Quality Initiative Recognition Program State Affiliate Innovation Award Submission Form

State affiliates have played an enormous role in implementing the Quality Initiative across the nation. That’s why the AHCA Quality Improvement Recognition Program is not just about our skilled nursing centers, but our state affiliates as well! We want to recognize your efforts, tell your story, and share your great work with others!

Please complete the very brief survey below by July 15, 2013 to tell us about your unique approach to promoting member participation in the Quality Initiative goals. After the submission deadline, the AHCA Quality Cabinet will select one state affiliate to bestow the Innovation Recognition upon, to be recognized at the 2014 Quality Symposium in New Orleans. Please feel free to send any material/documents used for promotion to: qualityinitiative@ahca.org. If you have further questions, contact Sandy Fitzler at sfitzler@ahca.org.

Question Title

* 1. Background Information

Your Name: *

State Affiliate: *

Title:

Email Address: *

Phone Number: *

Question Title

* 2. Have you created any promotional products, tools or resources related to the Quality Initiative, of which are you most proud? Please tell us why.

Question Title

* 3. Have you promoted the AHCA/NCAL Quality Initiative and Recognition Program using any of the resources below to members? (mark all that apply)

	Yes	No
On our website	On our website Yes	On our website No
Via social media	Via social media Yes	Via social media No
Via association newsletter	Via association newsletter Yes	Via association newsletter No
Quality committee involvement	Quality committee involvement Yes	Quality committee involvement No
During state trainings	During state trainings Yes	During state trainings No

Please explain your promotion efforts

Question Title

* 4. How have you acknowledged centers achieving quality results?

	Yes	No
Via your website	Via your website Yes	Via your website No
Via social media	Via social media Yes	Via social media No
Via association newsletter	Via association newsletter Yes	Via association newsletter No
Via press releases	Via press releases Yes	Via press releases No
At meetings	At meetings Yes	At meetings No

Other (please explain)

Quality Initiative Recognition Program State Affiliate Innovation Award Submission Form

Question Title

* 1. Background Information

Question Title

* 2. Have you created any promotional products, tools or resources related to the Quality Initiative, of which are you most proud? Please tell us why.

Question Title

* 3. Have you promoted the AHCA/NCAL Quality Initiative and Recognition Program using any of the resources below to members? (mark all that apply)

Question Title

* 4. How have you acknowledged centers achieving quality results?

Question Title

* 5. Please describe any other unique approaches you have taken to engage members in the initiative?

Question Title

* 6. Please describe any significant results you have seen from your efforts.