2020 NEQCA Leadership Academy Application

The NEQCA Leadership Academy is a six-part series, providing one-day classes taught by international experts in their fields over a six-month period. (Please see 2020 curriculum and schedule below)

All applicants must complete this form by Thursday, December 12, 2019.

Applicants will be notified whether they are selected for participation by Friday, December 20.

All participants who complete the program will receive a Certificate in Healthcare Leadership. In addition, qualified clinicians may receive up to 29.5 CMEs.

Question Title

* 1. About You

Name

Title

Credentials (e.g., MD, PA, NP, PhD, MBA, etc.)

Practice/Company

NEQCA Local Care Organization

Number of years in current position

Undergraduate degree(s) (institution/type/concentration/year)

Graduate degree(s) (institution/type/year)

Additional education (describe)

Best email to reach you

Phone number to reach you directly (mobile preferred)

Question Title

* 2. Why you would like to participate in the NEQCA Leadership Academy? [Maximum 500 words]

Question Title

* 3. Your involvement with NEQCA (current or prior)

Question Title

* 4. Please provide a reference

Name

Title

Practice/Company

Relationship to you

Best phone number to contact

Best email address to contact

Reference has participated in NEQCA Leadership Academy (yes/no)

The 2020 NEQCA Leadership Academy Curriculum and Schedule

January 25, 2020, 8:30 am – 2 pm
Becoming a Transformational Leader
Kevin O’Connor, American Association of Physician Leaders
4.5 CMEs

February 8, 2020, 8:30 am – 4 pm
Negotiations
Robert Bordone, Professor at Harvard Law
6.0 CMEs

March 14, 2020, 8:30 am – 2 pm
Performance Management
Marty Martin, Ph.D., American Association of Physician Leaders
4.5 CMEs

April 4, 2020, 8:30 am – 2 pm
Adaptive Leadership
Val Ulstad, MD, MPA, MPH
4.5 CMEs

May 2, 2020, 8:30 am – 3 pm
Financial Intelligence
Joe Knight, MBA, Business Intelligence Institute
5.5 CMEs

June 6, 2020, 8:30 am – 2 pm
Thriving Physicians: Choosing Resilience to Curb Burnout Hysteria
Wayne Sotile, Ph.D.
4.5 CMEs

Please note: A "snow date" may be added to the schedule in the event a course must be postponed due to inclement weather.

Question Title

* 5. Please read and attest to the statement below.

I have reviewed the NEQCA Leadership Academy curriculum/schedule and attest that I am able to participate in at least five of the six classes.