Minister’s Medal

2016

Individual Champion Application Template

The individual champion stream of the Minister’s Medal honours individuals who have demonstrated excellence across the criteria below (commitment to engaging patients, leadership, collaboration and dedication).

Please ensure the information below is included in your application for the 2016 Minister’s Medal Honouring Excellence in Health Quality and Safety, noting the word limits for each. Completed applications should be emailed to the corresponding LHIN by 5:00pm on July 15, 2016.

For more information and to review the Frequently Asked Questions (FAQs) related to your application, please visit the Minister’s Medal webpage.

*NEW for 2016*

This year, individual champion applications are being accepted as standalone submissions and do not necessarily have to correspond to a team-based application. Individuals can choose to self-nominate, or be nominated by organizational leadership, peers, or by a patient and/or caregiver. If you are nominating someone, it is recommended that you contact the individual to gather information that could support their nomination.

Name of individual champion nominee:

Name of Corresponding LHIN:Please identify only one LHIN to act as the ‘Corresponding LHIN’ – for example, this may be the LHIN that is most familiar with the nominee’s work

Affiliated Organization(s):

Title of Nominee:

Phone:

Email:

Name of nominator (if applicable):

Email of nominator (if applicable):

Notice of release of information

By submitting your application, you are consenting to the use of information provided in your application for promotional purposes, such as featured on Ministry publications and other materials. The Ministry will take all measures necessary to ensure advance notice is provided of how information related to your application will be used.

Brief introduction (200 words): [n.b.: this section is not scored – it is used to provide an overview of the individual champion nominee for review and ministry use (e.g., development of informational one-pagers)]

Please provide a brief introduction of the nominee, identifying: their experienceas a champion for quality in the health system,their role in any past or current patient-centred programs/initiatives, and a general statement about why they deserve consideration for the Minister’s Medal.

APPLICATION CRITERIA

The following information is intended to be a guideline to highlight the attributes and experience upon whichthenominee will be assessed.

1)Commitment to Engaging Patients(300 words): 30 Points

Describe how the individual strives to engage patients[1] and caregivers to ensure that their needs are put first. The individual must show a commitment to addressing the gaps in care that exist in Ontario, improving access to high-quality care, and providing patients with the information and tools to simplify navigation of the health care system, in alignment with the objectives described in the Patients First: Action Plan for Health Care.

Please also include patient/client testimony (attached as an appendix), helping to further demonstrate how the individual championed the improvement of quality and experience for patients under their care.

2)Leadership (300 words):30 Points

Leadership is the cornerstone for the success ofnew and innovative initiatives. Describe how the individual’s leadership ability has contributed to the results of the workthat they oversee. A successful candidate will havedemonstrated critical thinking, challenged the status quo, motivated others to drive quality, supported innovation aimed at systemic change, and championed change processes within an organization.

3)Collaboration (250words): 20 Points

Effective collaboration with partners is a critical enabler of driving integration in the health care system.Describe how the individual has purposefully worked with others as part of a team to drive advancement in their work. A successful candidate will have fostered connections and trust,facilitated cooperation and coalitions among diverse groups, incorporated a broad range of perspectives and built environments of collaboration and cooperation to achieve results.

4)Dedication (250 words): 20Points

Change is not always easy, and requires working together to overcome challenges. Describe the obstacles that the individual has faced in their work, and how the individual has tackled these obstacles.In what wayshas their dedication helped to achieve effective resultsdespite these challenges?

How to submit your application

Please submit your application by 5:00 p.m. on July 15, 2016to your local LHIN office. Only one application should be submitted for each individual.
Contact th any questions related to completing your application, or completing an application on behalf of someone else.
Good luck!

Note: All identifiable patient information should be removed prior to submission of the testimony to protect the confidentiality of the patient/client.

Applicants are encouraged to submit the patient/client testimony as an appendix to the application. Appendices to the team-based application must not exceed 3 (three) pages in total. Any additional pages of appendices beyond 3 pages may not be considered as part of the application.

2016 Minister’s Medal

Application TemplateIndividual Champion

[1] The term “patients” is used broadly to refer to recipients of any health service provided by the public health care system – whether a resident of a long-term care home, client of a mental health and addiction service or community support service, or a recipient of home or community care.