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Health Connect Hospital Candidate Application
1.
Contact Information
Name
Hospital
Email Address
Phone Number
Are the following statements true or false about you and your hospital?
2.
My hospital is independent and not facing closure or a merger with a larger system.
True
False
Comment
3.
I am open to change and new ideas.
True
False
Comment
4.
I am interested in how to get the best ROI in the shortest amount of time with the optimal use of resources.
True
False
Please describe:
5.
As CEO or Administrator, I have the support and trust of our board
True
False
Comments:
6.
I am actively trying to engage my community.
True
False
Please describe:
7.
I am uncertain about what else to do to mobilize my community leaders.
True
False
Comment
8.
I am willing to invest in something new.
True
False
Comments:
9.
I have nagging concerns including but not limited to: (Check all that apply)
Patient loyalty and out migration
Lack of community awareness about hospital's capabilities
Lack of community awareness about hospital's intentions
The economic reality of hospital survival
Significant lack of community leader engagement
Other (please specify)
10.
Is there anything else you would like us to know about your interest in the Health Connect Program?
