1. Title Team members (do not include initials or professional affiliation after your names)

2. Background Information No more than 5 or 6 bullet points, no less than 24-point font Identify key structural aspects of the case (hospital, people, mission, values) –What is it about this institution that is important to know and share?

3. Diagram of Analysis of Case Use a process diagram, deployment flow diagram, or a cause and effect diagram Templates available on next 2 slides For process diagrams, use the “flowchart” items in the “Autoshapes” menu –These are very helpful. –Connect boxes with “connectors” in the “Autoshapes” menu

5. Use four of these terms to label the main branches of the diagram:  People  Processes  Policy  Methods  Materials  Environmental Factors Cause-Effect Diagram In this box, write a focused description of the problem under evaluation.

6. Root Cause Statement Name 1 or 2 root causes No blame! Focus on the system issues.

7. Recommendations 2-3 recommendations Be clear about what could be done to prevent this adverse event from occurring in the future Consider how you will measure whether this is successful?