Quality Improvement Initative

A. Give this Quality Improvement Initative a short Description:

 

B. Describe the goal of this initiative in 100 words or fewer:

 

C. Identify the Single AQIP Category which you feel this initiative will impact most:

 

D. Describe the process(es)/events/services/etc. that you feel this initiative will improve:

 

E. List the organizational areas - institutional deparments, programs, divisions, or units - most affected by or involved in this initiative:

 

F. Describe how you plan to monitor the net improvement created by this initiative:

 

G. Describe the Overall "outcome" measures or indicators that will tell you whether this initiative has been a success in achieving its goals

 

H. Who will be the chief contact person for this initiative?:

 

I. Is there a budget for this initiative?: YES NO

 

Where will the funding come from?
(Please list costs appropriately):
Labor Costs:
Materials Costs:
Postage Costs:
Travel Costs:
Other Costs:
TOTAL COST:

 

 

 

 

 

 

 

J. Signature:

 

Submitted by:
Initials:
Date: