Reflection on Excellence form

This online form is designed for you to document reflections on an episode of excellence. Once the form is completed, you can choose to receive a copy of your reflections by email.

Reflection on Excellence

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Describe the excellence you wish to reflect on (please be careful not to include any patient identifying information):

What was particularly good?

How did it feel to be involved / to witness this episode?

How could this excellence be re-created / amplified?

What will you do differently as a result of this reflection?

If you wish to receive a copy of your responses in this form, please enter your email address here. (Check your spam/junk folder if you don't receive a copy).

Confirm that you are human, and there are no patient identifiers in this report *

Learning from Excellence

A call to learn from what goes well in healthcare

Reflection on Excellence form