J6OJQJ^JhkTh" 0J6OJQJ^JO)1,5,../%/0///000M1N1P1U1V172;2?2\2222222221555:5;5'6+67799:;);G;O;t;;;;;;鱡铌|h\hQ5h\hQ>* h\hQhl/hJ\OJQJ^Jh4hQ0J6OJQJ^JhQ0J6OJQJ^Jh4hQ0JOJQJ^Jh4hQOJQJ^Jh`FhQ0JOJQJ^JhQOJQJ^Jh`FhQOJQJ^J/s;t;;;<P<<< $IfgdWxikd8$$Ifl& !< t0<644 la<;;;<<<<<<C=D=F=G=`=a=>>>>>>@@@@@@9B:B;BB@BbBdBBBBCCCD D¸’’}xsksssh=%h" 5 hW5 hWx5hkThJ\5 h" 5h=%h" ]h=%h" 5] hWx5]hkTh" 5 h" ]hkTh" ]hkTh" 5] hW5] hQ5]hkTh" \ h" \ hQ\h\hQ>*h\hQ5 hJ\5h\hJ\5*<<<<< $IfgdWxikd:9$$Ifl !< t0<644 la<<<C=>@;B!D"D\D]DttttoZUgdZ & F 8-^`-gdZgd" 0dd[$\$^`0gd" dd@&[$\$gd" ikd9$$IflV !< t0<644 la< D!D"D[D\D]DDDDDDDEEEFFGGGGGGHHHHbJkJJJJJDLELFLHL]L^L_LMMMM5N?NNNOO O:O;OK 0^`0gdl/gdl/ & F 8-^`-gdl/ dd[$\$gdWxkdB<$$IflFj \&= t0#    44 la?TUUWWWWWWWWWWWWWWWh]hgd6 &`#$gd6 dd@&[$\$gdkDgdl/ & Fgdl/WWWWWWWWWWWWWWWWWWhZhl/5hXOhh dhh dhh dCJaJhpPhh d0JmHnHuhb,! hb,!0Jjhb,!0JU5 01h:p6/ =!n"n#n$n% 8Ddv ?L  C (A0042133bH8Y+Yt$8D_n8Y+YtPNG  IHDR*0PLTE222FFFȩzzziiiոXXX!bKGDH cmPPJCmp0712Om7qIDATx `ՙxdi%Ypx!3 $ mE B@[J+Be R 6HemVaeoSǕ[JP(K A4#;-ɶd;8f̙@GuQGuv$K?+Y*XPJV,V:Tdա"Ydub%CE+Y*XPJV,V:Tdա"Ydub%CE+Y7͏ F/'W>ox8vKGqqqЕ2?W qIVo^7G"oh]se*zOf;cR䐒\AT-M_ vZ0I*Q)ՔtE0H |RK{R)&P sR0Dsd窐T TzVJ% b:B6D׃!oWgB?t#*h.rh3+mcss2Ţ^SRK{JzWfc+{P! xv> y%x{ӌE+RQ*6#7 JCR *{})URT*k9ˇUu ?}.U8u̫'@EJI㩘'"ݠ.^%TJT SHe7'aY@p@zX 'yE[(Q9R'hC'>'SlSOp!CŏN)j13R̄H?],J-qn; p7^U~wYa[oxN+ry=_l=dWK&Ii˘̬dz}ΌSN{TDj&$V(s̡vVJVu(Ydub%CE+Y*XPJV,V:Tdա"Ydub%CE+Y*XPJV,V:Tdա",a}"7Q`)?i&^aG:_߸q.C48r*0 *!_*JZT4!^X=dUSP!lFő,QyvS'Qn5FEj^08lõ -jw+xA_[UohDowU~ckXc*ϭK?N3N`N|=r$*.#W[x̒} '=\D>{UxmqK|loߛEŐ1}{F^p$~K#)lJ, Gmt^xK/ع@b=gv9}煷?߹FȑQ[~ϤA,V+i2O FE䋀};K?@ыnlPI/Ae*M4|[">A LB '}SJfѾ<ņTC~-7 y,pM/{*J@wFW/h1KOJ[ 1&-)}GH X-m#^ZwAKD+)9sAƍ5i&ii\ݍέ723 q*k~3^ԛ\#aI4_֐0H^R ogz\TEߑܶ2ނ+Y3;Ύpq*Պ[thRib%CE+YTL'-8ՄN^/V sryW⫍n,>t*׫s_/8MS5F[:g@)Oq[FP=Jh_z[C|*蟹/.Q!-SN8C/Aگɑ2.槑O' f -\-2u@ W󔊥D/ q:?TV&BڡJ's߷7Me\+H*>~($L5WU=z<2*HWɯ\TIy;gEaO>X](`ԌNr=fжx!c$H9nF q쪵͒։2# 5b>U3f _cm.ƺrb%CE+Y*XPJV,V:Tdա"Ydub%CE+Y*XPJV,V:Tdա"Ydub%eT  Z;'[8&|f>C`_p Ab:~JAL_*x:{sCtq~gt"/ 5+x!+b}; e11m.z s}>W}K .eB%H= 6*:eiV/QIts?0V 9BӣҫqOJew |ߘA,VQbN./QQ!+Sbfu M=D/P*$01Pos2X+R\W*i^1r1*tKk:ATCLz HJ DH!+R8HTIb|_P $XsTyBͅ$*1]F7FfXȑ/drlߟ-S$JNJۜ#/SK0|JDZ7 Q&~POWuʥtR}E& y V:Tdա"Ydub%CE+Y*XPJV,V:Tdա"Ydub%CE+Y*XɪiDu˔)M*7-;]*|52c3CN?+k4K%$̂·; N^@'LtW&:Pc; 3/q.oԬ\8YWڝY[@}Tڝ&Uo)*Vl} ܡBա2:T&RDL洛S3aTsPuF$8}l?Sr6&*h륢>˲;'T#aȻ?ܠ2LEs~WlG̯Oi*bh[W$\8+d+4_D4)ZȐ -Z4(+Cs3~)[`rmOEи&BStEt V3:$~)ʩHо?_g"LcT)LRg%wlR( ntca o[ƨ\_# E%*Rz# v$jR/T%*HP\'.DGAsbGgL5"÷ D*\\UD T*4EvTa=!ΚmWu.WotHRBMSRw8 b}% $RAw^ŏ9> yAd!}4`jϽWa5% Q Ayz`:TD|obݬ\ݜ_Ss‡tv8[][?W}NMyTseFey*Χ P yB]ka.'m[!O| lK)B-JBsN'|QrNW(R9vh#TxT ȃg7Ku֍>)@mv-ߨ*cn .*{#Wz.A7@Eoß$T.ҭ?~ȃUJ1JO6o٣؍߹Þ;rW"IsN #5_~m<8q*T"ԭ{:c7\Dgcp`f[鑣#-x*J0DLb!i{S&tc~<ҳ\u (};:W7" Wᛢ7|MMevn=T*ۢRlNǷ|_(M?9V`rr3SJe}ɮ~HXMDwvIń aj`Q!5M0D%aj (/#RY{Xf~P ?k^$O 3he^*F1$t5ɰLCzIT)<y t =OE6GC =xy`LV}BK?gv&vGrӻ$:F[IŃևfJ$ a:aRuiݪ)?nz_q nE]k<덚OƩ(In\7{Jun=4B;cat.LsS{Ե ɑe*K6gD3 Q}WVqt%, {_.[ݴ@Z+JRp)\ 6Wv Ib8킲0Q B]B~]uړ@_7vE"~1YEH%?6\k*JR |&eӛi?XL"ތIkUi}Bo S:D^P WrM1 pNzSP1l+@W>% tzIyw@]sr 5T\ ?Y>tx*F1P7$ tdesҼ;=Gz*g/@v'`b5PM͗mU'NR*WlTkmZHaxx(Z_{O,Ԙrz2$" kxVSVN>7J*?]kS*/c,I*5+@ug`bzd-ފp*h l]*W]ύ6"^Z!r}%5qti?.~smP[bz2![ I*h *qG'"o OڬcMtJIbzFs4 Y5AEqIGĿö|L%v9(+uLGL_Y[_|BS}y#GKy%\9J㑠kϸc]Kh ,8Qxձ醤Cy栴\ jr6 Vyp w*:#ʹ?:wqctYpEqb-vsvr?cmӊfiĂr Oh 1W@Zc4̑#gywlٶHx+B J<q"«5FJ7B{mynL_ASבO8`uG@K=~I.ƥ7WTA iPpυmFqpl©ous]̰)Ԙism {Fp&UKh78,?V1G~v\;~ʩ~qp~7i&-08uF# ];9"ՓbMNER[{Ji V'+2 BE a.<\53T4HiXƩ@ S1- YrQ*tj(NY |Ǜ4j4ӛ{żb#d.B{F 3c¡[5ɻ >r׆I:7L)5Le7hIW8I+Yg*Z@+r{b~g K3ɍAI%+]6ƜOWmyxK*p/ is6xAP8<7;^u"˻`(k G/ж#9+C}VH\E*ܤ2;_U G e9rE<%:T t/FL$-y[w-5n]4}NR;@$:MtTtz#TJjRʮ;y0;x[m;(aa:,uTAev&IO4u,'`R9^sTfrԓ{b$_i';2ۢnBE5 /ȯq.;XNC.#U*F49:k9Au2gEnxQ͍[Qi;~1rc䲛ӧ2KOP]v$w>#R1ٌP16xܥp^1p/WHE A7%*ڕ#)ϡs̆,?Z_I,l*t;v᳷9At.cN]Sg ?%U#:(#PяꇧM%>=?{%呏ک!G{ .:(/P&Ƴ+nPI"J]2oudC;'TOD3@E3L/VitB/axɾY+/X@ٷ|=K#jPӖ/njDT,o0y2@N*+XP|voPɾ26n2LxY0dt~ #d?,PhhVXN1*3;u$rD5vL5T0FRTN*:t;O}-l* P*СBSK ;TD*\۩ 7AGHnBSMJ^;T aR( D SၡTY)O%N۩1 %Se)De6cDFvLCe*P(lDa(Nu* ֜2T&R`xaRa-Wl]/L*{q*uE0xzHl]/H*jD_)LEuO-H0rUs_[W uE@Rk-9[W J֮ l]/P*B-wQl]1>Ei&R`ұ+ךgkh+[Jl0C@t_]\6M*9I^\\k'epmT|s45]T XݗgX]w_nc 2ٵ*9MRTO;~`oEF틆\%&0{X?wTo٩;n]mrwNR]ߢNٌJn@/7ޮGٯn ENsTpNR>-QTe+Aأs덷+biBLEv$Ȝrn}8]59G*! Wf#98䶩Qr.cb')W(iJlNRcj\w8k=tR331 lpxn>܆BO8"i/E*@$(yBEk ENsT cG0|tEbϹOEHHs ^9ouPwh=  н>E]0lE4pQ֙D7)j:[PT@C|Oj.]XT4HyQQ-7+Zw5Fe_+ Ys8hR}X_EWVN$+*OWѭ9&*-[f˾*5CESTOEpP{sVWѭ9ԮҨό&4uE35wIъI T't:Ӝ 'jZAen%-b׷rf[{8T q|uPȏR-?U{8Tv+T~dAr^b(K%&=b*-R=qAr3~ P>%T *'=fX㗽j%co]T@'ꑱTj{ulQhn Q56B-2vT᠖QQ˛ڶIP=4*˭+3ȑseMY\ts+sĨ!j];,#ǿASoڼU<ci.fi)$GV=b?0yBѧ޹B2 a8l1`SFR: &Ӧ"xA"f!(/.9R=IxHdP8}#R3P4ؿ6|Oz* "UP ýDei~iBObE&O]"Uo;}KT@@^%*tw :ôVO=4*#W0J #J6 A*@{'d*wQK)V ({)<;^&yEX*RQXBX8z-򼧒LNG-5{KT"3^O]atTLyʒ)B(WrpDEIZ("A+7)?B'yKTV,* }Ŀ;a1ƾnZ>;Z-A pcJ?Ar3yD.<-BvG=0q$< q9 ^CAIlBFGsa48'u$]:!ҝzRQ-ك2PVE%wåo$!uϧo+gv['SYE* @wAOoJc LI䳆fTĺR,5[0Xʋv>6wrB*EU(2X  J*y%D qj LTJR|*-` jvIx_':*~wLDe ^x&uzh,e*]k σmTZ16n+I10 9ZMT6b8v >U}YTd8v >U}YcTZ4N;ZIgk!*ާVPѠ#;H`~Qip\㯡nDIBOE糎;M+|PuS1gEr' U/Ryl\+|PuR!-/pS>I: $VN$r ə!r' U:B r' U 9 bO*?nt,VN$Ҫak)$ԔTir' 5\az <0IDZdզE\+Y@k-5OXɪMEI;fZg[:;IiI\dMB vu5 ]0cRrxfuP*R^ jyaW_?'(́Wd8SOrS!1q(ݩ+bJTt7ڑ:u.t/]WξZڜ0)S尼 E]hJWw%F~@rLM *ɁUT$ ,ԡwTX„ 2CWez02h ܮpͮwS v|Y ywJcpzT9!"T-*~1ay>=ޘKgza(){ႬӃxۣ1 r &_[5;oUpj.DȃÑWwhonC3fF>DYٴI  >Yi~4K-V oCNX4!-ww0qg;[20g+5 czBzNWخo)D0l-hd?u.;,>A яePHZziiď٠?^g|I~I.߄7a(nAMoTU ӿ-+D*9ĢTRjB*yŘapX*W&R /@D*1HZ'> RIh.ZY/R*NP{m"\H y 2;+%Rjv*m0M^7>p xTrFm')H^OzֺjS&%ZP9Qe*7?~,@ %}s^GZwJ X 5~o 7KF U?,TK6RhwITL|LHn-UEwƪ ս r 1wO ].*?E@>ᑆȁ3e*ƈXq*,Qc;=CToU6X.]q)juG`)m_Rɐdt+PaC~0 sQN?uo4VY7#yy<݂\:>gٞ{{&joЎjE\ Zy@{KίYèM%L~+ żn.أe]?y/զz]5f!|(j?*W_)[ ۻF[F1[Iw} M74IJv{?i]zޅtĈ(x/6VN2RM,;ǥGNTGlV#@w1(xPQoshtTr%1ҽ9B%{ &?P++o&Λ-SIA FmQaOh[]HзDxݰ|S˳QÇ|=TFނ$cw2bz67}ޮHcc,*-29EMʧwqLw`GcKZzF[?cM=MLk(,:xZd/c(żm;{&Ɨt-mDe% p|#*NürB6GT[J%D2!T7?UbAPqiP)NC˨xPM= tr I!Tյq@yh d/En^ Hm:ϔBjad~ Őlz~SaS],R1qX_면LM =э_%~ z#s|9"Ƃ"Ɯ5W^lHHZ VB 5SŪT~*Le*-D1VdI*m+Y*Xj)SҲ%\*+in"mr*ZwIqzġe:b|`@I,`-*CtZ>- HM70 -J>ځ|[0'׾uP1Ѷ?0m$eez ?Z8uhc10hr76TS0|oazlv+>̥oTdJϻ;C$GRT4]9."~kz |HyDE鳤?g-|ETF(Փ_+ w 5ԼPԡomJz b%kQxWԳ5רSdub%CE+Y-Is`kxA@{("Spo+$TKJԃ.l=T $mW[ nnfOv >[o `7qۣ9޴~. m3/ȅ?g_ cژ˄{I&$/}'l 0&v<\hThR.n+>1F7tac? vjrEb=Th"Ry-+\  %*5‰Th+LJbQIa8BBYe7'#g{_;gw*mz% gx9^d>Q{qu zDr=VuP-6b%kP)-jXɚ#T-Vs 5G ա"Ydub%CE+Y*XPJV,V:Tdա"Ydub%CE+Y*XɚaZ2N^Ŷ:ꨣ:ꨣ:jZ,IENDB`P$$If<!vh5<#v<:Vl& t<65<a<P$$If<!vh5<#v<:Vl t<65<a<P$$If<!vh5<#v<:VlV t<65<a<|$$If?!vh555= #v#v#v= :VlF t#6555= a?x$$If?!vh555= #v#v#v= :Vl t#6555= a?|$$If?!vh555= #v#v#v= :Vl t#6555= a?u$$If?!vh555= #v#v#v= :Vl t#555= a?u$$If?!vh555= #v#v#v= :Vl t#555= a?y$$If?!vh555= #v#v#v= :Vl t#555= a?P@P Normal'5CJOJQJ^J_HaJmH sH tH X@2X ?[ Heading 3dd@&[$\$CJOJQJ\^JaJDA@D Default Paragraph FontRi@R  Table Normal4 l4a (k(No ListR^@R ?[ Normal (Web)dd[$\$5OJQJ^J*W@* ?[Strong5\.X@. ?[Emphasis6]4U!4 ?[ Hyperlink >*ph>@2> kD Footnote TextCJaJ@&@A@ kDFootnote ReferenceH*j@Sj _|; Table Grid7:V04b4 GHeader  !4 @r4 GFooter  !.)@. G Page NumberZOOO&<M0>Zt 4   t  / mcW>/K!K!1$2'(7*1-'.1G3s3t3334P44444444C568;:!<"<\<]<<<<<<<==>????BEDFDHD^D_DEEEG G;G????BEDFD^D_DEEG G;Gs;<<]DEELOQSTW-148:;=>?@BCDW. !!t    ,R$!`kG^eJ|s:Z&@H 0(  (  h  # C"? B S  ?O!0W*tK bL<{fMtaNS-ObPaQ/ggOppOV*urn:schemas-microsoft-com:office:smarttagsplacehttp://www.5iantlavalamp.com/_*urn:schemas-microsoft-com:office:smarttagscountry-regionhttp://www.5iantlavalamp.com/h*urn:schemas-microsoft-com:office:smarttagsCity0http://www.5iamas-microsoft-com:office:smarttagsg*urn:schemas-microsoft-com:office:smarttagsdate/http://www.5iantlavalampft-com:office:smarttags 10112006DayMonthYear MOOOOOOOOOMOOOOOOOOO&<@e 3G3<=??HD_DIIK;KMOOOOOMOOOOpaulinedtheresee})Pfj " \Fnј+\"1!S;#^U0#>*ze>3\z77\>M;$I=tLXsAbdgFj=YF}aH>Sa2F cg:>ZtmoT-Q6n0^\vXu.&>c~:J(p^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(808^8`0o(.^`o(.808^8`0o(..^`o(... ^`o( .... `^``o( ..... `^``o( ...... pp^p`o(....... pp^p`o(........hh^h`o(hh^h`o(.0^`0o(..88^8`o(... 88^8`o( .... `^``o( ..... `^``o( ...... ^`o(....... ^`o(........^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(hh^h`o(hh^h`o(.0^`0o(..88^8`o(... 88^8`o( .... `^``o( ..... `^``o( ...... ^`o(....... ^`o(........^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(0^`0o(0^`0o(.0^`0o(..88^8`o(... 88^8`o( .... `^``o( ..... `^``o( ...... ^`o(....... ^`o(........^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(hh^h`o(hh^h`o(.0^`0o(..88^8`o(... 88^8`o( .... `^``o( ..... `^``o( ...... ^`o(....... ^`o(........^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(808^8`0o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.^`CJOJQJo(pp^p`CJOJQJo(o@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(  ^ `CJOJQJo(p0p^p`0OJPJQJ^Jo(  ^ `OJQJ^Jo(hHo  ^ `OJQJo(hHxx^x`OJQJo(hHHH^H`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(pp^p`CJOJQJo(o@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(  ^ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(^`CJOJQJo(^`CJOJQJo(opp^p`CJOJQJo(@ @ ^@ `CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(^`CJOJQJo(PP^P`CJOJQJo(88^8`o(. ^`hH.  L ^ `LhH.   ^ `hH. xx^x`hH. HLH^H`LhH. ^`hH. ^`hH. L^`LhH.hh^h`o(hh^h`o(.0^`0o(..88^8`o(... 88^8`o( .... `^``o( ..... `^``o( ...... ^`o(....... ^`o(........ XPS;#77M;dLH5X})qR cg>*I=sAtm #M\"=Y-Q6nSagFXLUY}ac~" j vXu1!>3tv        ]        Te        a |        \<D{*,b^5- \a RUC<ds)YC<J<%I&*,A8 @<9$`1A{8d<Dk ,Ov#Eb5NI))a4 J@<IKJ<%k ,O5NIVQI&RU{'_VQ9$`IK))a\a{8d'_DOyk9j~ds^5- fUuDOyk9j~v#E@?.hS   K lLLpPb,!56#=%5)v.l/0"4?4k:_|;)AkDXOWjZZ?[J\h d9fp0i}k(3n BnnTw0xWxH6 >M\,i2:[G`FJaQ* 8" 4X/2+ 6Yd(DkTG3s3t34444<<<<<=>???BEDFDHD_DEG G?@ABCDEFHIJKLMNOPQRSTUVWXYZ[\]^_`abcdeghijklmnopqrstuvwxyz{|}~Root Entry F/-$Data G<1Tablef~WordDocument7SummaryInformation(DocumentSummaryInformation8CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q