SDAHO wants to recognize outstanding achievements, innovation, and effective quality improvement projects and patient safety. The Quality Excellence Award must demonstrate successful implementation of strategies that have produced performance improvement in AIM areas.

APPLICATION INFORMATION
ORGANIZATION NAME*
ADDRESS
CITY
STATE/ZIP
PHONE
E-MAIL
CONTACT PERSON

*As you want it to appear to others

PROJECT SUMMARY

(The summary must not exceed 250 words.)

Summary should not refer to names, organization and/or location as this will deem the application ineligible. This will ensure unbiased judging takes place.

Supporting Documentation.

APPLICATION
(The application narrative must not exceed6pages.)

Application answers should not refer to names, organization and/or location or the application will be deemed ineligible.

APPLICATION INFORMATION
Application Category: / Choose an item from drop down-click arrow to select /
Triple Aim Alignment - 10 points max (unless bonus points are applied)
Please check all that apply and provide supporting documentation in the open text field provided.
☐ / Improved Population Health - improvements address population cared for with at least one shared characteristic contributing to health behaviors or health outcomes.
☐ / Improved Experience of Care - improvements address experience of care.
☐ / Lower Cost, Increased Value, or Reduced waste - reduced costs/waste, penalties or increased value of care.
Supporting Documentation.
Aim Alignment - 10 points max
Please check all that apply and provide supporting documentation in the open text field provided.
☐ / Safe –Project improved safety of care
☐ / Timely – Project reduced waiting or delays in receiving care and services.
☐ / Effective –Project used science and evidence based care as the standard in the delivery of care.
☐ / Equitable –Project reduced or removed unequal treatment, provided equity of access to the care and treatment that improves disparity of population served.
☐ / Efficient –Project focused on removal of waste and impacted cost of care and service.
☐ / Person-Centered –Project impacted the system of care by respect personal preferences and put the person and/or family in control.
Supporting Documentation.
Problem Statement (supported by data) - 5 points max
Please describe the following in the open text field provided.
  • Identify the relevant issue.
  • Why was this issue selected for improvement over other identified concerns?
  • Support the issue identified with data to support priority area needing improvement.
  • Link to overall organizational strategy

Supporting Documentation.
Project Goal - 5 points max
Please describe the following in the open text field provided.
  • Specific goal(s) developed for this project
  • Specific measures used to track improvement in the process/outcomes
  • Data sources and time period used to measure change

Supporting Documentation.
Strategy to Improve - 15 points max
Please describe the following in the open text field provided.
  • Describe the strategy/plan for this improvement project.
  • Improvement interventions implemented specifically for this project.
  • Knowledge/evidenced used to support improvement plan.
  • Implementation process.
  • Location(s) for this improvement project (one area, all areas, community, etc.) and why this location was selected.
  • Ongoing evaluation plan.

Supporting Documentation.
Methodology Used for Improvement and Evaluation of Progress - 10 points max
Please describe the following in the open text field provided.
  • Methodology and/or framework used to develop and implement the improvement project (PDSA, Lean, IHI cycle, etc.)
  • Improvement tools used to implement the improvement project (Small tests of change, diagrams, surveys, etc.)
  • Dissemination of knowledge plan.
  • Change management strategies used to motivate and support change.
  • Strategies to hard-wire improvement

Supporting Documentation.
Engagement of Leaders and External Stakeholders - 10 points max
Please describe the following in the open text field provided.
  • Specific actions that demonstrated leadership engagement.
  • Specific actions that demonstrated stakeholder (staffmembers, population/family served) engagement, if appropriate.
  • Reporting strategies that demonstrate ongoing leadership support.

Supporting Documentation.
Results - 20 points max
Please describe the following in the open text field provided. Please note: one, five-page supplemental document in Word, Excel or PDF format may be submitted with the application to support this section; tables and graphics are encouraged.
  • Include before and after data to support work
  • Specific results achieved include time periods
  • Align the results to specific project goal(s)
  • Use results to support impact on Aims selected
  • If possible, compare results with national, state or other recognized benchmarks, targets or evidence-based practices

Supporting Documentation.
Sustainability of Resources and Results - 10 points max
Please describe the following in the open text field provided.
  • Plan for sustained results, further improves and/or expansion of project
  • Resource allocation used to support work and/or sustainability

Supporting Documentation.
Lessons Learned - 5 points max
Please describe the following in the open text field provided.
  • Significant positive lesson(s) learned as a result of this improvement project - how will you build on this success?
  • Significant challenge(s) identified as a result of this improvement project - how did you address or mitigate this challenge?

Supporting Documentation.

GLOSSARY OF TERMS

(This page does not count in the application narrative total number of pages. May delete if not needed)

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APPENDIX
(Up to five pages)

(This section does not count in the application narrative total number of pages.)

Type here.