Title Author Date

Problem Statement & SMART Aim Remember SMART Aims are: specific, measurable, attainable, relevant, and time-bound For Example: I am to run an average of 2 miles a week by December 2015.

Process Map

FISHBONE xx xx xx xx xx xx xx xx Effect xxxx xxxx XXX This is an optional slide xx xx xx XXX

Baseline Data For a tutorial on how to insert a scatter plot in excel go to: http://www.dummies.com/software/microsoft-office/excel/how-to-create-a-scatter-plot-in-excel/

Alternative Example Baseline Data For a tutorial on Hisograms go to the following link: https://support.office.com/en-us/article/Create-a-histogram-b6814e9e-5860-4113-ba51-e3a1b9ee1bbe

PDSA 1 Plan: The change you plan on making Do: make the change Change Concept – What change concept are you using? Do: make the change Study: Track the outcome of your change in these three categories. Outcome measures: The impact on the patient, the end result of doing things Process measures The things that you do (processes) and how systems are operating.  Balancing measures Whether unintended consequences have been introduced elsewhere in the system. Act: Based on results what have you learned? What will you keep or change based on these results?

PDSA 1 Data Display Include at least 1 data display for each PDSA Cycle. You must use a minimum of 2 different data displays during your presentation For a tutorial on Run Charts go to the following link: http://www.cfhi-fcass.ca/sf-docs/default-source/on-call/22-10-14-how-to- make-a-run-chart-in-excel-cfhi-tutorials-en.pdf?sfvrsn=2 PDSA 1

PDSA 2 Plan: The change you plan on making Do: make the change Change Concept – What change concept are you using? Do: make the change Study: Track the outcome of your change in these three categories. Outcome measures: The impact on the patient, the end result of doing things Process measures The things that you do (processes) and how systems are operating.  Balancing measures Whether unintended consequences have been introduced elsewhere in the system. Act: Based on results what have you learned? What will you keep or change based on these results?

PDSA 2 Data Display For a tutorial on Control Charts go to the following link: https://www.extendoffice.com/documents/excel/2429-excel-control-chart.html

PDSA 3 Plan: The change you plan on making Do: make the change Change Concept – What change concept are you using? Do: make the change Study: Track the outcome of your change in these three categories. Outcome measures: The impact on the patient, the end result of doing things Process measures The things that you do (processes) and how systems are operating.  Balancing measures Whether unintended consequences have been introduced elsewhere in the system. Act: Based on results what have you learned? What will you keep or change based on these results?

PDSA 3 Data Display For a tutorial on Control Charts go to the following link: https://www.extendoffice.com/documents/excel/2429-excel-control-chart.html

Conclusions & Actions to Hold Gains Overall conclusions from your PIP What will you continue, modify or stop? What did you learn? Plan for sustainability? Reflect on your learning