*1.Your Name(Required.)

*2.Your Email Address(Required.)

*3.Your Role(Required.)

*4.Your Organization(Required.)

*5.Nominee Organization/Health System(Required.)

*6.Nominee Contact Name(Required.)

*7.Nominee Contact Email Address(Required.)

*8.Please select the award category for your nomination(Required.)

Organization: Quality Leadership
- Publicly Reports all measures
- Is making meaningful strides for quality improvement strategies and implementing change projects to improve clinical work flows.
- Participating in WCHQ projects and workgroups
- Dedicated to reduction in healthcare disparities and improving patient outcomes

Organization: Excellence in Healthcare
- Using innovative interventions to make meaningful improvement within their patient population.
- Making meaningful strides for quality improvement strategies and implementing change projects to improve clinical workflows.
- Participating in WCHQ projects and workgroups
- Dedicated to reduction in healthcare disparities and improving patient outcomes

Team or Department: Thrive Through Change
- Exemplifies positivity, adaptability, and compassion during times of change.
- Creatively leads primary care team efforts to improve care quality
- Thinks outside of the box to improve workflows
- Champions change and leads quality improvement projects while focusing on team dynamics during times of change.

*9.Describe the Nominee's Work:

Provide a brief summary of the innovative or quality improvement work for which the organization/team is being recognized.

For example:
- What issue or challenge does the organization/team work to address?
- What innovative approach, process, or improvement was implemented?
- How is the organization/team focused on improving care outcomes for disparate/vulnerable populations?
- What leadership attributes does their work showcase?
- Explain how the initiative or improvement has been sustained over time or how it could be expanded to benefit other areas of healthcare(Required.)

*10.Provide any data, metrics, or evidence demonstrating the impact of the nominee’s work.

For example:
- Improved patient outcomes (e.g., reduced hospital readmissions, infection rates, patient safety events)
- Increased efficiency or cost savings
- Enhanced patient satisfaction or provider engagement
- Championed and lead a quality improvement project; created buy in and excitement with team members(Required.)

11.Describe any broader benefits, such as improved teamwork, morale, or community impact.