Kentucky Society for Healthcare Risk Management

Kentucky Society for Healthcare Risk Management GuidelinesExecutive CommitteeCommittee Purpose : The Executive Committee has the authority of the Board of Directors in the management and governance of the Society in intervals between meetings of the Board of Directors and shall report in writing to the Board of Directors at its next scheduled meeting. The Committee works to set and accomplish short and long term goals of the Society.Committee Chair Responsibilities  The Chair is the current president and she/he schedules meetings and agendas.  The Chair provides a summary of the Executive Committee activities to the Board of Directors.  Attend the annual KSHRM Risk Management Seminar and board meeting. .Committee Membership:  The committee is composed of the current, immediate past and president elect in accordance to the bylaws. Committee Role/Function  The committee facilitates the “day to day” operations of the Society.  The committee serves as the finance committee of the Board of Directors and Society on matters regarding the budget, the allocation of resources and expenditures.   Reviews, recommends and approves other Society committee goals and objectives.  Monitors and reviews any legal matters that could impact the Society and presents to the Board of Directors.  Reviews and revises criteria for KSHRM awards, i.e. Risk Manager of the Year.  Review and make recommendations to the Society’s Bylaws.  Coordinates transition to incoming officers.  Coordinates Risk Management week activitiesDocuments/Forms:  Minutes of executive committee meetings and financial reports. Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesBylaws CommitteeCommittee Purpose: Ensure the bylaws accurately reflect practice and are consistent with ASHRM bylaws.Committee Chair Responsibilities  Recruit at least three (3) committee members  Conduct conference call meetings.  Establish goals and budget for the calendar year.  Record meeting minutes and assign action plans to committee members.  Serve as liaison to the KSHRM board.  Oversight of processes should bylaw changes by requested by KSHRM board or member.  Maintain and convey to the next committee chair all pertinent KSHRM bylaws documents.  Provide annual report to membership at annual meeting summarizing committee activities.  Attend the annual KSHRM board meeting usually held in November.Committee Member Responsibilities  Assist in collecting recommendations for change to the KSHRM bylaws from the board or general membership.  Serve as temporary chair in the absence of the Chairperson.  Assist in drafting recommended changes for presentation to the board.  Assist in getting proposed changes to the general membership.  Assist in preparation of the annual report for the annual meeting.Committee Activities Solicit recommendations for bylaw changes from KSHRM board and/or membership.  Review ASHRM bylaw changes and evaluate KSHRM bylaws for any required changes.  Draft and present bylaw committee recommendations to KSHRM board  Assure KSHRM membership receives by mail or alternative communication method such as email, the proposed bylaw changes at least sixty (60) days prior to the annual business meeting. See Example 1 for hard copy mailing.  Incorporate amendments to the bylaws that are submitted by a minimum of 25% of the membership in good standing.  Present for vote any changes/recommendations at the annual meeting.  Follow Robert’s Rules when bylaw changes to membership when a vote is required.Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesExample 1 Bylaws Committee Print on KSHRM letterheadDateDear KSHRM Member,Enclosed are recommendations for amending the KSHRM bylaws. The bylaws will be considered by the general membership and voted upon at the annual business meeting in November. Please review the changes noted in bold and be prepared to vote on the changes at the annual meeting. Thank you.Respectfully,Bylaws Committee ChairpersonVersion 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesEducation CommitteeCommittee Purpose - Facilitates the planning, development, presentation and follow-up related to formal education programs within the membership, including but not limited to: Annual Fall Risk Management Conference.  Development of other programs per membership needs.Committee Chair Responsibilities  Recruit at least 5 committee members.  Coordinate committee conference calls.  Develop/present annual goals and budget to board.  Serve as liaison to the KSHRM board. Discuss and solicit ideas for programs at regular board meetings.  Facilitate educational programs or designate a committee member to facilitate in chair’s absence.  Determine date for annual business meeting.  Communicate calendar of events with Newsletter/Website chair.  Monitor expenses and assure committee stays within budget. If additional funds are requested by committee, discuss and obtain approval from KSHRM board.  Present annual report to membership at annual meeting  Updates changes with mailing list (based on email returns when programs announced)  Facilitates KSHRM membership within programs offered  Attend the year end KSHRM board transition meeting usually held in December.Committee Member Responsibilities  Attend conference call or in person meetings as scheduled  Review the evaluations from programs and annual meeting held the previous year. These should be available from the previous year’s committee chair.  Identify topics and speakers for annual risk management seminar usually held in November.  Tasks as assigned by committee chair.  Participate and encourage KSHRM members to attend educational programs and the annual business meeting and risk management seminar.Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesCommittee Role/Function Educational Programs Review ASHRM Audio conference and Web-cast programs. Consider broadcasting the presentation at multiple sites to minimize travel for interested members.  Coordinate payment of registration fees with treasurer.  Prepare and distribute information on educational program offerings to include: o Date and Time o Location o Registration Information and Fee if applicable. o Prepare handouts if provided. Utilize KSHRM Listserve to facilitate educational offerings Review educational programs that are being offered by organizations and consider forwarding to KSHRM membership.Annual Business Meeting and Advanced Risk Management Seminar Determine topics for seminar. - Review evaluations from previous year for potential topics. - Legislative/Regulatory issues. - Review topics to be discussed at ASHRM annual conference.  Identify and confirm speakers for seminars. - Determine expenses/honorarium if applicable. Coordinate with KSHRM Treasurer for reimbursement of expenses and/or honorarium. - Request speaker biography - Develop/review seminar objectives with speaker - Request presentation materials to allow time to copy for distribution - Determine audiovisual equipment needs - Assist with arrangements for speakers traveling from out of town if applicable. - Determine speaker gift if appropriate and designate a committee member the responsibility for purchase. Consider there may potential company guidelines restricting the dollar amount one may accept. Usually a $25 maximum value is acceptable.  Determine location. The location will be considered for each educational offering and location will be selected based on program content and membership/attendee needs. Committee designee should be the liaison with the facility location to coordinate: - Contract review and obtain signatures if applicable - Meal and break time and food selections - Room set up - Registration set up/signage - Audio visual equipment - Hotel room block if applicableVersion 2 2014 Kentucky Society for Healthcare Risk Management Guidelines Continuing Education Units. Develop request for contact hours for nursing CEU’s and fulfillment of ASHRM designation or CPHRM renewal. This process should be followed for any educational program sponsored through the year. - Prepare written request for contact hours. Include in the written request the speaker bio’s, program agenda and objectives. CEU information should be received in time to print the provider, number of hours awarded and provider number in the registration information. To obtain CEU’s for nurses, consider talking to the education department at a committee member’s hospital. Contact hours from ASHRM can be obtained by submitting the same information as described above. - Request CEU certificates for attendees. The certificates will be distributed to attendee at the conclusion of the seminar and meeting when evaluation forms are turned in.  Registration Fees. Several things should be considered when determining registration costs. These may include: - Speaker expenses - Meeting room rental and set up charges - Meal and break costs - Sponsor Contribution. Committee members may approach potential sponsors for sharing of meal or break costs. - Budget - Board Opinion - Chapter dues. Historically the KSHRM chapter dues is included in the cost of registration at the annual seminar and business meeting. - Incidentals. Office supplies, printing cost of program, mailing verses email.  Program Brochure. Design can be created to email or provide hard copy mailing. The brochure should include the following information: - Title of the Session - Date/Time - Location. - List of Sponsors - Program Objectives - Agenda . Include the title of each session and the speaker(s) - Continuing Education Contact Hours - Request for Special needs, i.e., accommodations or special dietary needs - Facility information such as hotel room rate and reservation cut off date if applicable. - Registration Form . Attendee Demographics to include:  Name  Facility/Title  Address, City, State, Zip  Phone/Fax  Email addressVersion 2 2014 Kentucky Society for Healthcare Risk Management Guidelines. Deadline date for registration. . Registration Fee . Make fee payable to: . Address/Fax of person to receive registration form and fee. Usually this is the KSHRM Secretary/Treasurer. . Special Instructions  Program Promotion Several methods can be utilized to make membership aware of program to include: - Chapter Newsletter - Email/Fax - Chapter scheduled or special mailings. - KSHRM Website - ASHRM e-news  Session Materials (Electronic copies of all educational sessions will be utilized when appropriate). Place materials in a binder or folder for each attendee. Include: - Agenda - Speaker(s) bio - Speaker presentations such as power point or other handouts. - Evaluation form. Each attendee will be requested to complete the evaluation form at the conclusion of the meeting and seminar. - Committee Reports. See example 1. - Each committee chair should submit an annual report for presentation at the annual business meeting. Coordinate receipt of a copy for inclusion in the binder. The education committee chair can facilitate receipt of reports.  Registration – Day of Session - Have sign in sheets available for attendees. If nursing CEU’s are offered have the applicable sign in sheet from the person/entity providing the contact hours. - Have name tags available - Copies of the session materials in a binder or folder. - Have sign up sheets for each KSHRM committee for attendees to sign if interested in serving on a committee during the following calendar year. Conclusion of Program This is applicable to any program arranged by the committee throughout the year. Collect evaluation forms. Distribute CEU certificates if applicable. Review and create a summary report of findings from the program evaluations. Chair should report findings to KSHRM board at next scheduled meetingVersion 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesEducation Committee Example 1 Kentucky Society for Healthcare Risk Management Name of ProgramPlease rate the extent to which you are able to Above Below meet each of the following objectives listed below. Average Average AverageInsert program objectives in these text boxesPlease rate the following aspects of the offering Above Average Below Average AverageSpeaker one name ______Speaker two name ______Speaker three name ______Audio visual helpful ______Content Appropriate ______Opportunity for Participation ______Facilities ______Please list your level of education RN____ LPN____ Other ______Will this offering have a positive effect on your current role? ______Please list any offerings you would like to see in at future programs.Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesLegislative CommitteeCommittee Purpose: Monitor legislative activities relevant to healthcare risk management.Committee Chair Responsibilities  Recruit at least 3 committee members.  Coordinate committee conference calls.  Serve as liaison to the KSHRM board.  Develop/present annual goals and budget to board.  Present annual report to membership at annual meeting summarizing related legislative and regulatory issues of concern.  Attend the year end KSHRM board transition meeting usually held in December.Committee Member Responsibilities  Identify and track legislative and regulatory issues.  Obtain copies of pertinent legislation or regulatory documents for review  Obtain publications and reference materials related to proposed legislative or regulatory changes.Committee Activities  Review pertinent legislation or regulatory documents and summarize impact on healthcare risk management from a risk management perspective.  Review proposed legislative or regulatory changes and summarize the potential impact on healthcare from a risk management perspective.  Prepare communication for general membership on related topics of interest on legislative or regulatory issues.  Develop communication for review by KSHRM board if committee recommends communicating with state legislators on a topic of interest to healthcare risk management. Communication can be in support or opposition to proposed legislative or regulatory change.Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesMembership CommitteeCommittee Purpose: To focus on membership retention as well as membership growth by identifying healthcare professionals who would benefit in joining KSHRM. Committee Chair Responsibilities  Establish at least three (3) committee members  Conduct conference call meetings.  Establish goals and budget for the calendar year.  Record meeting minutes and assign action plans to committee members  Serve as liaison to the KSHRM board.  Provide information from committee to webmaster, i.e., current membership roster for posting on the website. Review the roster prior to forwarding to webmaster to assure any members who have requested information not be posted is removed from the roster for this purpose only.  Assure compliance with KSHRM Bylaws if applicable to membership committee or member participation.  Provide annual report to membership at annual meeting summarizing committee activities.  Attend the annual KSHRM board meeting usually held in November.Committee Member Responsibilities  Conduct activities as assigned during conference call committee meetings  Review application and suggest any edits that should be considered.  Identify healthcare professionals who would benefit from joining KSHRM  Maintain current roster of KSHRM members  Provide a current membership roster to other KSHRM committees when requested. This could include committee mailings such as notification of educational programs and the KSHRM annual business meeting and risk management seminar.  Encourage membership to participate in KSHRM education programs and the annual business meeting and risk management seminar.  Provide information on KSHRM membership and guide the member to the KSHRM website http://kyha.com/kshrm.htm  Provide information on ASHRM membership and guide the member to the ASHRM website http://www.ashrm.org/ashrm/brochure/memberbenefits.htmlVersion 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesCommittee ActivitiesMembership Application Review and update the KSHRM Membership Application. (See example 1) If changes are made forward updated form to the webmaster for posting on KSHRM web-site.Membership Retention Obtain a current member roster from the previous year’s membership chair.  Receive a list of the previous year’s annual meeting attendees. (The annual meeting is usually held in November. Meeting registration fee includes the $25 membership dues for the following calendar year).  Update the KSHRM roster to indicate those who paid dues for the current year by registering for the annual meeting or submitted their annual dues at the time the annual meeting registration form was distributed. Check demographic information and assure updates are added to the roster.  E-Mail a membership renewal notification on to include a membership application to members on the roster who did not renew their membership by attending the annual meeting or mailing their membership dues if unable to attend the meeting. (See example 2)  Monitor for responses to the renewal notice email. Update the roster to reflect current year membership and assure demographic information is correct.  When renewal application and dues payment is received email recognition letter to the member. (See example 3)  If the member does not have a KSHRM lapel pin, forward one to them.  Forty five (45) to sixty (60) days after the renewal notice is emailed review the response. Send out a second notice to members who have not responded.New Members Respond to inquiries regarding membership in KSHRM with correspondence. (See example 4). Follow up on the inquiry in thirty (30) to forty five (45) days after the communication has been mailed.  Email information regarding KSHRM to healthcare professionals who are identified as potential KSHRM members.  Review new member application to determine eligibility and member classification.  Email a welcome letter to each new member. (See example 3).  Forward a KSHRM lapel pin to the new member.  Add new member information to the KSHRM Membership Roster.Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesKentucky Society for Healthcare Risk ManagementExample 1 Membership Committee KSHRM Membership Application Form ► Complete the following information: (NOTE: If obtaining this application online, please print the application form before completing.) Check One: □ New □ Renewing Member If new, referred to KSHRM by: ______Name ______Address ______City / State / ZIP ______Work Phone ______FAX ______E-mail Address______Employer ______Position or Title ______Degrees ______Professional Designations/Certifications ______► KSHRM includes a membership roster containing members’ demographic information in the MEMBERS ONLY Section on its Web site, www.kyha.com/kshrm.htm . If you do not want any of your information listed on this roster, please include a separate request with your application. ► Check appropriate membership for you: □ Regular Membership (Actively involved in the field of healthcare risk management or whose primary job responsibility includes healthcare risk management.) □ Student Membership (Full-time student interested in the field of healthcare risk management.)□ Emeritus Membership (Has been a regular member of KSHRM in good standing for the past ten (10) years and is retired from employment.) □ Inactive Membership (Regular member who is unemployed at the time of membership renewal and requests inactive status in an accompanying letter to the Board of Directors.) ► Are you currently a member of the American Society for Healthcare Risk Management? Check one: □ Yes □ No, but please tell me how I can apply.► Send completed application form and check for $25 annual membership dues to: Kentucky Society for Healthcare Risk Management Membership Committee P.O. Box 436629 Louisville, KY 40253-6629 (Rev. 03/06)Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesPrint on KSHRM Letterhead DateDear KSHRM Member,It is time to renew your KSHRM membership for insert yearPlease print and complete the attached membership application and return along with your $25.00 membership dues by insert date to: KSHRM Membership Committee PO Box 436629 Louisville, KY 40253-6629If you have any questions please contact insert contact information or email at Thank you for your participation in KSHRMSincerely,KSHRM Membership ChairVersion 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesExample 3 Membership CommitteePrint on KSHRM LetterheadDateDear Thank you for joining/renewing your membership with the Kentucky Society of Healthcare Risk Management (KSHRM). KSHRM provides educational and networking opportunities for healthcare risk managers throughout the state. The chapter affiliation with the American Society for Healthcare Risk Management also provides additional information and educational opportunities for chapter members. If you are first time member, a KSHRM lapel pin has been included with this letter.Information to include chapter leadership, the biannual newsletter and educational opportunities are posted on the KSHRM website. The site can be accessed at www.kyha.com and clicking on Allied Societies and choosing KSHRM. If password access is required use the following:User Name: KSHRM Password: RiskThank you for your continued support of KSHRMSincerely,Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesExample 4 Membership CommitteePrint on KSHRM LetterheadDateDear Colleague,The Kentucky Society for Healthcare Risk Management (“KSHRM”) is a dynamic organization of healthcare risk management professionals throughout the State of Kentucky. KSHRM provides members with both educational and networking opportunities for its members. Join the nearly one hundred professionals who recognize the importance of advancing risk management initiatives within their own organizations, as well as distinguishing themselves within the healthcare industry by joining KSHRM. To continue this important work, we need your support.Become a KSHRM member and you will:  Participate in educational opportunities  Network with other professionals  Receive bi-annual newsletters  Enhance your career  Demonstrate your commitment to your fieldTogether in membership, we will continue to work for positive change in our healthcare communities and within the organization itself by providing leadership, advocacy and supportive professional relationships. For more information, please contact ______at ______or access a membership application on our website at http://www.kyha.com/kshrm.htmSincerely,Name Membership CommitteeVersion 2 2014 Kentucky Society for Healthcare Risk Management Guidelines Kentucky Society for Healthcare Risk Management GuidelinesCommunications CommitteeCommittee Purpose The committee will be responsible for facilitating communication regarding leadership, membership, chapter activity, and local/national topics in risk management through a variety of communication modes.Committee Chair Responsibilities  Recruit at least 3 committee members. Coordinate committee conference calls. Develop/present annual goals and budget to board. Coordinate KSHRM website content with committee members. Serve as liaison with KHA representative in managing information on the website. Maintain up to date membership list serve. Present annual report to membership at annual meeting summarizing committee activities. Attend and report activities at KSRHM board meetings and annual meeting.Committee Member Responsibilities  Contribute ideas for website content. Contribute ideas as well as solicit information to be disseminated to the membership. Committee Role/Function  Communicate information to the KSHRM membership relevant to the healthcare risk management profession in a variety of modes such as e-mails, website updates and mailings. Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesNominating CommitteeCommittee Purpose: To facilitate and carryout the nominating process for election of KSHRM officers and board members for the following calendar year. Committee Chair Responsibilities The Nominating Committee is chaired by the immediate past-president as stipulated in the society bylaws.  Coordinate with the KSHRM President five (5) committee members to appoint five (5) committee members. See society bylaws Article IX, Section 1.  Coordinate committee conference calls.  Serve as liaison to the KSHRM board.  Develop/present annual goals and budget to board.  Assure compliance with society bylaws relevant to the nomination and election process.  Attend the annual KSHRM board meeting usually held in November.  Present annual report to membership at annual meeting summarizing committee activities.  At the annual business meeting introduce elected officers and board members for the following calendar yearCommittee Member ResponsibilitiesNominations  Determine positions to be filled. As per the society bylaws the following apply: Officers: President, President-Elect, Secretary/Treasurer - One year terms. Board Members: Three Year Term – One Position Two Year Term - Two Positions One Year Term – One Position Nominations for Risk Manager of the Year are also requested when nominations for board positions are requested. Prepare a cover memo and a call for nominations. Email the memo and call for nomination form to all current members. A current membership roster canVersion 2 2014 Kentucky Society for Healthcare Risk Management Guidelines be referenced to assure all members receive the mailing. Nomination forms should be returned to the committee chair or designated committee member. See example 1 and 2.Candidate Nomination Review  Review all candidate nominations received to ensure the nominee is in good standing with the society. Reference the KSHRM Membership roster for verification.  Prepare and email a letter of interest to each nominated candidates informing them of the nomination and request response in writing as to their interest in running for the nominated position. See example 3. Include in the email a Candidate Information form to be completed if he/she accepts the nomination. See example 4.  Prepare and email communication informing nominees of the Risk Manager of the Year nomination. See example 5. Include a form with the email requesting the nominee provide requested information for use in the final selection process. See example 6.  Review the written responses from the nominees to include Risk Manager of the Year.Election  Prepare a cover memo (see example 7) ballot listing the position and candidates approved by the committee. See example 8. Include the Candidate Information sheets (example 4) for each candidate.  Scan and email a ballot, or prepare a survey tool such as Survey Monkey to each society member in good standing not less than sixty (60) days prior to the membership meeting usually held in November. This is in accordance with the society bylaws Article VII, Section 4.  Responses will be directed to the KSHRM Secretary. The Secretary will inform the KSHRM board outcomes of the election prior to the annual membership meeting. In the event of an election tie, discussion and decision will be made by the KSHRM officers and board.  A letter or email is sent to each candidate informing them of the outcome of the election.Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesExample 1 Nominating CommitteeTo: KSHRM Members, Active StatusFrom: Chair, Nominating CommitteeDate:Re: Nominations - KSHRM BOARD OF DIRECTORSCall for nominations for the insert date KSHRM Officers and Directors is underway. Enclosed you will find the official KSHRM nomination form. Your participation in selecting the KSHRM leadership is important. Please take the opportunity to review the open positions and nominate fellow KSHRM members for these leadership positions.Return the completed form to the individual listed below by insert dateInsert Nominating chair or designee to receive nomination forms.Thank you for your participation. Should you have any questions please contact me at insert contact information.Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesExample 2 Nominating Committee Use this template for positions that will be open for the following calendar year. At the minimum there will be a call for President Elect, Sec/Treasurer and One Year Board Member and Risk Manager of the Year Insert Year GENERAL ELECTION Call for Nominations FormUse this form to suggest potential candidates for nomination to the offices listed below. Suggestions will be considered by the Nominating Committee for inclusion on the date slate for KSHRM board positions in date . KSHRM will verify status of all nominated individuals to ensure that nominees are in good standing prior to review by the Nominating Committee.Print or type all information. Completed forms must be postmarked no later than insert date and send to:Insert information You may also return this form via fax to insert fax number and must be received no later than Insert datePRESIDENT ELECT (assumes SECRETARY/TREASURER Presidency in insert date)______Name Name ______Title Title ______Organization Organization ______Address Address ______City State Zip City State ZipBOARD OF DIRECTORS BOARD OF DIRECTORS (One-year term) (Two-year term)Version 2 2014 Kentucky Society for Healthcare Risk Management Guidelines______Name Name ______Title Title ______Organization Organization ______Address Address ______City State Zip City State ZipBOARD OF DIRECTORS RISK MANAGER OF THE YEAR (Three-year term)______Name Name ______Title Title ______Organization Organization ______Address Address ______City State Zip City State ZipVersion 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesExample 3 Nominating CommitteeDate RecipientRe: KSHRM Nomination – insert date Board Member – length of termDear Congratulations. You have been nominated for the position of insert position.Please take this opportunity to consider you willingness to assume this position and the commitment required if elected.In order to proceed with the election process please complete the attached biography and returned to my attention by insert date. Should you not wish to accept this nomination please respond in writing as such. Please send your correspondence to:Insert informationThank you for your continued membership and contribution to KSHRM.Respectfully,Insert name, Chair, Nominating CommitteeVersion 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesExample 4 Nominating Committee Candidate InformationName: ______Title: ______Organization Address: __________________Office Nominated for: ______Description of Current Position and Responsibilities:Experience:Education:Professional Affiliations:Please provide a brief description of your proposed objectives as a member of the societies’ governing body:Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesBy virtue of completing this form, if elected, I agree to commit the necessary time to fulfill the level of participation required. I affirm that the above statements are true and complete.______Signature DateExample 5 Nominating CommitteeDate RecipientRe: KSHRM Nomination – insert date Risk Manager of the YearDear Congratulations. You have been nominated for KSHRM Risk Manager of the Year.Please take this opportunity to congratulate yourself on this nomination from a risk management peer.In order to proceed with the selection process please complete the attached form and returned to my attention by insert date. Should you not wish to accept this nomination please respond in writing as such. Please send your correspondence to:Insert informationThank you for your continued membership and contribution to KSHRM.Respectfully,Insert name, Chair, Nominating CommitteeVersion 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesExample 6 Nominating Committee KENTUCKY SOCIETY FOR HEALTHCARE RISK MANAGEMENT RISK MANAGER OF THE YEAR SELECTION CRITERIAName of Nominee______Organization______I. ACADEMIC CREDENTIALSCOLLEGE EDUCATION (Use Highest Degree Obtained; Maximum of 10 Points)______Master’s/Doctoral Degree 10 Points ______Bachelor’s Degree 8 Points ______Associate’s Degree 6 Points ______Diploma 4 PointsCERTIFICATION (Check all that apply)______Certified Professional Healthcare Risk Manager 4 Points ______ASHRM Healthcare Risk Management Program 4 Points ______Associate in Risk Management 4 Points ______Associate in Claims/Adjuster License 4 Points ______Associate in Loss Control Management 4 Points ______Certified Professional in Healthcare Quality 4 Points ______Chartered Property Casualty Underwriter 4 Points ______Certified Infection Control 4 Points ______Certified Case Manager 4 Points ______Other Certification Exam (please explain) 4 PointsPROFESSIONAL RECOGNITION (Maximum of 6 Points)*______Diplomate of ASHRM 6 PointsVersion 2 2014 Kentucky Society for Healthcare Risk Management Guidelines______Fellow of ASHRM 4 PointsII. CONTINUING EDUCATION IN HEALTHCARE (Within 1 year; maximum of 8 points)*______More than 30 hours 8 Points ______21-30 hours 6 Points ______11-20 hours 4 Points ______Less than 10 hours 2 Points* Send evidence of accomplishmentsIII. EMPLOYMENT EXPERIENCE (Maximum of 14 Points)RISK MANAGEMENT EXPERIENCE______More than 10 years 8 Points ______5-10 years 6 Points ______Less than 5 years 4 PointsHEALTHCARE EXPERIENCE______More than 10 years 6 Points ______5-10 years 4 Points ______Less than 5 years 2 PointsIV. CONTRIBUTING TO THE FIELD (Check all that apply within 1 yr)KSHRM (Kentucky Society for Healthcare Risk Management)______Board Member 6 Points ______Committee Member 4 Points ______Current Member 2 PointsASHRM (American Society for Healthcare Risk Management)______Committee/Board Member 4 Points ______Current Member 2 PointsPUBLICATIONS* (Provide Titles/Dates of Publications)______ASHRM Journal article 10 Points ______KSHRM Newsletter article 10 Points ______Healthcare/Risk Insurance Publication 2 PointsVersion 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesPRESENTATION/LECTURES* (Within 1 year) (Exclude job related orientation/inservice, audience other than members of own organization)______College Courses (per hour) 8 Points ______National programs (per hour) 6 Points ______KSHRM Programs or statewide program (per hour) 4 Points ______Local program (per hour) 2 Points ______Membership referrals to KSHRM 2 PointsTOTAL POINTS ______Example 7 Nominating CommitteeTo: KSHRM Members, Active StatusFrom: KSHRM Secretary Date:Re: Elections – BallotElections for the KSHRM Board of Directors and Officers are underway. Enclosed you will find the official ballot that was prepared by the Nominating Committee to elect the President-Elect, Secretary/Treasurer and insert number of Board Member.Biographies prepared by the candidates are included to assist you with your selections. These individuals will serve the membership under the guidance of President and Past-President .According to KSHRM Bylaws, only members with active status are eligible to vote. Please complete the ballot, date it, and return to , KSHRM Secretary/. . Results of the election will be announced at the Annual Membership Meeting on .Thank you for your participation. Should you have any questions please contact at Version 2 2014 Kentucky Society for Healthcare Risk Management Guidelines.Example 8 Nominating KSHRM ELECTION BALLOT Committee INSERT YEARSelect one candidate in each category. Return no later than insert datePRESIDENT ELECT____________SECRETARY/TREASURER______ONE YEAR BOARD MEMBER__________________TWO YEAR BOARD MEMBER__________________Version 2 2014 Kentucky Society for Healthcare Risk Management GuidelinesTHREE YEAR BOARD MEMBER__________________Version 2 2014

Kentucky Society for Healthcare Risk Management

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