Facilitation Tool: Goal to Action template Anticipated result: ____________________________________________________________________________________ Cycle 5: ____________________________________________________________________________ Long Term Goal: ________________________________________________________________________Short – term Goal: ________________________________________________________________________ Cycle 4: ____________________________________ ___________________________________________ Learning Cycle 3: _________________________________________ ________________________________________________ Cycle 2: : _______________________________________________ _______________________________________________________ Cycle 1: _____________________________________________________ ____________________________________________________________

Example: Goal to Action Anticipated result: Diabetes Flow Sheet used by all clinicians in the clinic within 3 months Cycle 5: Final version implemented across clinic within 2 months and guideline driven measures of care tracked. Long Term Goal: Improved Planned Care for patients with diabetes ______________________________________Short – term Goal: Implement a diabetes flow sheet to improve delivery of guideline-based care Cycle 4: V4 discussed at monthly all staff meeting and V5 tested with providers new to the process Learning Cycle 3: V3 test with 3 providers for one week with 30 patients. Data on number of care gaps addressed is tracked Cycle 2: : Revise flow sheet and test V2 with same provider on Thurs. Cycle 1: Download CDA diabetes flow sheet and test with one provider on Tuesday using all patients with diabetes coming in that day

Facilitation Tool: Multiple Goals Template Cycle 5: _________ Cycle 5: _________ Cycle 5: _______ Learning Cycle 4: ________ Cycle 4: ________ Cycle 4: _________ Learning Learning Cycle 3: _________ Cycle 3: _________ Cycle 3: _________ Cycle 2: _________ Cycle 2: _________ Cycle 2: _________ Cycle 1: _________ Cycle 1: _________ Cycle 1: _________

Example: Multiple Goals Goal 1: Increase foot exams Goal 2: Group Visits Goal 3: Self care goals Cycle 5: Implement protocol Cycle 5: Increase recruiting Cycle 5: Implement protocol Cycle 4: MA removes shoes/socks Cycle 4: Community resource added Cycle 4: Info in waiting room-RN sets BAP Learning Cycle 3: Remind MD about foot exam Cycle 3: Healer added Cycle 3: RN sets BAP end of visit Cycle 2: Sign in exam room Cycle 2: MD added when on site Cycle 2: MA sets BAP rooming pt. Cycle 1: Check-in reminder about socks/shoes Cycle 1: RN visit Cycle 1: MD sets BAP w/1 pt.

Facilitation Tool: Multiple PDSA Template Goal 1: __________________________________________________________ Cycle 5: _________ Cycle 5: _________ Cycle 5: ______ Learning Cycle 4: ________ Learning Cycle 4: _______ Learning Cycle 4: ________ Cycle 3: _________ Cycle 3: _________ Cycle 3: _________ Cycle 2: _________ Cycle 2: _________ Cycle 2: _________ Cycle 1: _________ Cycle 1: _________ Cycle 1: _________

Example: Multiple PDSAs Goal 1: Proactive Outreach to Targeted Populations Using Registry Cycle 5: Implement protocol Cycle 5: Multi med rec strategy implemented Cycle 5: 2 pronged care mgt strategy Cycle 4: MD calls non-responders Cycle 4: RN does med rec on phone Cycle 4: MD visits home bound Learning Learning Learning Cycle 3: RN calls lost to follow up Cycle 3: Pt. Re-scheduled if no meds Cycle 3: RN recruits pts at visit Cycle 2: MA calls lost to follow up Cycle 2: Front office calls to bring in meds Cycle 2: Letter to complex pts Cycle 1: Front office mails letter to lost to FU Cycle 1: Letter to bring in meds Cycle 1: Complex care risk identifier tested