iPOP-UP Learning Collaborative PDSA & Team Meeting #3 Form

Question Title

1. Please provide your practice name: (Required.)

Question Title

2. Please provide your last name: (Required.)

Question Title

3. Now, please report on your local team meeting. Please report the date, the team members who attended, if your team reviewed data reports together, and a very brief description (i.e., phrase or sentence) of the topics discussed. (Required.)

Date (mm/dd/yy)

Attendee Names and Roles (PCC, MA, Nursing staff, Nursing/Office manager)

Team Review of Data Reports (Yes or No)

Brief Description of Topics Discussed

Question Title

4. Please describe your test of change. (Required.)

Rationale (Why are you testing this change. e.g., awareness of specific need, opportunity, etc.?)

Plan (What specific type of change will you test? e.g., workflow or process change, new tool or resource, staff training, etc.?)

Do (Who will do what, when, and how?)

Study (What information will you collect to know if the change worked?)

Prediction (What do you predict will happen?)

Question Title

5. Are there any particular issues or topics you would like to have discussed during a webinar (or directly with project leaders/staff)?

Question Title

6. Please share any additional comments or suggestions.