Homecare Leadership Awards Nomination Form

The Fall Collaborative is almost upon us and we look forward to honoring all the great work being done by our Interim HealthCare Leaders throughout the country. We are pleased to continue the tradition of nominations for Homecare Awards. Eligibility for the Excellence in Leadership/Embracing Change Award, Creativity in Leadership Award, and Leadership in Operational Efficiencies Award will be by nomination only. Nominees may be Clinical or Operations Leaders in Medicare, Skilled PCSS and PCSS Homecare offices.

To have your Leadership nominations considered please send this form along with detailed comments and examples to support your nomination via email to Jan Quilty at jquilty@interimhealthcare.com no later than Friday, July 12, 2019.

Office Location (please use a separate form for Primary Provider Office and/or Branch Locations):

     

Contact Information for person submitting information:

Name:       Email:      

Excellence in Leadership /Embracing Change Award

Please nominate an Administrator or DHCS that you consider an excellent leader.

Name       Job Title       1. Give an example of when this person used leadership skills to deal with a difficult situation, provide leadership to the

team during a stressful time, or guide the team through a process improvement effort.

2. Rate this individual based on the following criteria and provide a specific example that supports your rating:

Communication to Staff, Patients, Caregivers & Others:

5 Excellent

4 Very Good

3 Good

2 Poor

1 Very Poor

Example:

     

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Homecare Leadership Awards Nomination Form

Providing Education Timely to Staff:

5 Excellent

4 Very Good

3 Good

2 Poor

1 Very Poor

Example:

     

Demonstrating Change Management and Accountability

5 Excellent

4 Very Good

3 Good

2 Poor

1 Very Poor

Example:

     

Overall Leadership Skills

5 Excellent

4 Very Good

3 Good

2 Poor

1 Very Poor

Example:

     

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Homecare Leadership Awards Nomination Form

Motivating the team toward a vision and goals surrounding a significant change:

5 Excellent

4 Very Good

3 Good

2 Poor

1 Very Poor

Example:

     

3. Is there any additional information you would like to include that would demonstrate why you think this person should win the Excellence in Leadership/ Embracing Change Award?

     

Creativity in Leadership Award

Please nominate an Administrator or DHCS who demonstrates excellence in leadership and problem-solving by using creative/unconventional solutions to achieve planned objectives.

Name       Job Title      

1. Give an example of a situation where this person planned and implemented actions to resolve a problem or contribute to agency goals using imagination and creativity.

     

2. Give an example of when this person demonstrated a high degree of maturity and wisdom in dealing with a difficult situation, handling a serious or complex issue or implementing a plan that furthered the agency’s mission or goals.

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Homecare Leadership Awards Nomination Form

     

3. Is there any additional information you would like to include that would demonstrate why you think this person should win the Creativity in Leadership Award?

     

4. Give an example of a situation where this person planned and implemented actions to resolve a problem or contribute to agency goals using imagination and creativity.

     

5. Give an example of when this person demonstrated a high degree of maturity and wisdom in dealing with a difficult situation, handling a serious or complex issue or implementing a plan that furthered the agency’s mission or goals.

     

6. Is there any additional information you would like to include that would demonstrate why you think this person should win the Creativity in Leadership Award?

     

Leadership in Operational Efficiencies Award

Please nominate an Administrator or DHCS who demonstrates excellence in leadership in operational efficiencies.

Name       Job Title      

1. Give an example of a situation where this person planned and implemented actions to resolve a problem or contribute to agency goals using operational metrics.

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Homecare Leadership Awards Nomination Form

     

2. Give an example of when this person demonstrated a high degree of leadership identifying specific areas for operational improvement and accountability; putting processes in place to overcome obstacles.

     

3. Give an example of when this person identified revenue opportunities through operational process improvement.

     

4. Give an example of when this person improved operational efficiencies by bringing clinical and billing teams together for collaboration.

     

5. Is there any additional information you would like to include that would demonstrate why you think this person should win the Leadership in Operational Efficiencies Award.

     

Please send this form along with any additional supporting documentation to Jan Quilty via email at jquilty@interimhealthcare.com no later than Friday, July 12, 2019.

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