VON Award for Excellence in Quality Improvement - Application Form

Thank you for your interest in this recognition from VON. See the criteria checklist and other information here.

Please be sure to enter information in all of the open fields.
Note that you cannot save the form and return to it, so you will need all the information available to you at this time.
Names and emails should be provided with the individual's permission.
After you complete this form, we will contact you with an invoice for your center's $2,500 application fee.

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* 1. Your name:

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* 2. Your email address:

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* 3. Your position/role:

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* 4. Your center name:

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* 5. Your center number:

Organizational Support

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* 6. Met with senior leaders to review VON QI project plan.

Yes

Enter Date of Meeting

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* 7. Our team has a plan to review our project with our senior leaders.

Yes

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* 8. Our current VON QI project is supported by our senior leaders.

Yes

Enter names and emails of senior leaders

Quality Improvement Team

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* 9. Our team consists of at least 4 members from 3 disciplines, including family.

Yes

Enter names, emails, and disciplines for team members.

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* 10. We have identified a VON QI Project Leader who is the VON Champion.

Yes

Enter name and email of VON Champion(s).

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* 11. Our team meets on a regular schedule in person, virtually, or hybrid.

Yes

Enter meeting schedule and method.

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* 12. At least 4 team members have completed the VON QI Foundations course.

Yes

Enter names and emails of qualifying team members.

Quality Improvement Performance
To be verified by VON with the poster assessment.

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* 13. We defined at least one SMART Aim for our VON QI project.

Yes

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* 14. We used a formal QI method such as the Model for Improvement, Lean, or 6 Sigma.

Yes

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* 15. We measured performance over time using Annotated Run or SPC Charts.

Yes

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* 16. We submitted a poster documenting our VON QI work for the current collaborative.

Yes

Enter Poster Reference Number.

Families as Partners

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* 17. The parent of an infant cared for in a NICU (who is not a member of the care team) is a working member of the multidisciplinary VON QI team and participated in the project reported in the team QI poster.

Yes

Enter name and email of non-care team parent of a NICU infant who is part of your multidisciplinary QI team.

Application Fee
Please provide the contact information for the person at your center to receive the invoice for the $2,500 application fee.

VON Award for Excellence in Quality Improvement - Application Form

Question Title

* 1. Your name:

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* 2. Your email address:

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* 3. Your position/role:

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* 4. Your center name:

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* 5. Your center number:

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* 6. Met with senior leaders to review VON QI project plan.

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* 7. Our team has a plan to review our project with our senior leaders.

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* 8. Our current VON QI project is supported by our senior leaders.

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* 9. Our team consists of at least 4 members from 3 disciplines, including family.

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* 10. We have identified a VON QI Project Leader who is the VON Champion.

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* 11. Our team meets on a regular schedule in person, virtually, or hybrid.

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* 12. At least 4 team members have completed the VON QI Foundations course.

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* 13. We defined at least one SMART Aim for our VON QI project.

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* 14. We used a formal QI method such as the Model for Improvement, Lean, or 6 Sigma.

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* 15. We measured performance over time using Annotated Run or SPC Charts.

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* 16. We submitted a poster documenting our VON QI work for the current collaborative.

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* 17. The parent of an infant cared for in a NICU (who is not a member of the care team) is a working member of the multidisciplinary VON QI team and participated in the project reported in the team QI poster.

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* 18. Name:

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* 19. Contact Information