Home - HCSEC Summit Awards

I-1 Service Excellence Advisor – 1st Year

Please complete all required fields!

Name of Nominee(*)

This is a required field, please fill it in.

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this individual is being nominated.(*)

This is a required field, please fill it in.

B. How has this nominee made a difference? (*)

This is a required field, please fill it in.

C. How and what impact has this SEA had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. What’s the impact this SEA has had on improving employee morale and the culture of the organization? How did he/she accomplish this?(*)

This is a required field, please fill it in.

E. What impact has this SEA had on improving the community’s perception of the organization?(*)

This is a required field, please fill it in.

F. What behaviors distinguish this nominee from other SEAs?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

I-2 Service Excellence Ambassador

Please complete all required fields!

Name of Nominee(*)

This is a required field, please fill it in.

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this individual is being nominated.(*)

This is a required field, please fill it in.

B. How has this nominee made a difference? (*)

This is a required field, please fill it in.

C. How and what impact has this Ambassador had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact did this Ambassador have in improving employee morale and the culture of the organization?(*)

This is a required field, please fill it in.

E. What impact has the Ambassador had on improving the community’s perception of the organization?(*)

This is a required field, please fill it in.

F. What behaviors distinguish this nominee from other Ambassadors?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

I-3 Exceptional Nurse

Please complete all required fields!

Name of Nominee(*)

This is a required field, please fill it in.

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this individual is being nominated.(*)

This is a required field, please fill it in.

B. How has this nominee made a difference? (*)

This is a required field, please fill it in.

C. How and what impact has this nurse had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact does this nurse have in improving employee morale and the culture of the organization?(*)

This is a required field, please fill it in.

E. What impact has this nurse had on improving the community’s perception of the organization?(*)

This is a required field, please fill it in.

F. Which behaviors differentiate this nominee from other nurses?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

I-4 Exceptional Employee

Please complete all required fields!

Name of Nominee(*)

This is a required field, please fill it in.

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this individual is being nominated.(*)

This is a required field, please fill it in.

B. How has this nominee made a difference? (*)

This is a required field, please fill it in.

C. How and what impact has this employee had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact does this employee have in improving employee morale and the culture of the organization?(*)

This is a required field, please fill it in.

E. What impact has this employee had on improving the community’s perception of the organization?(*)

This is a required field, please fill it in.

F. Which behaviors differentiate this nominee from other employees?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

I-5 Empowering Manager

Please complete all required fields!

Name of Nominee(*)

This is a required field, please fill it in.

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this individual is being nominated.(*)

This is a required field, please fill it in.

B. How has this nominee made a difference? (*)

This is a required field, please fill it in.

C. How and what impact has this manager had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact does this person have in improving employee morale and the culture of the organization?(*)

This is a required field, please fill it in.

E. What impact has this person had on improving the community’s perception of the organization?(*)

This is a required field, please fill it in.

F. What empowering behaviors distinguish this nominee from other managers?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

I-6 Customer Focused Physician/Provider

Please complete all required fields!

Name of Nominee(*)

This is a required field, please fill it in.

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this individual is being nominated.(*)

This is a required field, please fill it in.

B. How has this nominee made a difference? (*)

This is a required field, please fill it in.

C. How and what impact has this physician/provider had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact does this physician/provider have in improving employee morale and the culture of the organization?(*)

This is a required field, please fill it in.

E. What impact has this physician/provider had on improving the community’s perception of the organization?(*)

This is a required field, please fill it in.

F. Which behaviors distinguish the nominee from other physicians/providers?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

T-7 Service Excellence Advisor Team

Please complete all required fields!

The Nominated Team’s Name(*)

This is a required field, please fill it in.

Team Member Names (List them separated by a comma)(*)

Please fill in the Team Member's names

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this team is being nominated.(*)

This is a required field, please fill it in.

B. How has this team made a difference?(*)

This is a required field, please fill it in.

C. How and what impact has the SEA Team had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact did the SEA Team have on improving employee morale and the culture of their environment?(*)

This is a required field, please fill it in.

E. What impact has this team had on improving the community’s perception of the organization?(*)

This is a required field, please fill it in.

F. What behaviors allowed this SEA Team to stand out from others?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

T - 8 OASIS Team

Please complete all required fields!

The Nominated Team's Name(*)

This is a required field, please fill it in.

Team Member Names (List them separated by a comma)(*)

Please fill in the Team Member's names

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this team is being nominated.(*)

This is a required field, please fill it in.

B. How has this team made a difference?(*)

This is a required field, please fill it in.

C. How and what impact has the OASIS Team had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact did this OASIS Team have on improving employee morale and the culture of their environment?(*)

This is a required field, please fill it in.

E. What impact has this team had on improving the community’s perception of the organization?(*)

This is a required field, please fill it in.

F. Have the team’s activities resulted in an improvement in productivity, or in reducing expenses, improving income or reducing turnover, etc.? Please cite the benefits in the areas impacted.(*)

This is a required field, please fill it in.

G. What behaviors mark this OASIS Team as exceptional?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

T – 9 DO IT Improvement of the Year

Please complete all required fields!

The Nominated Team's Name(*)

This is a required field, please fill it in.

Team Member Names (List them separated by a comma)(*)

Please fill in the Team Member's names

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of "why” this DO IT Team project is being nominated.(*)

This is a required field, please fill it in.

B. How has this "DO IT improvement project" made a difference?(*)

This is a required field, please fill it in.

C. How has the improvement made an impact on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. Did the improvement improve employee morale and the culture of the environment?(*)

This is a required field, please fill it in.

E. What impact has this improvement had on the community?(*)

This is a required field, please fill it in.

F. If the improvement had a positive impact on productivity, or in reducing expenses, improving income or reducing turnover, we’d like to hear how any of these areas of the organization benefited.(*)

This is a required field, please fill it in.

G. What behaviors differentiate this DO IT Team and their project from other DO IT Teams?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

L – 10 Super Coach

Please complete all required fields!

Name of Nominee(*)

This is a required field, please fill it in.

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this individual is being nominated.(*)

This is a required field, please fill it in.

B. How has the Super Coach made a difference?(*)

This is a required field, please fill it in.

C. How and what impact has the Super Coach had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact did the Super Coach have on improving employee morale and the culture of our workplace? (*)

This is a required field, please fill it in.

E. What impact has this Super Coach had on improving the community perception of the organization?(*)

This is a required field, please fill it in.

F. What behaviors differentiate this Super Coach from other Super Coaches?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

L – 11 Implementation Coordinator (Program Director)

Please complete all required fields!

Name of Nominee(*)

This is a required field, please fill it in.

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this individual is being nominated.(*)

This is a required field, please fill it in.

B. How has the Implementation Coordinator (Program Director) made a difference?(*)

This is a required field, please fill it in.

C. How and what impact has the individual had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact did the individual have on improving employee morale and the culture of their environment?(*)

This is a required field, please fill it in.

E. What impact has this individual had on improving the community’s perception of the organization?(*)

This is a required field, please fill it in.

F. Which behaviors distinguish this individual from others?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

L – 12 Service Excellence Council

Please complete all required fields!

Nominee Council Name(*)

This is a required field, please fill it in.

Team Member Names (List them separated by a comma)(*)

Please fill in the Team Member's names

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” the council is being nominated.(*)

This is a required field, please fill it in.

B. How has the Service Excellence Council made a difference?(*)

This is a required field, please fill it in.

C. How and what impact has the Council had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact did the Council have on improving employee morale and the culture of their environment?(*)

This is a required field, please fill it in.

E. What impact has this Council had on improving the community perception of the organization?(*)

This is a required field, please fill it in.

F. What behaviors define your Council as exceptional?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

L – 13 Motivating Administrator

Please complete all required fields!

Name of Nominee(*)

This is a required field, please fill it in.

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this individual is being nominated.(*)

This is a required field, please fill it in.

B. How has the individual made a difference?(*)

This is a required field, please fill it in.

C. How and what impact has this individual had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact did this individual have on improving employee morale and the organization’s culture?(*)

This is a required field, please fill it in.

E. Describe what impact the individual has had on improving the community perception of the organization?(*)

This is a required field, please fill it in.

F. What behaviors differentiate this individual from other administrators?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

L – 14 Inspiring Chief Executive Officer/President

Please complete all required fields!

Name of Nominee(*)

This is a required field, please fill it in.

Name of Organization(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” this individual is being nominated.(*)

This is a required field, please fill it in.

B. How has the individual made a difference?(*)

This is a required field, please fill it in.

C. How and what impact has this individual had on patient/customer satisfaction?(*)

This is a required field, please fill it in.

D. How and what impact did this individual have on improving employee morale and the organization’s culture?(*)

This is a required field, please fill it in.

E. Describe what impact the individual has had on improving the community perception of the organization?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

O – 15 The Medical Clinic of Choice

Please complete all required fields!

Nominate Your Facility(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” you are nominating your facility.(*)

This is a required field, please fill it in.

B. How has the clinic made a difference to your community?(*)

This is a required field, please fill it in.

C. What’s changed regarding patient satisfaction at your clinic?(*)

This is a required field, please fill it in.

D. How and what impact did the Clinic’s leaders have on improving employee morale and the facility’s culture?(*)

This is a required field, please fill it in.

E. What impact has Service Excellence had on improving the community’s perception of your clinic?(*)

This is a required field, please fill it in.

F. If the clinic is experiencing improved productivity, and/or income, or in reducing expenses and/or in reduced staff turnover, please give evidence of these benefits. Numbers? Percentiles?(*)

This is a required field, please fill it in.

G. What facility-wide cultural behaviors distinguish your Clinic from others?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.

O – 16 Hospital Provider of Choice

Please complete all required fields!

Nominate Your Facility(*)

This is a required field, please fill it in.

Nominated By(*)

This is a required field, please fill it in.

Approved by Service Excellence Council?(*)

Yes

This is a required field, please fill it in.

A. Provide a brief snapshot of “why” you are nominating your facility.(*)

This is a required field, please fill it in.

B. How has the hospital made a difference?(*)

This is a required field, please fill it in.

C. What’s changed regarding patient/customer satisfaction at your hospital?(*)

This is a required field, please fill it in.

D. How and what impact did the facility have on improving employee morale and the culture of their environment?(*)

This is a required field, please fill it in.

E. What impact has Service Excellence had on improving the community’s perception of your hospital?(*)

This is a required field, please fill it in.

F. If the facility is experiencing improved productivity, and/or income, or in reducing expenses and/or staff turnover, please give evidence of these benefits. Numbers? Percentiles?(*)

This is a required field, please fill it in.

G. What hospital-wide cultural behaviors distinguish this healthcare facility from others?(*)

This is a required field, please fill it in.

Upload Picture(s)(*)

This is a required field, please upload at least one picture.