We need your name and email address to let you know that we have received your submission. We may also need to contact you if we have any queries about your submission.
* Name:
* Job title:
* Organisation name:
* Address:
Town:
County:
* Postcode:
* Telephone:
* Email address:
Fax:
* Strategic health authority:
-- Please select below --
North West Health Authority
North East Health Authority
Yorkshire and the Humber Health Authority
East Midlands Health Authority
West Midlands Health Authority
East of England Health Authority
South West Health Authority
South Central Health Authority
South East Coast Health Authority
London Health Authority
Other
* Type of organisation:
-- Please select below --
Primary care trust
Acute trust
Mental health partnership trust
Foundation trust
Ambulance trust
Local government
National or regional NHS
Not-for-profit
Patient organisation
Academic
Other
Sector:
-- Please select below --
Primary care
Secondary care
Tertiary care
Education
Voluntary
Social services
Other
Are you willing to share your contact details and the content of your submission on our website so other users can contact you?
Type and title of submission
To help us to understand the context of your submission we need to know more about it.
Title of submission (avoid generic titles like 'implementing NICE guidance')
* Title:
Description (please keep to a maximum of three sentences)
* Description:
[Max. 1000 characters]
Does the submission specifically refer to the implementation of NICE guidance?
Warning: NICE can only accept submissions on the implemenatation of NICE guidance
Does the submission relate to the general implementation of NICE guidance?
Does the submission relate to the implementation of a specific piece of NICE guidance?
Does the submission relate to the whole guidance or a specific recommendation?
Specific recommendation the submission relates to: [Max. 600 characters]
Submission type:
Please tick the category or categories that most closely reflect the nature of your submission.
Other submission type:
Category of Submission (for Shared learning award purposes)
Category:
-- Please select --
2010 Shared Learning examples
Industry sponsorship:
Is the submission industry-sponsored in any way?
If yes, please give details
[Max. 250 characters]
Your submission
Aim:
* Please provide a brief paragraph summarising the overall aim of the implementation initiative.[Max. 2000 characters]
Objectives:
* Using a numbered list, please describe the most important objectives (maximum of 3).[Max. 2000 characters]
Context:
* Briefly describe your starting point - for example, what baseline assessment did you undertake, what was happening prior to the intervention and why was it needed?[Max. 2000 characters]
Results:
* Using a numbered list, describe the main results against the objectives. How did you go about implementing the changes to achieve the objectives, including any barriers you overcame?[Max. 2000 characters]
Monitoring and evaluation:
* If applicable, briefly describe how you monitored progress and evaluated results. What impact did the project/changes have on patient outcomes? Please indicate whether you will be publishing these results and if so, where.[Max. 2000 characters]
Key learning points:
* What did you learn that could be transferred to other organisations facing similar challenges? Please give pointers as if you were coaching someone on what might be successful and what to avoid.[Max. 2000 characters]
Attach supporting material
Where possible please collate all supporting material into one MS Word file not exceeding 2 Mb. If you need to submit multiple files please email them to
the Shared learning coordinator . Your submissions will not be edited by NICE
Thank you
Your submission will automatically be entered into the new Shared Learning Award . If you do not want your submission to be entered for the award, please tick this box
Thank you for your submission. If you have answered all of the necessary questions, checked your answers and are happy with your form please press 'Submit'.
