Partners in care: Consumers and clinicians co-designing services

PERSONAL DETAILS: PARTICIPANT 1 (Patient/consumer/consumer representative)
Title: / Firstname: / Family name:
Position/Role (if relevant):
Organisation (if relevant):
Postal Address:
Post Code: / Telephone: / Mobile:
Email:
Preferred method of contact: / Email ☐ / Phone ☐ / Post ☐

Please tick the box if you do not want to be included in the Health Quality & Safety Commission database:☐

PERSONAL DETAILS: PARTICIPANT 2 (Clinician/health professional/health sector worker)
Title / First name: / Family name:
Position/Role:
Organisation:
Postal Address:
Post Code: / Telephone: / Mobile:
Email:
Preferred method of contact: / Email ☐ / Phone ☐ / Post ☐

Please tick the box if you do not want to be included in the Health Quality & Safety Commission database:☐

WORKSHOP 2012 – Keynote speaker Lynne Maher
We would like to attend the workshop (tick one)
☐ / 16 May / Auckland / venue to be confirmed / 0830 – 1600 hours
☐ / 17 May / Wellington / venue to be confirmed / 0830 – 1600 hours
SPECIAL REQUIREMENTS
Please state if you have any dietary requirements or other needs.
PROJECT CRITERIA
Title: / Project title
Project Support: / Applications must include information that shows the project has the support of the organisation where the project changes will be implemented.
Project Description: / Please provide up to 500 words about why your team and project should be sponsored. We are particularly interested in projects that demonstrate patient and consumer engagement with clinicians and improve the quality, safety and experience of care.
Some questions that may help you to describe your project: /
  • What is the problem? (Why this project? Why now?)
  • What is the aim or objective (The project will [what] to [why] by [when] for [how much]?)
  • What changes will this project deliver? (What would patients and key stakeholders want from the project?)
  • How will you measure/evaluate the changes your project will make? (What data are available that could be used for measuring baselines and improvements of the project?)
  • How will others learn about the project?
  • How will your project deliver value for patients, consumers and your supporting organisation?

Project Completion / Please Note: Project teams will be required to produce a project report (600 – 1000 words) that summaries the results from the project, including measures used and results achieved, and what changes have occurred.
TIMEFRAME
Your proposal must be in by: / 24 April 2012
You will be notified by: / 27 April 2012
Your proposal report must be submitted by: / 30 June 2013
MORE INFORMATION
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Contact / Gillian Bohm on