Visionary Leadership Award Submission

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Jackie Gatz

Senior Vice President of Quality, Safety and Research

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573-893-3700| ext. 1330

Hospital/System Name

Name of Senior Leader

Title

Number of years of service in the current role

Number of years of service with nominating organization

CEO Name

Street Address

Street Address 2 (Optional)

City

Zip / Postal Code

Phone

Nominator's Name

Please complete the following fields with the nominator’s information.

Title

Phone

Select the description(s) that most accurately describes the strategic initiative upon which the award nomination is based. Please note this award does not focus on building or service-line expansion.

access to quality care within the community, including disparate, medically underserved, lower socioeconomic and chronically ill populations

improvement of patients’ clinical outcomes

coordinated chronic disease management between the community and acute care settings

safety outcomes for patients and the community, including disaster planning

partnership with public health or similar organization addressing a population-based health issue

An overview of the initiative, including implementation and current status.

Results of the initiative, to date.

The role and contributions to the initiative(s) made by the nominee.

Key stakeholders and partners, if applicable