1. VETERANS HEALTH ADMINISTRATION Insert Site Logo Insert Organization Name/Logo Team Report Out Date: Project Name: Project Origin: Process Owner: Team Members: Metrics or Deliverables: Metric/Deliverable 1 Metric/Deliverable 2

2. VETERANS HEALTH ADMINISTRATION Insert Site Logo Insert Organization Name/Logo Aim - 1. Reason For Improvement Problem Statement: Scope: Trigger:  Process Start:  Process Stop:

3. VETERANS HEALTH ADMINISTRATION Insert Site Logo Insert Organization Name/Logo Map - 2. Current State

4. VETERANS HEALTH ADMINISTRATION Insert Site Logo Insert Organization Name/Logo Map - 3. Target State Ideal or Target State Process Map Targets/Goals/AIM Statement

5. VETERANS HEALTH ADMINISTRATION Insert Site Logo Insert Organization Name/Logo Measure - 4. Gap Analysis Current State versus Target State Waste difference Metrics comparison Process step comparison Gap Analysis Tools Used Root Cause(s)

6. VETERANS HEALTH ADMINISTRATION Insert Site Logo Insert Organization Name/Logo Measure - 5. Solution Approach If we do this…then we will achieve this….. Effect on Metric 1Effect on Metric 2Effect on Metric 3

7. VETERANS HEALTH ADMINISTRATION Insert Site Logo Insert Organization Name/Logo Change - 6. Rapid Experiments DescriptionWhoHypothesisActualBenefit

8. VETERANS HEALTH ADMINISTRATION Insert Site Logo Insert Organization Name/Logo Change - 7. Completion Plan DescriptionWhoWhen% completed% Sustained

9. VETERANS HEALTH ADMINISTRATION Insert Site Logo Insert Organization Name/Logo Sustain - 8. Confirmed State MetricBaselineGoalActual Countermeasures Fill in when needed in sustainment phase Baseline or below Above Baseline, trending to goal Goal or better

10. VETERANS HEALTH ADMINISTRATION Insert Site Logo Insert Organization Name/Logo Sustain - 9. Insights What went well? What did not go well? Lessons Learned