Patient Experience Awards Submission Form

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2027 Patient Experience Awards – Part A Submission Form

Your Part A submission must include:

  • a 500-word project summary
  • two items of support from patients or family members/caregivers directly involved with your program (see details below).

Please have those ready before beginning your application. You will not be able to save your form and return to it.

The information you provide will be kept confidential. If you have any questions about the submission requirements, or need any assistance, please email info@hqa.ca.

Evaluation framework

The selection panel uses an evaluation framework with the following weighting: identification of the opportunity for change or improvement (25%), the change or improvement made (25%), evidence of success (25%), plus the judges’ overall impression (25%). Please refer to the user guide for details.
Have you previously applied for a Health Quality Alberta Patient Experience Award for this initiative?*
What is the area(s) served by your initiative? Check all that apply.*
Who is the key contact person for the initiative (the person Health Quality Alberta will work with if your initiative is successful in moving to Part B)?*
Key contact's email address:*
Who is the contact person for the secondary organization (if applicable)?
Secondary contact's email address:
Please confirm the secondary organization is aware of this submission.*
List the name(s), title(s), and organization/unit/department of contributing team members. Click the plus (+) button at the end of each line to add another person.*
Accepted file types: pdf, doc, Max. file size: 64 MB.
You may enter your text in the space above or upload a pdf (preferred) or MS Word file. Please do not exceed the 500-word limit.
Drop files here or
Accepted file types: jpg, mp3, mp4, mpg, mpeg, pdf, png, ppt, pptx, wav, wmv, Max. file size: 64 MB, Max. files: 3.

    Your application must also include two items of support from a patient or family member/designate (these do not count as part of your 500-word limit). Ensure at least one of your two statements is from a patient/family who experienced the change you made. Only one of your statements can come from a patient advisor, if you involved one. If the patient population you serve makes it difficult to obtain statements of support, contact us to talk about options.

    Acceptable formats include: Written letters or emails, a letter of commendation, a brief video or audio clip (under five minutes), any artform that is shareable and identified as being made by a patient and/or family, and a specific patient/family’s response to a survey. Do not use social media posts.

    Sometimes, a PEA submission is relevant to other Health Quality Alberta projects. If we feel this is the case with your submission, may we share it internally at Health Quality Alberta and contact you in the future?
    Before you submit Part A, have you:*
    If you were not able to upload your file(s), please email them to info@hqa.ca and indicate below. Ensure you include your project title and key contact information in your email.*

    Ready to submit

    Thank you for taking the time to prepare an application! You will be notified in December of the status of your application. If your submission is shortlisted, you will be invited to move to Part B and submit a longer, more detailed project summary due in February 2027.
    Consent to share information*