2012 Press Ganey National Client Conference
Call for Presentations Submission Form

Deadline for submissions: March 19, 5:00 p.m. ET

Be sure to complete the entire application once you begin entering your information. You will not be able to save the application and return to it later.

Did you or anybody else from your organization participate in the 2012 Success Story Award^® call for submissions?
No
Yes

If you plan to submit a narrative for the 2012 Success Story Award, you can still submit for this opportunity. Please note that this National Client Conference call for presentations is separate from the Success Story Award call for submissions. To provide as much variety as possible to the conference schedule, if your organization is chosen as a Success Story Award winner, your National Client Conference presentation submission may no longer be eligible.

Applicant Contact Information

All communications regarding this presentation submission will be sent to this individual. If you are not the person who will make the presentation at conference but are completing this application on behalf of the presenter, please provide your information in the following section. If you are the presenter, you may skip this section and proceed to the next section, Presenter Information.

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Address
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Country	Select a Country United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of the Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic Of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic Of Korea, Republic Of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palestine Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania, United Republic Of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands U.S. Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
ZIP/Postal Code
Email
Phone

Presenter Information

This information should be about the person who will present this session at the conference. If the Applicant Contact Information (above) is left blank, then all communications regarding this presentation submission will be sent to the presenter (below).

*Denotes a required field.

First name*
Last name*
Title*
Facility*
Address*
City*
State	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Country*	Select a Country United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of the Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic Of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic Of Korea, Republic Of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palestine Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania, United Republic Of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands U.S. Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
ZIP/Postal Code*
Phone*
Email*
Credentials

*Describe the speaker's expertise specific to this presentation.


*Has this speaker presented at other health care conferences?
No
Yes

If yes, please list the conference(s):


*Will the speaker have a co-presenter? Press Ganey will cover expenses for up to two (2) presenters from your organization.
No
Yes

If yes, please provide name and title.


*Have you considered having a Press Ganey representative co-present with you? Press Ganey representatives may serve as a third presenter, if appropriate.
No
Yes

If yes, please provide name and title of the Press Ganey representative.

About the Presentation

*Title of the presentation:


*In approximately 150 words, describe the content of your presentation.
Your description should provide a compelling overview that will attract people to the session.


*Has the speaker or someone else from your organization presented this topic at another conference?
No
Yes

If yes, please list the conference(s).

Press Ganey Solutions Used

*Please check all solutions related to your submission.

Press Ganey Clinical Performance Suite^SM for Hospitals Press Ganey Operational Performance Suite^SM for Hospitals Press Ganey Partnership Performance Suite^SM for Hospitals Press Ganey Satisfaction Performance Suite^SM for Hospitals Press Ganey Strategic Planning & Marketing Performance Suite^SM for Hospitals Press Ganey Satisfaction Performance Suite^SM for Medical Practices & Outpatient Facilities
Press Ganey Satisfaction Performance Suite^SM for Home Care Agencies
Press Ganey Performance Consulting Suite^SM
*What type of documentation do you have to help support your presentation?

None/Not Applicable PG Clinical Performer Report PG Employee Partner Report PG Patient Satisfaction Report	PG Physician Partner Report PG Quality Performer Report PG Value-Based Purchasing Calculator Report PG Operational Insights Report
Other:

Learning Objectives

*What, if any, other organizations, tools or resources have you or your organization used to help you achieve success?


*Please select the focus area that best describes your presentation.

	Academic Medical Centers: Presenters should focus on the distinctive challenges faced by academic medical centers when implementing best practices that may be less common in general acute care. Choose the AMC focus area if you would like to present to your AMC peers at the Preconference Seminar. If you wish to present a breakout session at the National Client Conference, please select a different focus area.
	Clinical Quality and Efficiency: Presenters should explore best practices relating to core measures, clinical quality, operational efficiency and patient throughput.
	Employee & Physician Engagement: Presenters should demonstrate how to actively engage employees and physicians in improvement initiatives with positive results.
	Home Care: Presenters should share strategies for overcoming the challenges of implementing patient satisfaction, clinical improvement and employee engagement initiatives away from a centralized office.
	International: Presenters should describe their improvement initiatives and share best practices from across the globe.
	Medical Practice: Presenters should focus on describing the specific challenges they faced in their quest to improve patient experience and operational performance.
	Patient Satisfaction: Presenters should demonstrate how exceptional interactions between patients, families, staff and physicians can lead to high levels of patient satisfaction.
	Strategy & Leadership: Presenters should explain how they created positive change within their organizations through exceptional corporate, executive, community or marketing strategies.

*Please indicate the experience level attendees of this session should possess in this subject matter.
Select experience level Introductory Intermediate Advanced

Introductory – Participants need only a very basic understanding of the health care environment discussed in this session and do not need experience with the processes/content discussed.
Intermediate – Intermediate sessions are for participants who have at least a general understanding of the health care environment discussed in the session. Personal work experience or study about the environment is needed to fully appreciate the material.
Advanced – These sessions are designed for participants who have personal experience with the processes and content discussed and/or have direct experience with the health care environment being discussed. Participants will need to have worked within the specific care environment to fully appreciate the material presented.

*Who should attend this session?
Please briefly describe the target audience for your session, indicating organizational or functional roles of those who would benefit most from this presentation.


*Would you like this presentation to be considered for other Press Ganey speaking opportunities as they arise?
No
Yes