Action Plan Worksheet
Action Plan WorksheetINSTRUCTIONS:Discuss with your team some improvements you’d like to make specific to the High Leverage Changes listed in the table. Use the data from the Quality Improvement Change Assessment (QICA), current patient panel data, discussions with your coach and team, or observations you’ve made about how things currently work in your site to guide your discussion.High Leverage ChangesImprovements we want to make90-Day GoalMake it SMART: Specific, measureable, actionable, realistic and time-boundTestable IdeasEmbed Clinical EvidenceUtilize DataEstablish Quality Improvement ProcessList a few improvements that your team agrees on in the table.Choose one improvement for at least three of the High Leverage Changes and write a 90-day goal. Remember to write your goals in a SMART (specific, measurable, actionable, realistic, and time bound) format. In the final box, list a few ‘testable ideas’ that will help you get to your goal.High Leverage ChangesImprovements we want to make90-Day GoalMake it SMART: Specific, measureable, actionable, realistic and time-boundTestable IdeasIdentify at-risk PatientsDefine Roles & ResponsibilitiesDeepen Patient Self-Management SupportDevelop Robust Linkages ................
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