1 Start 2 Complete Hospital or Health System Name * Hospital CCN (if system, include any CCN in system) * Has your hospital leadership committed to support this initiative? * Yes Has your hospital submitted the 2024 Hospital Survey, and are you committed to submitting the 2025 Hospital Survey? * Some readable option Please upload the signed template letter. * Upload Follow this link to download the template letter of support to attach to your application: https://www.leapfroggroup.org/sites/default/files/Files/Leapfrog%20Support%20letter%20template.docx More informationFiles must be less than 2 MB. Allowed file types: pdf doc docx. Has your hospital convened a team including, at a minimum 3-5 clinicians including physician, nursing, and pharmacy personnel who will regularly participate in the collaborative and have the standing to implement or recommend changes based on findings/learnings? * Yes Are you confident your hospital has adequate technical infrastructure to support implementation of quality improvement projects, including the ability to stratify quality measures by patient self-identified demographic characteristics? * Yes Hospital or Health System Contact Name (First and Last) * Contact Email * Submit
