NATIONAL CENTER FOR HEALTHCARE LEADERSHIP

2017Gail L. Warden Leadership Excellence Award

The National Center for Healthcare Leadership is accepting nominations for the 2017 Gail L. Warden Leadership Excellence Award. The award honorsahealthcare leader whose commitment, values, and contributionshave improvedthe health of the public throughleadership and organizational excellence.The Leadership Award is given to an individual who has made significant and lasting leadershipcontributions to the health and healthcare field. Nominees can representany sector,including healthcare delivery, community health, public health,insurance, suppliers, public policy, government,professional/trade associations, research, and academic institutions.Nominees for the Award must be actively engaged in the field and have broadnational influence. Self-nominations are not eligible.

The recipient of the 2017 GAIL L. WARDEN LEADERSHIP EXCELLENCE AWARD will be honored on Tuesday, NOVEMBER14, 2017 at the Palmer House Hilton Chicago.

Nominations are due Friday, June 9, 2017

If you have any questions about the nomination form or nomination process,

we encourage you to reach out to Joyce Anne Wainio or 312-563-6632.

Copies of prior award recipients’ nominations are also available upon request.

Please send the completed nomination via email to Nilu Faiz-Ali at .

NOMINATION CRITERIA:

1)Demonstratessignificantinnovationsuch asimproving patient experience, reducing the cost of care, improving population health,research/public policy that advances the field, fostering a culture of health and wellness, or advancing technological solutions to improve healthcare value.

2)Mentors future leaders toward the goal of transforming organizational performance and improving health and healthcare

3)Creates and fostersleadership teamswho have achieved quantifiable improvements in organizational performance, health and wellness, community health status, quality, and value

4)Serves as a role modelfor future generationsof leaders and works to improve talent to advance the field

5)Demonstrates strong leadership practices and actively advocatesfor effective leadership throughout the industry

6)Demonstrates ability to lead across organizational and professional boundaries in order to bring about transformation within communities, regions, and beyond

7)Is sought out to provide perspective, guidance, and direction to the field

8)Recognized and respected in the field and uses this influence to shape the industry through national forums, policymaking, and other strategic groups

NOMINATION PACKAGE:

Theseitems are required for a nomination to be considered by NCHL’s Selection Committee:

Completed nomination form

Signatures of two nominators

Nominee’s vita or résumé

NATIONAL CENTER FOR HEALTHCARE LEADERSHIP

2017GAIL L. WARDEN LEADERSHIP EXCELLENCE AWARD

NOMINATION FORM

ABOUT THE NOMINEE

Name: ______

Title: ______

Organization/Institution:______

Address:______

______

City: ______State:______Zip Code:______

Country:______

Phone:______Fax:______

Email:______

Industry Sector (choose all that apply):

 Healthcare Provider / Delivery Payer/Insurer Supplier

 Community Health / Public Health Professional / Trade Association

 Public Policy / Government Research / Academic Institution

 Other: ______

Gender:FemaleMale

Race/Ethnicity:______Age: ______

Education (schools, degrees):

Principal Honors and Awards:

Major National Leadership Positions, Societies, and Boards:

NOMINATORS’ SIGNATURES

We recommend that one nominator be internal to the organization and one nominator be external to the organization.Electronic signatures, or signatures sent under separate cover, are acceptable.

(1)Nominator Signature:______

Name (print): ______

Title:______

Organization/Institution:______

Phone: ______

E-mail: ______

(2) Nominator Signature:______

Name (print): ______

Title:______

Organization/Institution:______

Phone: ______

E-mail: ______

NOMINEE’S ACCOMPLISHMENTS

Use the space below (or a separate document) to describe how the nominee meets the Leadership Award criteria. When describing the person’s accomplishments, please be as specific as possible and provide examples of how they differ from other healthcare leaders in the field.Do not exceed more than four (4) total pages of narrative for A and B.

  1. PLEASE DESCRIBE THE NOMINEE’S MOST SIGNIFICANT CONTRIBUTION TO HEALTHCARE LEADERSHIP:
  1. PLEASE DESCRIBE THE NOMINEE’S CONTRIBUTIONS RELATIVE TO EACH CRITERIA:

1)Demonstrates significantinnovation such as improving patient experience, reducing the cost of care, improving population health, research/public policy that advances the field, fostering a culture of health and wellness, or advancing technological solutions to improve healthcare value.

2)Mentors future leaders toward the goal of transforming organizational performance and improving health and healthcare

3)Creates and fosters leadership teams who have achieved quantifiable improvements in organizational performance, health and wellness, community health status, quality, and value

4)Serves as a role modelfor future generationsof leaders and works to improve talent to advance the field

5) Demonstrates strong leadership practices and actively advocates for effective leadership throughout the industry

6)Demonstrates ability to lead across organizational and professional boundaries in order to bring about transformation within communities, regions, and beyond

7)Is sought out to provide perspective, guidance, and direction to the field

8)Recognized and respected in the field and uses this influence to shape the industry through national forums, policymaking, and other strategic groups

2017 NCHL Gail L. Warden Leadership Excellence Award Nomination Form1