1. Your Hospital’s Name Location Process Improvement: Name of your Improvement

2. Which Key Improvement Area How you identified the need What you did

3. Measures Measures tracked so far Include a graph or chart, if you have one

4. Testing How did you test and refine the change? What did you learn?

5. Implementation Summary of activity Key steps Scope of the improvement project Plans for further spread

6. Lessons Learned What went well with the project? What would you do differently next time?

7. Project team Names and roles of project team member Photo, if you want Who to contact for more information