FOCUS PDCA Template Dr Arjaty
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……………………. HOSPITAL IDENTIFICATION AND TRACKING SHEET POTENTIAL OPPORTUNITY FOR IMPROVEMENT PERFORMANCE
Dept./Unit/: ___________________ (Manager keep original and send copy to Dept Head and to Quality Mgt.)
Date: __________________________________ Initiated by: ________________________________________
NoHow do you know this is
an opportunity for improvement?
What is the concern or opportunity for improvement?
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IDENTIFICATION AND TRACKING SHEET POTENTIAL OPPORTUNITY FOR IMPROVEMENT PERFORMANCE
Dept./Unit/: ___________________ (Manager keep original and send copy to Dept Head and to Quality Mgt.)
Date: __________________________________ Initiated by: ________________________________________
How does this (or could this) affect consumer
care?
What are the possible causes or sources of
the situation?
What action(s) could be taken, and by whom to resolve the concern or improve care/services?
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QUALITY IMPROVEMENT PROJECT WORKSHEET
PROJECT TITLE :TEAM LEADERTEAM MEMBER :
WHO WILL BENEFIT : PATIENTS/ CLIENTS/ FAMILY / STFF
PROBLEM / OPPORTUNITY STATEMENT(WHAT'S WRONG WITH QUALITY ?)
AIM :(WHAT ARE WE TRYING TO ACCOMPLISH?)SMART : (TARGET & TIME)
MEASURE :STRUCTURE MEASURES :PROCESS MEASURES :OUTCOME MEASURES :
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FLOW CHART
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FISHBONE DIAGRAM
Number of Main Causes: 6
‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗ ‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗Methods Manpower
‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾╗ ╗
╗ ╗╗ ……… ╗ ………………
╗ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾ ╗ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾╗ ╗
╗ ……… ╗ …………..╗ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾ ╗ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾
╗ ╗╗ …………… ╗ …………..
╗ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾ ╗ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾
╝ ╝╝ ……………. ╝ ……………..
╝ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾ ╝ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾╝ ╝
╝ …………. ╝ ……………..╝ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾ ╝ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾
╝ ╝╝ ……………. ╝ …………
╝ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾ ╝ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾╝ ╝
‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗ ‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗Environment Machines
‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾
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FISHBONE DIAGRAM
‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗
‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾╗
╗╗
╗ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾╗
╗╗ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾
╗╗
╗ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾
╝╝ ………….
╝ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾╝
╝ ……………╝ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾
╝╝ ………….
╝ ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾╝
‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗‗Material
‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾
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╗
╝
##################
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Causes
Criteria
Reputation
Acceptance
Total Score
SKOR
SEVERITY
Impact on patient
Time Needed
PROBABILITY
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© 2009 Vertex42 LLC Templates by Vertex42.com
Pareto Analysis
[Brief Project Description][Date]
[42]
The first 9 Causes cover 84.42% of the Total Defects
Cumulative Percentage Cutoff: 80%
# Causes Defects Cumulative%1 Less number of experience and special den 20 13.0%2 No Policy 18 24.7%3 Finish patient one by one 16 35.1%4 Material not available 16 45.5%5 Short of experience Technicians 14 54.5%6 Increase Load of Patients 14 63.6%7 Space for lab not enough. 12 71.4%8 Low Encouraged Culture 10 77.9%9 No Computer available to save data 10 84.4%
10 Not Fixed one responsible on waiting list 8 89.6%11 Patient not came in his appointment 6 93.5%12 Waiting list not accurate because hand writ 6 97.4%13 Patient Late more than three times 4 100.0%14 100.0%15 100.0%
0
5
10
15
20
25
0%
20%
40%
60%
80%
100%
[Chart Title]
Vital Few Useful Many Cumulative% Cut Off %
Causes
De
fec
ts
Cum
ulat
ive
%
[42]
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ACTION PLAN TOOL
WHAT WHO WHENACTION 1
ACTION 2
ACTION 3
ACTION 4
……
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WHERE
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Gantt Chart Version 1.7.3 © 2006-2012 Vertex42 LLC
[Project Name][Company Name] Today's Date:
Project Lead: [Name]
Start Date: 1/2/2012 Monday
[42]
WBS Tasks Start End Dur
ation
(Day
s)
% C
ompl
ete
1 Task Category 1 [Name] 1/2/12 1/31/12 30 0%
1.1 Sub Task level 2 1/2/12 1/6/12 5 0%
1.2 Sub Task level 2 1/7/12 1/11/12 5 0%
1.2.1 Sub Task level 3 1/12/12 1/16/12 5 0%
1.2.2 Sub Task level 3 1/17/12 1/21/12 5 0%
1.3 Sub Task level 2 1/22/12 1/26/12 5 0%
1.4 Sub Task level 2 1/27/12 1/31/12 5 0%
2 Task Category 2 [Name] 1/2/12 1/27/12 26 25%
2.1 Sub Task level 2 1/2/12 1/6/12 5 25%
2.2 Sub Task level 2 1/9/12 1/13/12 5 25%
2.3 Sub Task level 2 1/16/12 1/20/12 5 25%
2.4 Sub Task level 2 1/23/12 1/27/12 5 25%
3 Task Category 3 [Name] 1/2/12 1/28/12 27 50%
3.1 Sub Task level 2 1/2/12 1/7/12 6 50%
3.2 Sub Task level 2 1/9/12 1/14/12 6 50%
3.3 Sub Task level 2 1/16/12 1/21/12 6 50%
3.4 Sub Task level 2 1/23/12 1/28/12 6 50%
4 Task Category 4 [Name] 1/2/12 1/21/12 20 0%
4.1 Sub Task level 2 1/2/12 1/6/12 5 0%
4.2 Sub Task level 2 1/7/12 1/11/12 5 0%
4.3 Sub Task level 2 1/12/12 1/16/12 5 0%
4.4 Sub Task level 2 1/17/12 1/21/12 5 0%
1 Task Category 1 1/5/09 1/5/09 1 0%
1.1 Sub Task level 2 1/5/09 1/5/09 1 0%
1.1.1 Level 3 Task 1/5/09 1/5/09 1 0%
TaskLead
TEMPLATE ROWS: Copy and insert the entire section, or just the specific sub tasks, depending on which level you want to use (formulas are different for different WBS levels)
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1.1.1.1 Level 4 task 1/5/09 1/5/09 1 0%
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© 2006-2012 Vertex42 LLC 0
2/24/2009 Tuesday
(vertical red line)
First Day of Week (Mon=2): 2 1/2/2012 1/9/2012### 1/16/2012
Wor
king
Day
s
Day
s Co
mpl
ete
Day
s Re
mai
ning
02 -
Jan
- 1
2
09 -
Jan
- 1
2
16 -
Jan
- 1
2
22 0 30
5 0 5
3 0 5
3 0 5
4 0 5
4 0 5
3 0 5
20 6 20
5 1 4
5 1 4
5 1 4
5 1 4
20 13 14
5 3 3
5 3 3
5 3 3
5 3 3
15 0 20
5 0 5
3 0 5
3 0 5
4 0 5
1 0 1
1 0 1
1 0 1
HELP
Copy and insert the entire section, or just the specific sub tasks, depending on which level you want to use (formulas are different for different WBS levels)
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1 0 1
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1/17/2012 1/18/2012 1/19/2012 1/20/2012 1/21/2012 1/22/2012 1/23/2012
16 -
Jan
- 1
2
23 -
Jan
- 1
2
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1/24/2012 1/25/2012 1/26/2012 1/27/2012 1/28/2012 1/29/2012 1/30/2012
23 -
Jan
- 1
2
30 -
Jan
- 1
2
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1/31/2012 2/1/2012 2/2/2012 2/3/2012 2/4/2012 2/5/2012 2/6/2012
30 -
Jan
- 1
2
06 -
Feb
- 1
2
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2/7/2012 2/8/2012 2/9/2012 2/10/2012 2/11/2012 2/12/2012 2/13/2012
06 -
Feb
- 1
2
13 -
Feb
- 1
2
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2/14/2012 2/15/2012 2/16/2012 2/17/2012 2/18/2012 2/19/2012 2/20/2012
13 -
Feb
- 1
2
20 -
Feb
- 1
2
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2/21/2012 2/22/2012 2/23/2012 2/24/2012 2/25/2012 2/26/2012 2/27/2012
20 -
Feb
- 1
2
27 -
Feb
- 1
2
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2/28/2012 2/29/2012 3/1/2012 3/2/2012 3/3/2012 3/4/2012 3/5/2012
27 -
Feb
- 1
2
05 -
Mar
- 1
2
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3/6/2012 3/7/2012 3/8/2012 3/9/2012 3/10/2012 3/11/2012 3/12/2012
05 -
Mar
- 1
2
12 -
Mar
- 1
2
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3/13/2012 3/14/2012 3/15/2012 3/16/2012 3/17/2012 3/18/2012 3/19/2012
12 -
Mar
- 1
2
19 -
Mar
- 1
2
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3/20/2012 3/21/2012 3/22/2012 3/23/2012 3/24/2012 3/25/2012 3/26/2012
19 -
Mar
- 1
2
26 -
Mar
- 1
2
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3/27/2012 3/28/2012 3/29/2012 3/30/2012 3/31/2012 4/1/2012 4/2/2012
26 -
Mar
- 1
2
02 -
Apr
- 1
2
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4/3/2012 4/4/2012 4/5/2012 4/6/2012 4/7/2012 4/8/2012 4/9/2012
02 -
Apr
- 1
2
09 -
Apr
- 1
2
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4/10/2012 4/11/2012 4/12/2012 4/13/2012 4/14/2012 4/15/2012 4/16/2012
09 -
Apr
- 1
2
16 -
Apr
- 1
2
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4/17/2012 4/18/2012 4/19/2012 4/20/2012 4/21/2012 4/22/2012 4/23/2012
16 -
Apr
- 1
2
23 -
Apr
- 1
2
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4/24/2012 4/25/2012 4/26/2012 4/27/2012 4/28/2012 4/29/2012 4/30/2012
23 -
Apr
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Apr
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5/1/2012 5/2/2012 5/3/2012 5/4/2012 5/5/2012 5/6/2012 5/7/2012
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Apr
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07 -
May
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5/8/2012 5/9/2012 5/10/2012 5/11/2012 5/12/2012 5/13/2012 5/14/2012
07 -
May
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2
14 -
May
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2
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5/15/2012 5/16/2012 5/17/2012 5/18/2012 5/19/2012 5/20/2012 5/21/2012
14 -
May
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2
21 -
May
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2
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5/22/2012 5/23/2012 5/24/2012 5/25/2012 5/26/2012 5/27/2012 5/28/2012
21 -
May
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2
28 -
May
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2
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5/29/2012 5/30/2012 5/31/2012 6/1/2012 6/2/2012 6/3/2012 6/4/2012
28 -
May
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04 -
Jun
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6/5/2012 6/6/2012 6/7/2012 6/8/2012 6/9/2012 6/10/2012 6/11/2012
04 -
Jun
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11 -
Jun
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6/12/2012 6/13/2012 6/14/2012 6/15/2012 6/16/2012 6/17/2012 6/18/2012
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Jun
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Jun
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6/19/2012 6/20/2012 6/21/2012 6/22/2012 6/23/2012 6/24/2012 6/25/2012
18 -
Jun
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2
25 -
Jun
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2
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6/26/2012 6/27/2012 6/28/2012 6/29/2012 6/30/2012 7/1/2012 7/2/2012
25 -
Jun
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02 -
Jul
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7/3/2012 7/4/2012 7/5/2012 7/6/2012 7/7/2012 7/8/2012 7/9/2012
02 -
Jul
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2
09 -
Jul
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7/10/2012 7/11/2012 7/12/2012 7/13/2012 7/14/2012 7/15/2012 7/16/2012
09 -
Jul
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2
16 -
Jul
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7/17/2012 7/18/2012 7/19/2012 7/20/2012 7/21/2012 7/22/2012 7/23/2012
16 -
Jul
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Jul
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7/24/2012 7/25/2012 7/26/2012 7/27/2012 7/28/2012 7/29/2012 7/30/2012
23 -
Jul
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Jul
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7/31/2012 8/1/2012 8/2/2012 8/3/2012 8/4/2012 8/5/2012 8/6/2012
30 -
Jul
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06 -
Aug
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8/7/2012 8/8/2012 8/9/2012 8/10/2012 8/11/2012 8/12/2012 8/13/2012
06 -
Aug
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13 -
Aug
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2
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8/14/2012 8/15/2012 8/16/2012 8/17/2012 8/18/2012 8/19/2012 8/20/2012
13 -
Aug
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Aug
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8/21/2012 8/22/2012 8/23/2012 8/24/2012 8/25/2012 8/26/2012
20 -
Aug
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2
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Graphs of Key Measures Put Your Center Name Here
LATIHAN SOAL ENTRI DATA INDIKATOR
Month %
Pemeriksaan Kritis Waktu pelaporan 100Jan #N/A 100 80.0 100feb #N/A 50.0 100maret #N/A 80 90.0 100april #N/A 90 45.0 100mei #N/A 100juni #N/A 100juli #N/A 100agustus #N/A 100september #N/A 100okt #N/A 100nov #N/A 100des #N/A 100
#N/A 100#N/A 100#N/A 100#N/A #DIV/0! 100
Pasien Baru (Denum)
Pengkajian Awal selesai dlm wkt 24 j
(Num)
Jumlah Pasien yg Melakukan Pemeriksaan
Kritis
Waktu Pelaporan Hasil
Kritis < 1 jam
Goal for % with
Notification w/in 1 hr
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Graphs of Key Measures Put Your Center Name Here
6060606060606060606060606060606060
Goal for Acknow-
ledgement Time