Patient Experience Network National Awards 2017

Preparation Copy of Official Entry Form for Individual or Team Categories

Advocate of Tomorrow
Transformer of Tomorrow

Professional of the Year (including Complaints and PALs)

Manager of the Year (including Complaints and PALs)

Team of the Year (including Complaints and PALs)

PLEASE NOTE THAT ALL SUBMISSIONS MUST BE ENTERED ONLINE.

THIS FORM YOU TO PREPARE YOUR SUBMISSION ONLY, YOU WILL THEN NEED TO COPY & PASTE THE INFORMATION INTO THE ONLINE SUBMISSION FORM AND UPLOAD LOGOS, IMAGES AND SUPPORTING DOCUMENTS

Organisation Name
Category Entered
Entry Name
Entry Code

Welcome to the Official Entry Form for the PEN National Awards 2017 for all team and individual entries. Please note that entries will only be accepted using the online submission form.

If you are making multiple entries, please use a separate Official Entry Form for each entry.

To Complete and Submit your Official Entry Form
  • Complete Sections A -ENTRY CONTEXTand C – ENTRANT DETAILS - so that we refer to your organisation(s) and the entry correctly in all communications and publications.
  • Complete Section E - THE ENTRY
  • Please respond to all the questions on this form staying within the permitted word count. The total word count is 2000 words which includes a 200 word summary.Please respect the word count and keep within the permitted number - we may discount additional words, which may adversely affect your overall score.
  • You can incorporate visual and other non-written evidence to supplement your entry. A maximum of 3 pieces of supporting material may be provided.
  • Permissible additions to Entry text include photographs, other visual images e.g. graphs and links to web content e.g. YouTube, videos hosted online. For images we ask that you use .jpeg format.
  • Please be careful not to add so many links that this dilutes the time Judges have to spend on key information.
  • Please remember not all Judges will be familiar with the specifics of your particular organisation so please write in a form appropriate to “an outsider”.
  • Please ensure your Entry is checked and fully completed before submitting.
  • Provide us with all company logos required in colour high res .jpeg file format.
  • Submit your Official Entry Form - by uploading following the instructions provided in Section B.
NOTE THE DEADLINE FOR ENTRY SUBMISSION IS 5PM ON Friday 24TH NOVEMBER 2017.
You will receive an e-mail to confirm that your Entry has been safely received and has been put forward for screening by our Finalist Short Listing Judging Panel
Please note, there are no time limits on when the initiatives should have taken place, but the expectation is that timeframes should be appropriate to competing for a 2017 Award.
Please contact us on 03333 44 7060 or email f you have any questions about completing this entry form.

SECTION A: ENTRY CONTEXT

Authorisation:

On behalf of {name of Organisation/Company}, I am submitting this entry for consideration in the PEN National Awards 2017.

I confirm that the information given in this entry and any attachments are correct and accurate to the best of my knowledge.

Name
Job Title
Telephone Number
Email Address

Please let us know in which sector and region your organisation is located by highlighting below:

Sector
(please highlight) /
  • Ambulance Service
  • Appliances
  • Care Home/Hospice
  • Community
  • Clinical Commissioning Group or Support Unit
  • Dentist
  • Foundation Trust
  • General Practice
  • Government Body/ Institute
  • Home Healthcare
  • Hospital (please specify type)
  • Mental Health
  • Opticians
  • Partnership (please note all organisations involved and the lead organisation for the purpose of the submission in Section C)
  • Pharmaceutical Company
  • Pharmacy
  • Physiotherapy
  • Private Health
  • Professional Services/ Consultancy
  • Research/ Education
  • Technology Organisations
  • Voluntary/3rd Sector
  • Other (please specify)

Please specify
Region
(please highlight) /
  • Scotland
  • North West
  • North East
  • Ireland / North Ireland
  • Wales
  • Midlands
  • East
  • South East
  • South West
  • West
  • National
  • Non UK (please specify)
  • Other (please specify)

Please specify

B - SUBMISSION OF YOUR OFFICAL ENTRY FORM

Once you have completed the Official Entry Form you will need to upload the form along with

  • no more than three pieces of supporting material
  • a company logo(s)
  • photo of the person / team this nomination applies to (if possible)

Supporting material must be no larger than 5MB and company logo(s) need to be in colour high res .jpeg format.

To submit your Entry form, supporting material and logos please click here.

Terms and Conditions

By submitting this Official Entry Form you agree to the Patient Experience Network publishing non-private information from the Entry in the interests of PR and communications.

Full Terms and Conditions regarding your Entry can be viewed online.

Please note information given on this form may be used in the summaries of the case studies which will be available on the website and in other publications.

SECTION C – ENTRANT DETAILS

Nominations for this award can come from colleagues, employers, peers or friends. Self-nominations are also welcome.

To nominate someone for an Individual or Team category you will need to tell us about them and their work. When completing the nomination, please respond to each of The Entry sections. It is important that you answer as many questions, with as much information as possible. Each question will be scored individually.

Please note this is the name of the person that will appear in print as the main contact for the submission

Title: Mr, Mrs, Miss, Ms, Dr
First Name
Surname
Organisation Name
Address
Postcode
Telephone Number
Mobile Number
Email Address

Please let us know whether you are submitting this entry on your own, as a partner, in partnership with another organisation or on behalf of a client. Please highlight below.

  • Non-partnership (Single Organisation)
  • Partner only
  • Partnership on behalf of a client
  • Partnership with another Organisation (Agency/Client/Organisation)

Partner Name
Client Name
Other Organisation Name

SECTION D – THE ENTRY(Note – Boxes expand with text entry)

1 / ABOUT THE NOMINEE – Please tell us:
  • How you know the individual/team?
  • What inspired the individual / team to become/ be involved inpatient experience?Give us a bit of background to the formation / operation of the team.
Please include the organisation logo and if possible a photo of the person/ team you are nominating
2 / AT WORK
Please tell us about the individual / team when they are on assignments / work projects. For example:
•What makes this individual / team stand out from their peers?
•How does the individual / team provide a consistent, high quality service?
•Over what time period has the individual / team worked in their field?
3 / THE PROFESSIONAL – Please let us know:
  • What has the individual / teamdone to promote or improve standards in their field?
  • What part has the individual / team played in the provision and development of service to patients?
  • How has the individual / teamencouraged others to progress?
  • Is the individual / teaminvolved with any related professional associations? If so, in what capacity?

4 / SUMMARY - Please provide an overview of the team / individual that provides a robust, thorough and compelling argument for why this team or individual deserves special recognition
5 / SUPPORTING INFORMATION - Please add or attach any information you feel will support your entry (personal statements from colleagues, peers, press cuttings, other Awards, etc.)

E. WHAT HAPPENS NEXT

Thank you for completing a submission for this year’s Patient Experience Network National Awards. Once we have received your Official Entry Form, a confirmation will be sent to you by e-mail. The Short List of Finalists for the PEN National Awards 2017 is due to be announced on Friday 22ndDecember 2017.