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Project Planning Form

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Copyright © 2004 Institute for Healthcare Improvement Documentation Tools 1 Institute for Healthcare Improvement Boston, Massachusetts, USA Project Planning Form The Project Planning Form is a useful tool for planning an entire improvement project, including a listing of all of the changes that the team is testing, all of the Plan-Do-Study-Act (PDSA) cycles for each change, the person responsible for each test of change, and the timeframe for each test. The form allows a team to see at a glance the overall picture of the project. Use the Project Planning Form to help your team plan and keep track of an entire improvement project.

At the start of the project, state the aim and the goal of the project. List the changes you are testing, and the PDSA cycles for each change. Assign an individual responsibility for each change.

Estimate the time frame for each cycle. As the project continues, update the Project Planning Form. This tool contains: Project Planning Form Example Project Planning Form: Athsma Example Project Planning Form: Depression Copyright © 2004 Institute for Healthcare Improvement 2 Project Planning Form Project Planning Form Project / Team: Aim: Measure(s): Cycle No.

Change Tested Person(s) Responsible Week 1 2 3 4 5 6 ... more. less.

7 8 9 10 11 12 13 14 15 16 17 18 Copyright © 2004 Institute for Healthcare Improvement 3 Project Planning Form Example: Project Planning Form 3 Asthma Aim: To redesign our system of care for people with asthma to increase symptom free days by 30%, and increase patients on appropriate anti-inflammatory medication by 75% in pilot clinic and in 4 satellite clinics . Measures (goals): 60% of patients will report a significant increase in symptom free days; 90% of patients will have an asthma action plan on the chart, 90% of patients will use a form of self- management at home, and patient satisfaction with asthma care will increase by 25% Chronic Care Model Component: Self-management Support Cycle No. Change Tested Person(s) Responsible Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 1a Implement follow-up for all of Dr.<br><br> Martin 9s and Dr. Rowe 9s pts. Ken, Sue 1b * Teach Self management follow up to next clinics Sue 2a Implement Collaborative goal setting with all pts.<br><br> Dr. Smith 2b Modify process for collaborative goal setting and contracting and test for 5 patients Dr. Jones, Sue 2c Implement contracting for Dr.<br><br> Rowe 9s pts Sue 2d * Teach contracting to all other Clinic Physicians Clinic Director, Dr. Smith 3 * Expand use of Asthma Action Plan to all adult patients in Clinic B and C Sue, Clinic Director Copyright © 2004 Institute for Healthcare Improvement 4 Project Planning Form Example: Project Planning Form 3 Depression Aim: To redesign our system of care for people with depression to achieve a 30% increase in the proportion of patients experiencing a major improvement in depressive symptoms after 12 weeks, and a 25% increase in the number of patients continuing depression treatment at 12 weeks after initiation, in Medicine clinic and in three other primary care clinics (Family Practice, OB, Adolescent Med) Measures (goals): 75% of patients will have a structured diagnostic assessment, 80% of patients will have documented use of education materials, > 75% will have a follow-up assessment within 1st 8 weeks, and 60% of patients will have a 15 point decrease in PHQ-9 scores. Chronic Care Model Component: Practice Redesign Cycle No.<br><br> Change Tested Person(s) Responsible Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 1a Expand use of red flags and structured assessment to Family Practice clinic Rob, Dr. Johnson 1b * Assist with spread to other primary care clinics (OB, Adolescent Med) Rob 2a Implement active follow-up to all of Medicine Clinic. Lynn 2b Test active Follow- up in Family Practice Sandy, Rob 2c Implement follow-up in Family Practice Rob 2d * Assist w/ Spread: Teach process for active follow-up to other primary care clinics Lynn 3a Implement Same Day consults for Medicine and Family Practice Dr.<br><br> Smith 3b * Spread: Teach to Test and try Same Day consults in other primary care clinics Dr. Smith

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