Performance Improvement Project Checklist
Performance Improvement Project Checklist
Implementation Range:
PLAN
Name
Approver of Decisions:
Priority Problem
a.
b.
c.
1
☐ Do RCA/5whys (Use Root cause analysis form – Annex B)
No Solution
a.
b.
c.
d.
e.
f.
g.
No Literature/Best practice
a.
b.
c.
7. ☐ Establish Goals
2
DO
1. ☐ Establish the action plan. - Include: implementation, education/notification and compliance monitoring plan (use the action plan form – Annex D)
2.
☐ Implement the action plan.
CHECK
Numerator:
Denominator:
Compliance Rate:
Analysis:
☐ Yes – go to ACT
ACT
☐ Sustained?
☐ Yes – go to Standardize
3
Annex A
Problem Prone/ Poor Important to Customer Staff/Doctor High Cost from Feasibility of Data Regulatory
Opportunity High Risk/ Safety High Volume
Outcome Mission Satisfaction Satisfaction Failure Collection Requirement Score
(weight) (10) (8)
(9) (7) (6) (6) (4) (5) (7)
1 – Low Risk
High Risk Issue ( Safety to staff and patient) 10 3 – Medium Risk
5 – High Risk
1 – Low Volume
High Volume Issue 8 3 – Medium Volume
5 – High Volume
1 – Low
Problem Prone or Poor Outcome 9 3 – Medium
5 – High
1
3 – Moderately related
5 – Directly related
1 – Low
Customer Satisfaction 6 3 – Moderate
5 – High
1 – Low
Staff/Doctor Satisfaction 6 3 – Moderate
5 – High
1 – Low
High cost from Failure 4 3 – Medium
5 – High
1 – Not/Barely significant
2
Annex B
ROOT CAUSE ANALYSIS TOOL
Project name:
Project owner:
Preference number:
PROBLEM:
Manpower Material
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
+ why? + why?
3
+ why? + why?
+ why? + why?
Environment
- Proximate cause 1:
+ why?
+ why?
+ why?
+ why?
+ why?
- Proximate cause 2:
+ why?
+ why?
+ why?
+ why?
+ why?
4
Machinery Manpower Method
Problem:
Environment Material
5
Annex C
MEASURE PROFILE
1.
Measure Name:
2.
Data collection done by:
3.
Method of Data Collection (Retrospective or Concurrent):
4.
Type of Measurement (Process Measure or Outcome Measure):
5.
Rationale:
Excluded population:
6.
Data Collection Method Source of Data:
Sampling methods:
Sample Size:
Data to be computed:
Measure Unit:
Formula:
Numerator:
x 100
Denominator:
8.
Frequency Assessment: weekly
9.
Target/Goal:
10.
Data Aggregation and Analysis Plan Explanation:
11.
Benchmark value (if available, and precise source):
12.
Department or committee responsible:
13.
Departments, services, commitees, or individuals receiving reports/report cycle :
14.
Validation data:
15.
References:
Annex D
PERFORMANCE IMPROVEMENT PROJECT
6
ACTION PLAN
Project’s name:
Project’s owner:
Preference number: