AHMA – 2012 Entry Form for Clinical Service Improvement Category – for Drafting Entry

AHMA – 2012 Entry Form for Clinical Service Improvement Category – for Drafting Entry

Click HM12EntryFormClinical  to download copy.


Below are the elements (not fully reproduced) but can give you an idea.




A clinical improvement project that was successfully completed in any of the specialized (technical) areas of hospital management, such as Nursing, Laboratory, Radiology or in specialty clinics such as Eye center, Kidney center, etc. The project should show measurable results of having improved the service in such areas as reduction in medication errors, reduced waiting times, prevention of service defects, or faster results with little or no capital outlay.



a.    Please fill out all the sections below and abide strictly by the word count. Words exceeding the maximum word count will be cut off automatically/truncated.

b.    ONLY entries and attachments submitted online will be accepted.

c.    IMPORTANT: It is necessary that the CEO certifies that all information you provide is true and correct by signing the form indicated in the last page.

d.    By submitting an entry, you agree that HMA will share relevant aspects of the Entry submitted on the HMA or related Resource Center website.


Background Information

Project Title

Date Project Started

Enhancements made (for projects that did not start operations between January 2011 to May 2012)

Key staff involved in the project

1. Name


2. Name


3. Name


4. Name


5. Name


Click HERE to add names





1. Please give some background to the project or program including how it originated. Give details of what clinical improvements were achieved and how the project improved quality of care as a result of these improvements.  MAX 350 WORDS.


Word count: 0 / 350


2. Please describe how the project was beneficial from the patient’s perspective and experience, and how it improved patient care, patient safety or service. Preferably please present quantifiable information such as “before and after” measurements if any. MAX 200 WORDS.


Word count: 0 / 200



3. Please explain how the project reduced costs of or what other benefits were derived? Is it simple yet effective, something other departments can also adopt or adapt?  Were appropriate analysis tools used or was it only a matter of throwing money at the problem? MAX 200 WORDS.


Word count: 0 / 200


4. Please explain how significant were the results or outcomes?  Are these measurable? Are there testimonials, awards or other support to show impact on improvement of the department or unit’s service? MAX 150 WORDS.


Word count: 0 / 150


5. Please give some background to the project team that originated, studied and developed the project or program. MAX 200 WORDS.


Word count: 0 / 200


6. Please give any other information, including third party testimonial regarding your project which you think would help convince the judges that this project (or program) should win this category. MAX 200 WORDS.


Word count: 0 / 200



Name and contact details of person submitting entry (* Required fields)

First Name*

Last Name (Surname)*

Name of Hospital*

Job Title


Address 1

Address 2


Postal Code



Mobile Phone*

Office Phone


Supporting Materials

All entries need to be accompanied by documentation to support your entry such as:

a.    Press reports

b.    Awards won

c.    Commendations received

d.    Comments and testimonials from stakeholders

e.    Measurable results achieved

f.     Anything to convince the judges that your entry meets the criteria best.


Supporting materials MUST be in English or, if they are in another language, a certified translation must be provided. You may send up to 5 attachments of any other supporting material.


Attached files must be no larger than 1.5MB each. Documents must be in .pdf or .doc (word) format, images must be in .gif or .jpg format, videos must be in .wmv or .avi format. No exceptions sorry.



CEO Certification

          Please click here to download the certification to be signed by the CEO. Then please scan the signed form and attach it as a supporting material.


Attach File 1No file chosen

Attach File 2 No file chosen

Attach File 3 No file chosen

Attach File 4 No file chosen

Attach File 5 No file chosen

Attach CEO Certification* No file chosen


Note: If you wish to send any files larger than 1.5MB please email them directly to shynebacani@exedraevents.com. Maximum of 2 such files per entry can be submitted and should not be more than 10MB in total size.






*Click here to preview your entry. Recommended.



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