Sample Quality Improvement Plan (Page 3 of 3) in pdf

Sample Quality Improvement Plan Page 3

Sample QI Team Project Description

Project title:

Submitted by:

Briefly identify or describe the program, project or process that should be addressed:

Project Identification:

a. How did you determine that this was an issue for your health department?

b. Did you use a method to prioritize this issue? Yes ___ No ___ If yes, please describe the method used.

c. What resources and support will be needed to complete the project?

What are we trying to accomplish? (A brief goal statement)

How will we know that a change is an improvement? (These must be SMART objectives: Specific,

Measurable, Achievable, Realistic, and Time bound)

Long term:

Medium term:

Short term:

What changes can we make that will result in an improvement? (Initial hypotheses and description of data

needed to focus the project and the development of an intervention)

Who should be on this QI team?

Who should lead this QI team?

Developed by MarMason Consulting, November 2011

Sample Quality Improvement Plan Page 3