2010 - Q4

Texas Health Care Quality Improvement Award

Quarterly Process Improvement Plan
2010 - Q4

6 digit Medicare Provider Number:
Hospital Name:
Campus:	If you share a provider number with other campuses, specify a location.



Person submitting form (you)
Your name:
Your phone:	Phone number should include area code: xxx-xxx-xxxx
Your E-mail:
Re-enter E-mail:

Area for improvement - Specifically what you are trying to improve. Include targets /goals.

Actions required - Initiative type (new process, redesign of existing system) and implementation strategy (methods to enhance adherence, compliance, repercussions of noncompliance).

Timeframe for completion - When will it be done?

Responsible parties - Who will do it? Department heads, team leaders, specific teams, etc.

Support/Resources - Administrative, physician, nursing leadership, physician champion(s), etc.

Evaluation of our progress - Uses of data, reports providing current process, benchmarking, comparison with peers, etc.

By submitting this PIP, I am agreeing to share the information that I have documented with other hospitals in the program to promote quality improvement efforts. I understand that no self-identifiable information will be included.

Please review the information you have entered.
Once you click the "Submit Q4 2010 PIP" button, you will not be able to view or change your application. Please be sure that all contact information is correct. You will receive an e-mail with the status of your application within 3 business days of successful submission.

For questions, contact Linda Martinez, RN, BSN at 866-439-5863
or send e-mail to: PatientSafety@tmf.org