Worksheet for Testing Change Privileged & Confidential work product of the QAA Committee.

What is the aim or purpose of the cycle? 1. What are we trying to accomplish?

2. How will we know when a change is an improvement?

3. What change can we make that will result in improvement?

Plan What is your next test of change? Test Population? When to be done?

List the tasks needed to set up this test of change. Who is responsible? When to be done?

1.

2.

3.

4.

Predict what will happen when the test is carried out. Measures to determine if prediction succeeds.

Do Describe what happened when you ran the test: • What was actually done?

• Measured results:

• Observations:

Study Review and summarize the measured results and observations, and compare data to predictions:

Act Determine next steps (e.g. modify idea and retest {AdApt}, spread idea {AdOpt}, test new idea {Abandon this idea})

Act Plan

Study Do

This material was prepared by TMF Health Quality Institute, the Medicare Quality Improvement Organization for Texas, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-TX-C7-12-127