Foundations for Change 2017 Project Title Fellow Name Title/Dept Hospital Name City, State Date
Aim and Background Aim Background How much improvement? By when? For whom? Why this project and why now?
Measures Outcome Measures: Process Measures: Balance Measures: How is the system performing? What are the results? (Suggested 1-2) Process Measures: Are the parts or steps in the process or system performing as planned? (Suggested 3-5) Balance Measures: What happened to the system as we improve the outcome and process measures? (Suggested 1-2)
Driver Diagram Paste in your Driver Diagram
Change Ideas Please list the changes that you tested as part of this effort
Data Paste in your Run Chart(s)
Reflections Lessons Learned What were some of your key barriers and how did you overcome them? Lessons Learned What surprised you the most about this work? What advice do you have for others? Lessons Learned
Next Steps