Community Health Board Name

Health Departments within CHB

Optional – picture of locations and/or counties

• Could add text about agency/agencies overview – location, county population, how many health departments, etc.

Improvement Team Members• Who are your team members?– Names, titles, and roles – Team photo (optional, but photos are nice)-

MDH has team photos originally sent – would be happy to send them

PLAN

Problem Statement

Aim Statement

5

PLAN - Current Process

• Process map or list of the process• Information you have about the process• Any data collection you did about the current

process – check sheet examples, charts, surveys, etc.

6

PLAN - Root Cause Analysis

• Root Cause analysis – fishbone diagram, 5 why’s, etc.

7

PLAN - Improvement Theories

• Brainstorm list of change ideas• Prioritizing matrix of solutions if have• Improvement theories generated

8

DO - Tests of Change

– List any PDSA cycles you implemented– Data collected during DO

Study• What did you find as a result of the

PDSA’s–Any findings including charts, graphs,

check sheets, etc.

Act – Adapt, Adopt or Abandon

• What changes have you made as a result of your findings?– What did you adapt, adopt or Abandon of your

improvements?– List or provide pictures of the key improvements your

team made– List or provide pictures of your revised tools, forms, etc.

that you created – Include before and after photos– Include quotes from clients/staff about improvements

• What measurable results have you seen?– List them or show the graphs, charts, etc.

Key Learnings

• What are some of the lessons your team has learned by doing the QI process?−Aha moments−Challenges you overcame−Advice you would give to others

Future Plans

• What does your team plan to do next to spread and sustain QI?– Examples: Additional changes, ways to

involve more staff, new QI projects, training, performance management development, etc.