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MHA Keystone Speak-up! Award Nomination Form

MHA Keystone Speak-up! Award

The MHA Keystone Speak-up! Award celebrates patient and staff safety through the recognition of individuals or teams in Michigan hospitals who demonstrate a commitment to the prevention of patient or staff harm. Award recipients are recognized for voicing their concerns as part of their efforts to promote patient and staff safety and prevent avoidable harm.

Nomination Requirements
  • Nominations are open to all healthcare staff working at an MHA Keystone Center PSO member organization in good standing.
  • Nominees should exhibit the award motto: Speaking up when it’s easy to say nothing and difficult to say something.
  • All MHA Keystone Speak-up! Award nominations must be submitted online here. Nominations are accepted on an ongoing basis and will be reviewed and awarded quarterly, with one quarterly awardee receiving additional recognition at the annual MHA Patient Safety and Quality Symposium.
  • The MHA may publish the nominee's name if selected as a finalist.  Please email Adam Novak ( if you would not like your name shared.
  • Application and supplementary materials provided during the nomination process will not be returned.

Protected Health Information (PHI) should not be entered within this submission form. “Protected Health Information” or “PHI” refers to individually identifiable health information, and shall have the same meaning as the term “protected health information” as used in the federal Standards for Privacy of Individually Identifiable Health Information, also known as the “Privacy Rule”, at 45 CFR 164.501 .