Improvement Planning Worksheet

W-1

Improvement Planning Worksheet

Practice: Project title:

Current Team Members:

Date of this revision:

INSTRUCTIONS: After you make your first pass at roughing out your plan, revise it as you go, incorporating the ideas that emerge from the work of your team.

1. What problem or opportunity would you like to address?

a. In your current work situation, do you have any measures of the quality of your (and/or your team’s) performance that could serve as a basis for selecting an improvement target? _____ If yes, please describe:

b. What is your target for improvement? Please be as specific as possible even if you do not have measures of current performance.

2. Whom might you want to involve? (Include other members of the improvement team you hope to organize, potential collaborators and potential resource people.)

3. What data should we gather?

4. What might we do?

a. List several options for changes you might make that could help you achieve your target for improvement.

b. Of the options listed in your response to 4a, which intervention do you want to test first?

c. What barriers are you likely to encounter in this effort?

5. PDSA Plan

a. Preparation, implementation and monitoring notes:

b. What additional resources might you need in attempting this change

c. What measurement will you perform that will enable you to determine, if change occurs, whether it is an improvement, given your target? Please be specific as to how you will measure your progress.

6. Possible Next Steps: