SFHN Quality Academy 2017: Title Team Member Names Background Activities - Analysis Results/Impact Current Conditions Further Analysis/Lessons Learned Activities - PDSAs/Countermeasures Cause/Barrier Countermeasures Who? When? Problem Statement Follow Up Cause/Barrier Further Actions Who? When? Targets/Goals

Diagram Photos Charts Process Map SFHN Quality Academy 2017: Title Team Member Names Background Activities - Analysis Results/Impact Summarize your impact on the problem. Did you achieve goal? Include charts, annotations, results from PDSAs Tips for Background: What are you talking about and why now? [See Session 2 Exercise] Internal: Link to org’s True North, mission, vision, values, strategy? External: Link external forces (policy, regulatory, community, etc)? What is the operational, business or historical context? What did your team do to understand the problem, breaking it up into smaller problems or root causes? Consider including fishbone diagram, 5 Why tree diagram, gemba observations, and data that stratifies or identifies top contributors in the form of pareto charts. [See Academy Session 3] Current Conditions Photos Charts Diagram Tips for Current Conditions: Where do things stand today? What is the current process? Data that you have a problem? Visualize and specify data with charts/graphs/maps Clearly define “the real problem,” and its scale and impact [See Academy Session 2] Further Analysis/Lessons Learned How have you further analyzed your problem? Lessons learned? How have you stratified the problem into relevant groups? What top contributors/causes need addressing now (5 Whys)? Activities - PDSAs/Countermeasures Process Map What did your team do to test change, linked to the specific root causes you identified in your analysis of the problem? What is your team’s story? Include activities from academy sessions, meetings, and from the gemba Consider including timelines, data, diagrams (e.g. process maps, fishbone diagrams), images, examples, etc Include examples of PDSAs, tools, interventions, etc Option: Include a table to summarize countermeasures implemented Problem Statement One, specific summary sentence, with measurable baseline, clear Impact on organization, and not countermeasure in disguise [See Academy Session 2] Follow Up Further Actions Who? When? What adjustments or changes need to be tested to address the top contributors or stratified groups you have identified? What will you do to ensure follow-up, continuous improvement, sustainability? Cause/Barrier Countermeasures Who? When? Targets/Goals Specific, measurable, achievable, relevant, time bound targets May include process metrics in addition to outcome metrics [See Academy Session 2]

SFHN Quality Academy 2017: Title Team Member Names Background Activities - Analysis Results/Impact Current Conditions Further Analysis/Lessons Learned Activities - PDSAs/Countermeasures Cause/Barrier Countermeasures Who? When? Problem Statement Follow Up Cause/Barrier Further Actions Who? When? Targets/Goals