Thank you for your interest in submitting a self-nomination for the Quality Award Board. The self-nomination period is open from October 1 through October 23. All nominations must be submitted by the October 23rd deadline in order to be considered.

Qualified candidates should demonstrate:
  • Expertise and demonstrated competence in continuous quality improvement and/or the Baldrige criteria.
  • A strong professional reputation and serve in a senior position within their organization.
  • Commitment the Quality Award Program, AHCA/NCAL, and the LTC Community.

To ensure your nomination is eligible for review, please complete all sections of this form in full. Incomplete submissions will not be considered.

Questions may be directed to Urvi Patel at upatel@ahca.org.

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* 1. Name

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* 2. Address

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* 3. Email Address

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* 4. Phone Number

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* 5. Company

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* 6. Job Title

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* 7. Length of Time in Long Term Care

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* 8. What professional credentials or certifications do you hold (e.g., industry certifications, licensure, specialized training programs)?

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* 9. Type of Organizational Experience (select all that apply):

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* 10. Please indicate any professional boards you currently serve on, including your role, and length of service.

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* 11. Please indicate any AHCA/NCAL or state affiliate committees or councils that you currently serve on and your length of service.

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* 12. Have you ever written, or been involved with the writing of a Quality Award (or another Baldrige-based) application?

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* 13. Have you served as an Examiner for the Baldrige Program or a Baldrige Based State Award Program or another formalized Performance Excellence Award Program? Select all that apply.

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* 14. Please describe your involvement in continuous quality improvement, including any changes you have helped to support and resulting outcomes.

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* 15. Why do you want to serve on the Quality Award Board, and if elected, what impact could you have on the program?

The Quality Award Board currently has the following four strategic objectives:

  • Program Value: Members utilize the Quality Award Program as a systems-based solution to overcome key organizational challenges (regulatory, leadership, staffing, etc.).
  • External Recognition: Achieve recognition from one or more external stakeholders that positively impacts and/or incentivizes Quality Award Program participants from a financial, operational, or regulatory perspective.
  • Program Recruitment and Retention: Achieve increased levels of participation and retention of members into the Quality Award Program.
  • Program Capability: Achieve/sustain overall Quality Award Program capability, including applicant evaluation process, recipient recognition, and administrative processes.
In the following questions please share what expertise, professional networks or other resources you bring that could help advance each of these strategic objectives.

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* 16. Please share what expertise, professional networks or other resources you bring that could help advance the strategic objective of Program Value.

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* 17. Please share what expertise, professional networks or other resources you bring that could help advance the strategic objective of External Recognition.

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* 18. Please share what expertise, professional networks or other resources you bring that could help advance the strategic objective of Program Recruitment and Retention.

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* 19. Please share what expertise, professional networks or other resources you bring that could help advance the strategic objective of Program Capability.

Please provide the contact information of two professional references who can speak to your qualifications and leadership experience. While we may not contact all references, having this information on file helps us better understand your background if needed.

Please ensure your reference is aware of the potential for follow-up.

Note, AHCA/NCAL staff may not serve as a reference.

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* 20. Reference 1

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* 21. Reference 2

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* 22. Please review the following statements and check each box to confirm that you meet the associated requirements.

Note, the Quality Award Board Code of Ethical Standards is available for review here.

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