NAPPSS-IIN | Cohort B Hospital Team Recruitment

Primary Contact & Facility Information

Selected hospitals will be asked by the NAPPSS-IIN project team to complete the application below. Applications will be reviewed by NAPPSS-IIN project leadership and expert faculty. One hospital from each pilot state will be selected to participate in the NAPPSS-IIN Collaborative.

If you have questions or concerns, please contact us at nappss@nichq.org

1. Please provide the primary contact and facility information below *This question is required.

Primary Contact First Name *This question is required.

Primary Contact Last Name *This question is required.

Primary Contact Title *This question is required.

Phone Number *This question is required.

Email Address *This question is required. This question requires a valid email address.

Facility Name & System Name (If Applicable) *This question is required.

Facility Street Address:

Facility City *This question is required.

Facility State *This question is required.

Facility Zip Code *This question is required.

2. Making marked improvement in health care is not easy work. It requires dedication, hard work, a method for executing the work, leadership support and a committed multidimensional team. Being successful in this Collaborative requires that leaders fully understand and support the responsibilities of the project team involved in the work. Use the provided template to submit a letter of commitment to this Collaborative signed by a Senior Leader (CEO, COO, CNO, etc.). In your letter, briefly describe how the NAPPSS-IIN project aligns with facility's mission and work.

Please upload a letter of commitment to this collaborative signed by your leadership.

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