Quality Project/ Activity Summary Report Title of Project: Project: Division/Area Reporting: Date: Lead Staff: Initial report to QC Date: Complete Date: Overall Objective for Report back to QC Date(s): QI or larger scope process Method Utilized: improvement QI (single program or smaller scope process improvement) QP (new process/service design) Analysis If QI: What root causes were identified? If OP: What key customer needs were identified? Summary: Flow Qualitative Survey Analysis tools 05s Charts Utilized: BPA/ Work Flow Affinity Diagram Pareto Analysis Customer Needs (Check all that apply} Diagram Matrix Other: Histogram Benchmarking Cause-Effect Diagrams Data Other: Collection Matrix Other: Change Briefly describe changes made and how they address either identified root causes or customer needs: Summary: Measure #1 Measure#2 Measure#3 Statement of measure: %, (A number, count, average) (e.g. Percent of high risk pregnant women 1'1 with prenatal visit in trimester) Target Population: (e.g. All pregnant women) Numerator: if (Fill this out your measure is a %} (e.g.# high risk pregnant with 151 trimester prenatal visit) Denominator: if (Fill this out your measure is a %) (e.g. of high risk pregnant women # Source of data: (e.g. Clinic visit records) Baseline: (e.g. 85%) Target or Goal: ( e.g. 90%)
Quality Project/ Activity Summary Report Title of Project: Division/Area Reporting: Date: Initial report to QC Date: Overall Objective for Project: Lead Staff: Complete Date: Report back to QC Date(s): Method Utilized: QI or larger scope process improvement QI (single program or smaller scope process improvement) QP (new process/service design) Analysis Summary: If QI: What root causes were identified? If OP: What key customer needs were identified? Analysis tools Utilized: (Check all that apply} Flow Charts Pareto Diagram Histogram Cause-Effect Diagrams Data Collection Matrix Other: 05s BPA/ Work Flow Analysis Other: Qualitative Survey Affinity Diagram Customer Needs Matrix Benchmarking Other: Change Summary: Briefly describe changes made and how they address either identified root causes or customer needs: Measure #1 Measure#2 Measure#3 Statement of measure: (A %, number, count, average) (e.g. Percent of high risk pregnant women with prenatal visit in 1'1 trimester) Target Population: (e.g. All pregnant women) Numerator: (Fill this out if your measure is a %} (e.g.# high risk pregnant with 151 trimester prenatal visit) Denominator: (Fill this out if your measure is a %) (e.g. # of high risk pregnant women Source of data: (e.g. Clinic visit records) Baseline: (e.g. 85%) Target or Goal: ( e.g. 90%)
Performance-management-plan-and-QI-plan.docx