Annual Medical Staff Awards - Nomination Form (self-nominations are welcome)

The awards criteria are designed to reflect the core elements that are fundamental to the University of Minnesota Medical Center’s Medical Staff. Eligible nominees for the medical staff awards include members of UMMC’s Active Staff and Licensed Independent Practitioner categories. Awards will be granted to the nominee who meets the criteria for each award and embodies the University of Minnesota Health’s 3E Driving Principles as outlined below:

  • Clinical Care Award
    • Experience:
      • Achieves consistently high patient satisfaction scores,
      • Has contributed to exceeding patient expectations in a meaningful way
    • Excellence:
      • Demonstrates superior patient care outcomes.
    • Engagement:
      • Makes UMN Health a top place to practice medicine
      • Demonstrates excellent communication with providers and patients
  • Clinical Research and Innovation Award
    • Experience:
      • Recognized as a leader who brings out the best in their teams in pursuit of superior patient outcomes.
    • Excellence:
      • Has developed a new program or pathway that improves patient outcomes
      • Has developed new knowledge that contributes to better patient outcomes.
    • Engagement:
      • Develops and leads strong teams.
  • Clinical Education Award
    • Experience:
      • Sought out as mentor for faculty, fellows, residents or medical students
    • Excellence:
      • Models professional expertise and compassion
      • Develops and implements improved educational tools and processes
    • Engagement:
      • Demonstrates leadership in training the next generation of healthcare providers

*All nominations must include the following:

  1. Written narrative of not more than 750 words which can be sent separately or typed into the box below.

  2. Names of three clinical associates from any discipline to write statements of support (in addition to nominator). Medical staff services will contact the three individuals.
  3. If applicable, relevant supporting documents, which may include news media articles, committee reports, bibliography, patient satisfaction data or related material.
1. Award Category

Clinical Care Award
Clinical Research and Innovation Award
Clinical Education Award

2. Nominee Information


Nominee Name & Title


Nominee Organization


Nominee Street Address


Nominee City, State, Zip Code


Nominee Telephone Number


Nominee Email Address
3. Nominator Information


Nominator Name & Title


Nominator Organization


Nominator Street Address


Nominator City, State, Zip Code


Nominator Telephone Number


Nominator Email Address
4. Submission requirements

Once your electronic nomination form is received, you will be sent a confirmation e-mail that will ask you to send in the necessary nomination information.

This information can be submitted to the medical staff office by postal or interoffice mail or fax to:

Attention: Kathy Johnson, Medical Staff Awards
Medical Staff Office
University of Minnesota Medical Center
2450 Riverside Ave., C212 Corporate
Minneapolis, MN 55454
Fax 612-273-2457

Selection committee:
The committee will include medical staff officers, medical staff leaders and medical center administrative leadership.

For more information, contact:
Kathy Johnson, 612-273-9103
[email protected]