Team Based Quality Improvement Fellowship 2017/18

Team Based Quality Improvement Fellowship 2017/18

Please read the ‘Further information’ support document before completing your application

Application deadline: 10am Monday 2 October 2017

Please note that electronic signatures are acceptable; applications submitted in Word are preferable

The Team
Your Team Name
Name of employing organisation
Please complete the following information for all Team members who will be part of the Fellowship:
Name / Job Role / Email contact / Professional Registration (if applicable)
Name of team member to be contacted for all future correspondence regarding this application
Declaration of support from Team’s line manager or equivalent
I am aware that this Fellowship will require six days of off-site learning and time to complete a QI project. I confirm support for the application of this Team for this 12 month Quality Improvement Fellowship.
Name and Job Title
Organisation
Signature / Date
Declaration of support from Executive Director or equivalent
On behalf of the employing organisation or Sponsoring Clinical Network, I confirm support for the application of this team for the duration of this 12 monthQuality Improvement Fellowship, including senior level engagement in the project undertaken.
Name and Job Title
Organisation
Signature / Date
Personal Statement
Please tell us about your team, including why you are applying for the Fellowship, what relevant skills and experience you will be bringing, and what you hope to gain and learn from the Fellowship.
(Max 300 words)
Making a Difference
Please tell us about an example of where your team has already worked together to make a difference to improve the service the team provides. Please describe what prompted you to make the change, and what you did, as a team, to make this happen. Please also describe one lesson your team learned from this experience.
(Max 300 words)
Meeting Deadlines under Pressure
Please tell us about an example of where your team has had to meet a deadline under pressure, including howyou managed this. Please also describe one lessonyour team learned from this experience.
(Max 200 words)
Please identify the healthcare area(s) your Team is looking at as part of the Fellowship
Please note that preference will be given to work which focuses on one or more of the areas listed 1-9 below
1. Care of people who are frail / 2. Parity of esteem agenda for people with mental and physical health conditions
3. Maternity, children and young people / 4. Patient involvement
5. Using IT to improve patient and staff experience / 6. Cancer Care
7. End of Life Care / 8. Urgent and Emergency Care
9. Primary Care / 10.Other: Please state briefly (10 words max)
Healthcare Issue the Team is looking to address on the Fellowship
Please briefly describe the following:

The health issue you are looking to address and its relevance to your employer and your employer’s strategic plan and priorities
A brief background to the issue, including a brief explanation of what happens now and the importance of looking at this to patients, patient care and possibly staff and your employer
What you as a team expect to achieve, the specific outcomes and benefits for patients, staff and your employer
How you as a team plan to approach the work required to look at addressing the issue
The nature of resources you think you might need to complete the project and the people you are thinking of involving in working with your team

(Max 500 words)
Evidence that you have worked with your employer/a sponsor to prepare this proposal will strengthen your application
Applicant Declaration
I confirm that the Team has spoken with,and has received, the relevant executive level and line management agreement to apply for this opportunity prior to submitting this application.
Nominated Team Member
Signature / Date

Please submit your completed application form to by 10am on Monday 2 October 2017.