Visionary Leadership Award Nomination Form - MHA

To nominate a hospital or health system senior leader for MHA’s Visionary Leadership Award, fill out the form below.

Hospital/Health System:*
Name of Senior Leader:*
First Last
Title:*
Number of years of service in the current role:*
Number of years of service with nominating organization:*
Address:*
Street Address Address Line 2 City State ZIP Code
Phone number:*
Fax number:*
Nominator:*
First Last
Title:*
Organization:*
Phone number:*
Fax number:*
Email*
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.

Learn More

Visit the Visionary Leadership Award web page to learn more about the award.