The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

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Required format:

UT Southwestern Academy for Performance Excellence (APEX)

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Please review the Program Overview, and requirements for Levels of Achievement before completing the survey below.

The Academy for Performance Excellence at the University of Texas Southwestern Medical Center encourages a culture of performance excellence and patient safety. The Academy provides training and a recognition program for UT Southwestern Medical Center faculty, fellows, residents, students, nurses, and staff who are committed to lifelong learning, improvement activities, and scholarship in patient safety and performance improvement (PI).
The program rewards competency-based education, practical application of performance/quality improvement knowledge, and scholarly activities related to leadership, performance improvement methodology, and high-reliability principles. Individuals who accomplish defined milestones in performance improvement education, project completion, and scholarly activity can progress through a process that recognizes their achievements and competence.
All submitted applications are reviewed by a committee of Quality Professionals. Applicants not recognized are provided feedback and encouraged to reapply.

For additional information please contact us by email at QIEd@utsouthwestern.edu

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Please review the attached document prior to completing the application.

Attachment:Academy for Performance Excellence _Final 122022 v2.pdf

Please select one of the following:

* must provide value

Health System

UTSW Faculty

UTSW Fellow/Resident

UTSW Student

UTSW Research

Other UTSW professionals and administration not within the Health System

Name:
(Name entered will be added to certificate)

* must provide value

Professional Credentials:
(Limit of two (2) credentials) Credentials listed will be added to certificate.

Today's Date:

M-D-Y

Email:

Performance Excellence and Quality Management (PExQM) formerly Clinical Safety & Effectiveness (CS&E)- 2 point (two points are earned when the project is completed and presented through the participation category)

Date of the course:

M-D-Y

Quality Improvement Boot Camp - one week intensive for medical, engineering, nursing and health professions students - 2 point

Date of QI Boot Camp:

M-D-Y

Lean Basics (classroom training) - 0.5 points

Date of classroom training:

M-D-Y

Rapid Improvement Event (classroom) training - 0.5 points

M-D-Y

Upload certification (must be in PDF format):

UT Southwestern Quality Improvement Methodology in Taleo (with evidence of completion certificate) - 1 point

M-D-Y

Upload certification (must be in PDF format):

Twelve weeks of medical student scholarly activity - 2 point

Dates of scholarly activity:

M-D-Y

Lean Six Sigma Green Belt certification - (with evidence from a recognized certification body) - 1 point

Date of certification:

M-D-Y

Upload certification (must be in PDF format):

Lean Six Sigma Master Black Belt Certification (with evidence from a recognized certification body) - 3 points

Date of certification:

M-D-Y

Upload certification (must be in PDF format):

Institute for Healthcare Improvement (IHI) Basic Certificate in Quality and Safety - 1 point

Date of completion:

M-D-Y

Upload IHI certificate (must be in PDF format):

IHI Open School Online Courses - Certificates and Continuing Education - 1 point

M-D-Y

Upload IHI certificate (must be in PDF format):

Participation in an equivalent quality improvement educational activity

Activity Name
Short description of activity

Expand

Date of completion:

M-D-Y

Participation in performance improvement activities.
Each Quality Improvement (QI) project summary (entered or uploaded) must contain all the following elements of a QI project:
Project methodology (PDSA, DMAIC, etc.)
Background
Problem statement
Aim statement (including baseline and target measure(s))
QI tools used in project
Intervention (including rationale)
Post intervention data and analysis
Demonstrate at least 2 cycles of improvement (PDSA)
Results
Benefit to organization (financial, satisfaction, etc.)
Sustainability plan

Active participation involves active cooperation with others on the team, engaging in team activities, and tasks to move a quality improvement project towards completion.

Active participation in a quality improvement project as a project team member - 1 point

Name of project
Project Summary

Expand

Date of activity completion:

M-D-Y

-Or-

Upload project summary
(Must be in PDF format)

Active participation in a quality improvement project as a project team leader - 2 points

Name of project
Project Summary

Expand

Date of activity completion:

M-D-Y

-Or-

Upload project summary
(Must be in PDF format)

Active participation in a quality improvement project as a project team facilitator - 3 points

Name of project
Project Summary

Expand

Date of activity completion:

M-D-Y

-Or-

Upload project summary
(Must be in PDF format)

Project Champion - 1 point

Name of project
Project Summary

Expand

Date of activity completion:

M-D-Y

-Or-

Upload project summary
(Must be in PDF format)

Completion of medical student summer work program in quality improvement (QI) - 2 points

Name of project:

Date of project:

M-D-Y

Mentor(s):

Upload project summary
(Must be in PDF format)

Completion of medical student scholarly activity course - 2 points

Name of project:

Date of project:

M-D-Y

Mentor(s):

Upload project summary
(Must be in PDF format)

Equivalent QI project participation activity - per award committee review

Name of project:

Date of project:

M-D-Y

Upload project summary
(Must be in PDF format)

Publications and presentations of Quality Improvement activity.

Abstract of QI project (not peer-reviewed) - 0.5 points

Upload abstract
(Must be in PDF format)

Abstract of QI project (peer-reviewed) - 1 point

Upload abstract
(Must be in PDF format)

Title of project:

Reviewed by:

Local presentation of QI project - 0.5 point

Date presented:

M-D-Y

Title of project:

Venue:

Regional (State) or national presentation of QI project - 1 point

Date presented:

M-D-Y

Title of project:

Venue

Published QI article (peer-reviewed) - 2 points

Citation:

Published QI article (not peer-reviewed) - 1.5 points

Citation:

1 hour lecture involving QI principles- 1 point

Date presented:

M-D-Y

Title of lecture:

Venue:

Quality improvement grants and mentoring activities

Competitive grants awarded
Federal - 4 points (PI), 2 points (Co-PI)

Title of grant:

Program Director/Principal Investigator (PD/PI):

Co-investigator:

Grant-making agency:

Award date:

M-D-Y

Non-federal (competitive)- 2 points

Title of grant:

Program Director/Principal Investigator (PD/PI):

Co-investigator:

Grant-making agency:

Award date:

M-D-Y

Pharma, non-competitive grants, or institutional grant - 1 point

Title of grant:

Program Director/Principal Investigator (PD/PI):

Co-investigator

Grant-making agency:

Award date:

M-D-Y

Mentoring one (1) QI professional who has advanced to Silver Level - 1 point

Date Gold level awarded:

M-D-Y

Name of mentee:

Mentoring date range:

Summary Document

Please attach a summary file including any additional participation and/or scholarly entries that are not able to be entered above.

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