2007 David Lawrence Community Service Awards
Nomination Form

Many Kaiser Permanente employees and physicians have demonstrated extraordinary efforts to achieve the Program’s community benefit objectives.  To assist us in determining the 2007 David Lawrence Community Service Award recipients, please answer the following 4 questions.  Please write at least two paragraphs for each question and limit your responses to one page per question.  Be sure to address the criteria listed below when writing your responses.

Nominations will be evaluated on the following criteria:

The individual has demonstrated:

• Exemplary efforts
  • How do these efforts go beyond the individual’s customary work duties?
• A significant history of sustained contributions to the health of a cultural or geographic community.  
  • How long have the efforts in which the individual engaged been ongoing?
• A measurable impact on the health or well-being of a cultural or geographic community.  
  • How were people affected by what this person did?
  • How many people were affected by what this person did?
  • Define the cultural or geographical community
• Activities that address at least one of Kaiser Permanente’s four areas of Community Benefit focus:
  • Large-scale community health initiatives: organizing and focusing Kaiser Permanente’s clinical and community benefit resources around specific community health goals, in partnership with public health and civic activism
  • Safety net partnerships: deepening our community clinic partnerships to center around transfer of care management capabilities, and extending partnerships to health departments and public hospitals
  • Coverage for low-income families: redesigning our participation in Medicaid and SCHIP, and Kaiser Permanente's own Dues Subsidy and charity care programs, to achieve greater impact and to inform policy
  • Developing and disseminating knowledge: educating practitioners, empowering consumers, informing policy makers and advancing research
• Collaboration with a community organization
  • What is the name of the organization?
  • What is the mission of the organization?
• Understanding of disparities in health care
  • Racial and ethnic minorities experience a lower quality of health services and are less likely to receive routine medical procedures and have higher rates of morbidity and mortality than non-minorities.  The individual demonstrates an understanding of the environmental, social and economic factors of health disparities and addresses one or more of these factors in his/her work.

The group has demonstrated:

• Voluntary, replicable or collaborative efforts
  • How do these efforts go beyond the group’s customary work duties?
  • Can these efforts be replicated by other similar groups in other facilities/Regions?
  • How was collaboration demonstrated within the group and with others?
• A measurable impact on the health or well-being of a cultural or geographic community.
  • How were people affected by what this group did?
  • How many people were affected by what this group did?
  • Define the cultural or geographical community
• Activities that address at least one of Kaiser Permanente’s Community Benefit Program’s four areas of focus:
  • Large-scale community health initiatives: organizing and focusing Kaiser Permanente’s clinical and community benefit resources around specific community health goals, in partnership with public health and civic activism
  • Safety net partnerships: deepening our community clinic partnerships to center around transfer of care management capabilities, and extending partnerships to health departments and public hospitals
  • Coverage for low-income families: redesigning our participation in Medicaid and SCHIP, and Kaiser Permanente's own Dues Subsidy and charity care programs, to achieve greater impact and to inform policy
  • Developing and disseminating knowledge: educating practitioners, empowering consumers, informing policy makers and advancing research
• Collaboration with a community organization
  • What is the name of the organization?
  • What is the mission of the organization?
• Understanding of disparities in health care
  • Racial and ethnic minorities experience a lower quality of health services and are less likely to receive routine medical procedures and have higher rates of morbidity and mortality than non-minorities.  The group demonstrates an understanding of the environmental, social and economic factors of health disparities and addresses one or more of these factors in its work.
• Contribution to the facility’s community benefit plan
  • Example: the group’s activities support the facility’s commitment to strengthening the safety net

1. How has your nominee addressed the needs of the community?

2. How has your nominee met the challenges of providing community service/benefit?

3. How has your nominee demonstrated exemplary efforts to achieve community service/benefit goals?

4. How has your nominee advanced the understanding and awareness of Kaiser Permanente’s commitment to improve the health of our communities?

Any general questions regarding the David Lawrence Community Service Award should be directed to John Edmiston, National Community Benefit Department, at (510) 271-6381.

The Kaiser Permanente Board of Directors and National Community Benefit Department thank you in advance for your support and participation.