AHE Award Information and Application Innovation Award The AHE Innovation Award presents a tremendous opportunity for companies and organizations to be recognized for innovative and improved Products, Processes, and Technology Advancements. AHE’s goal with the Innovation Award is to increase awareness of innovations that empower individuals and organizations to improve measured outcomes in the healthcare environment. The award is open to AHE members and non-members. The AHE Innovation Award was debuted for the first time in 2014 which received positive feedback from members and award applicants. AHE is excited about the 2016 award program and encourage you to inform others that would qualify to submit their application. Key Characteristics of Nominations: The Innovation award will be presented to the individual, team, or company who’s innovation most significantly impacts or improves performance in management of and caring for the healthcare environment as demonstrated through various qualitative and quantitative metrics. Eligibility AHE recognizes the importance of being inclusive in its efforts to recognize the “best and brightest” as we look to challenge the existing expectations of performance, behavior, engineering, and quality outcomes through innovation. Innovations must be commercially available or otherwise already in the public domain as this award is intended to increase awareness of available solutions. Information, pictures, claims, or validation data is restricted to what is provided in the application. No additional information will be accepted once the application has been submitted. This application is an excellent opportunity to put your innovation in the AHE spotlight through the recognition for awards winners and publications described by the Award’s Recognition venues. This application does require an application fee of $300 at the time of application. 1|Page Award Recognition In addition to the award, the award recipient(s) will be the subject of an article to be published in an issue of Health Facilities Management magazine and/or in an issue of AHE EXPLORE quarterly magazine; providing excellent market publicity of your innovation by reaching approximately AHE members and Health Facilities Management magazine’s subscribers. The application is reviewed by industry experts within the AHE membership who collectively provide scoring and feedback on the submission, along with suggestions for improving marketability and product awareness. The feedback and information provided does not necessarily reflect the views or opinions of the AHE organization, but does provide excellent feedback from leaders within healthcare organizations that are likely to benefit from innovations that promote efficiency in the healthcare environment. How to Apply: Complete the entire application by responding to the following questions in entirety and scanning the completed application to ahe@aha.org by June 17, 2016 2 Ways to Pay: Make check payable to AHE, P.O. Box 75315, Chicago, IL, 60606-5315. (Please allow 2-3 weeks for processing). Fax the complete form to the secure fax with a credit card payment to processing at 312-422-3609 Please contact AHE for any questions at (312) 422-3860 or email to ahe@aha.org 2|Page Office Use Only 324Innovation16 324-02-3310 AHE Award Application Innovation Award Nominator Information This should be the person completing this form. Name of person completing this form ____________________________________ Title ______________________________________________________________ Organization _______________________________________________________ Address ___________________________________________________________ City, State, Zip _____________________________________________________ Phone number ______________________________________________________ Email address ______________________________________________________ AHE ID, if applicable _________________________________________________ I attest that the information contained in this entire application form is accurate and true. I understand that my submission becomes the property of AHE. Yes Applicant Primary Contact Information This should be the primary contact person for the particular innovation summarized in this application may be contacted by the award review committee for additional information. Contact Information Name _____________________________________________________________ Title ______________________________________________________________ Organization _______________________________________________________ Address ___________________________________________________________ City, State, Zip _____________________________________________________ Phone number ______________________________________________________ Email address ______________________________________________________ AHE ID, if applicable _________________________________________________ 3|Page Innovation Information Name/Title of Innovation ______________________________________________ Please provide a brief description (less than 35 words) of the innovative submission as well as a general overview of how the innovation improves performance in the management and care of the healthcare environment. Detailed examples must be provided at the end of the application. How long has the innovation been available in the market place or fully implemented at your facility? 4|Page Has this innovation been marketed specifically to healthcare facilities? If not, what is the primary target market and is the plan to market to healthcare professionals? How is the innovation similar/dissimilar to other available solutions? With respect to similar solutions, describe what differentiates this innovation? 5|Page Is your product environmentally friendly or does it contribute to sustainability as defined by LEED certification, EcoLogo or Green Seal standards? Please cite specific applicable standards. If this innovation is a product and it contains known harmful chemicals or carcinogens of any kind, please explain their purpose and why a safer alternative is not utilized? 6|Page Does this innovation improve or promote safety (resident/patient, worker, etc)? If yes, please include any reference to published standards and measurement metrics that apply. If this innovation is a training program, has it received the AHE Seal of Review and Recognition? 7|Page Does this innovation assist with natural resource and/or energy conservation? Please provide any information regarding published standards and measurement metrics that apply. Does this innovation improve employee productivity? If so, please explain how improvements are qualified and measured. 8|Page Does this innovation improve customer satisfaction? If so, please describe the level of improvement and the customer base (Baseline and improvement metrics should be identified if applicable). How does this innovation address end-user language and communication gaps? 9|Page As the applicant, do you consider this innovation to be a “disruptive technology”? If so, please explain. Please provide specific detailed examples how this innovation improves outcomes in the healthcare environment including metrics that provide evidence of this improvement. 10 | P a g e Thank you for submitting your application/nomination to the AHE Recognition Committee for consideration. Please submit any additional information and documentation to support your responses along with your completed application to AHE at ahe@aha.org by June 17, 2016. 11 | P a g e