Quality Awards Program

MT Flex/PIN Quality Award Program – 2016-2017 Criteria

Hospitals must meet all criteria during the grant year to qualify. The grant year is September 1 – August 31. By meeting the criteria listed below your hospital demonstrates leadership, community, willingness to share with peers and a commitment to improvement.

MT Flex Grant Quality Award Criteria for 2016-2017

 CAH MBQIP Project Submission Form

2015-2016 MT Flex/PIN Quality Award Recipients

Criteria #1: Performance Improvement

Hospital must submit baseline and remeasurement data, and show improvement by any means listed below. Estimated project launch and completion dates are in parenthesis. Plan accordingly; dates may not fall in the same grant year.

  • Flex QIS: Flu Immunizations for Health Care Workers (Sep-16/May-17)
  • Flex QIS: EDTC Project (Apr-17/Aug-17)
  • CAH MBQIP Project: The CAH may submit a project that is not guided by the Flex Grant. The CAH must provide baseline and remeasurement data showing improvement and a description of the project and interventions. Any improvement must be made during the grant year. Submit form to Jennifer.wagner@mtha.org by August 5, 2017.

Criteria #2: Data Reporting

Hospital must meet data reporting requirements for both MBQIP and the PIN Benchmarking.

  • MBQIP: Submit each required measure in at least three of the four MBQIP domains for cases from Q3-16 and Q4-16.
  • PIN Benchmarking: All core measure (1-26) data for Q3-16 through Q2-17.

Criteria #3: Engagement with MT CAHs

Hospitals must attend/complete two or more of the following networking and cohort opportunities. Plan accordingly; dates may not fall in the same grant year. See Looking Ahead to identify projects that will be considered for 17-18 Grant Year Awards.

  • DON/QIC Regional Meetings (October 2016)
  • Flex Aligned Sessions – MHA Health Summit (March 2017)
  • Finance/Operational Days in AR Cohort 2016 (Jun-16/Jan-17)
  • Trauma PI Project 2016 (May-16/Dec-16)
  • M2O: HCAHPS Care Transitions (Apr-16/Jan-17)
  • M2O: Outpatient ED Throughput Project (Jan-17/May-17)
  • Finance/Operational Rev. Cycle Management Cohort 2017 (Apr-17/Aug-17)
  • Trauma PI Project 2017 (Apr-17/Aug-17)

Criteria #4: Project Circulation

Hospital must share one improvement project with other PIN members by any of the following means:

    • Present at Flex Regional DON/QIC Meeting or MHA Health Summit
    • Submit an article related to performance improvement to the PIN Quarterly Newsletter (send to Jennifer.wagner@mtha.org).
    • Share Lean project summaries/resources and high performing skills/resources on the PIN Website (send to Jennifer.wagner@mtha.org).
    • Flex/PIN hosted statewide webinars


  • For PIN activities between September 1, 2015 and August 31, 2016.
  • Must meet all six (6) criteria.
  • No application is needed.   Flex will track participation and award those hospitals that meet above criteria.  A mid-year report card will be distributed to CAH CEOs, DONs, and QICs.


  • Announced at the MHA Annual Convention General Session (reserved seating available).
  • Plaque with facility name, date, and improvement category.  Plaques will be distributed at the QIC/DON Regional Meetings held in October.  Pictures will be taken at this time
  • Recognition in the PIN Newsletter and PIN Website.
  • Press kit, press release, and photos take at the Regional Meetings will be provided for hospital marketing

LOOKING AHEAD                                                                                                          

Some projects may launch during the 2016-2017 grant year, but will be tied to award eligibility for 2017-2018.   Watch Flex Grant correspondence and plan accordingly so you don’t miss a chance to complete criteria.

    • QIS: HCAHPS Communication Project – Using L.E.A.D (Apr-17/Oct-17)
    • QIS: Flu Immunizations for Inpatients (Jul-17/May-18)
    • QIS: Flu Immunizations for Health Care Workers (Sep-17/May-18)


Contact Jennifer Wagner at Jennifer.wagner@mtha.org or 406-457-8000.

MBQIP Required Measures:

EDTC 1-8 Seven sub-measures and EDTC-All
OP-1 Median time to Fibrinolysis
OP-2 Fibrinolytic therapy received within 30 minutes
OP-3b Median Time to Transfer to another Facility for ACI
OP-4 Aspirin on Arrival (dependent measure)
OP-5 Median time to ECG
OP-18 ED Arrival to Departure time (dependent measure)
OP-20 ED Throughput: Door to diagnostic eval by QMP
OP-21 ED Throughput: Median time to pain mgmt for long bone fx
OP-27 HCW Flu Immunization or enroll in NHSN and user group!
IMM-2 Eligible Inpatient Influenza Immunization
HCAHPS HCAHPS responses through a certified Vendor