1. Title
Author
Date

2. 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.

3. Process Map

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

5. Baseline Data
For a tutorial on how to insert a scatter plot in excel go to:

6. Alternative Example Baseline Data
For a tutorial on Hisograms go to the following link:

7. 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?

8. 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:
make-a-run-chart-in-excel-cfhi-tutorials-en.pdf?sfvrsn=2
PDSA 1

9. 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?

10. PDSA 2 Data Display
For a tutorial on Control Charts go to the following link:

11. 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?

12. PDSA 3 Data Display
For a tutorial on Control Charts go to the following link:

13. 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