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INTERVENTION:

[Name of your agency]. Agency logo here. INTERVENTION:. PROBLEM/SITUATION [Describe the issue/problem that you hope to address by implementing the intervention]. KEY ACTION STEPS [list the key action steps that you will implement to achieve your aim]. Aim [Insert your aim statement here].

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INTERVENTION:

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  1. [Name of your agency] Agency logo here INTERVENTION: PROBLEM/SITUATION [Describe the issue/problem that you hope to address by implementing the intervention] • KEY ACTION STEPS • [list the key action steps that you will implement to achieve your aim] Aim [Insert your aim statement here] ANALYSIS [Describe what worked well and what didn’t, changes that you made along the way, things that you might do differently next time] • Process Measures • [list your process measures here] RESULTS/OUTCOMES [Indicate whether or not you achieved your aim and your measures. Describe your results.] Outcome Measure [insert your outcome measure here] LESSONS LEARNED [describe 2-3 key lessons that you learned through this QI process]

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