Quality and Safety Project Idea Submission

Quality and Safety Project Idea Submission Form

The Children’s of Alabama Performance Improvement Department and the UAB Pediatric Residency QI Committee are excited to announce Quality Improvement Office Hours. QI coaches are available to those who are at any stage from beginning to publication of a QI Project. Expertise available include:

Developing a SMART aim
Collecting data through available data sources
Completing PDSA cycles
Utilizing QI tools such as key driver and fishbone diagrams
Creating run and control charts

HIPAA Note: Please ensure patient identity is protected with de-identified data

First Name

Last Name

Email Address

Project overview: Briefly describe your proposed project.

Project Goals: Describe your goals and/or include your AIM statement.

AIM statement: We will increase / decrease _________________________________ from_____________________to_____________ (outcome must be measurable) by:___________________ (end date)

Do you have Director/Supervisor support/approval?

Yes

Other…

If Other, please specify:

What is your plan to sustain this change?

Would this project be applicable outside of the target area?

Yes

If yes, with what modifications?

If no, explain why:

Any other information you would like to share about this project?

Submission Date:

I agree to the Terms and Conditions.

Terms and Conditions

Users are advised that the information submitted through this form may be transmitted over unsecured email and releases Children's of Alabama and its employees, agents, and subcontractors from all responsibility or liability for any claims or damages arising from the content of the Email Form or the transmission thereof. By selecting the "I agree to Terms and Conditions" checkbox user acknowledges these terms and conditions and consents to transmission of the form.

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Quality and Safety Project Idea Submission Form

HIPAA Note: Please ensure patient identity is protected with de-identified data

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