Republic of the Philippines

Department of Health
Regional Office I
MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER
City of Batac, Ilocos Norte
Trunk line 077-792-3144; Fax line 077-792-3133
e-mail address: [email protected]
“PHIC Accredited Health Care Provider”
“ISO 9001:2015 Certified”

CONTINUOUS QUALITY IMPROVEMENT

CY____

TITLE OF CQI OR ANY EYE CATCHING DESCRIPTION

OF THE STUDY

DEPARTMENT/SECTION/UNIT

PREPARED BY:

LIST THEIR NAMES HERE

AUTHORS

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 TABLE OF CONTENTS

PAGE

FRONT PAGE

TABLE OF CONTENTS

LIST OF TABLES

LIST OF FIGURES

FINAL APPROVAL SHEET

DEFINITION OF TERMS

ABSTRACT

INTRODUCTION OF THE STUDY

STEP I PROBLEM IDENTIFICATION AND PRIORITIZATION

1.1 NOMINATION OF PERCEIVED PROBLEMS IN THE WORKPLACE

1.2 CATEGORY OF PERCEIVED PROBLEMS

1.3 CLASSIFICATION OF PROBLEMS

1.4 VERIFICATION OF EXISTENCE OF THE PROBLEMS

1.5 SIGNIFICANCE OF THE CONTROLLABLE/INTERFACE PROBLEMS

1.6 PRIORITIZATION OF THE PROBLEM

1.7 PRIORITY PROBLEM

1.8 TENTATIVE PROBLEM STATEMENT

STEP 2 UNDERSTANDING THE PRESENT SYSTEM

2.1 REVIEW THE CURRENT SYSTEM AND STANDARD

2.2 DATA COLLECTION PLAN TO VALIDATE THE EXISTENCE OF THE PROBLEM

2.3 VALIDATION OF THE EXISTENCE OF THE PROBLEM

2.4 FINAL PROBLEM STATEMENT

2.5 TENTATIVE OBJECTIVE STATEMENT

2.6 APPROVAL OF THE FINAL PROBLEM STATEMENT

STEP 3 ANALYSIS OF ROOT CAUSES

3.1 IDENTIFICATION OF ROOT CAUSES OF THE PROBLEM USING ISHIKAWA DIAGRAM

3.2 VALIDATION & CONTROLLABILITY OF VERIFIED ROOT CAUSES

3.3 PARETO CHART, DIAGRAM & DISCUSSION (if applicable)

3.4 FINAL OBJECTIVE STATEMENT

3.5 APPROVAL OF THE FINAL OBJECTIVE STATEMENT

STEP 4 CREATION, EVALUATION AND SELECTION OF BEST ALTERNATIVE SOLUTIONS

4.1 CREATION, EVALUATION AND SELECTION OF BEST ALTERNATIVE SOLUTIONS

4.2 GANTT CHART OF ACTIVITIES FOR EACH OF THE SOLUTIONS IMPLEMENTED

4.3 PREVENTIVE AND CONTINGENCY PLAN USING POTENTIAL PROBLEM ANALYSIS TABLE
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 4.4 APPROVAL OF THE BEST ALTERNATIVE SOLUTIONS

STEP 5 SOLUTION IMPLEMENTATION

5.1 MONITORING PLAN

5.2 APPROVAL OF THE SOLUTION IMPLEMENTATION

STEP 6 EVALUATION OF RESULTS

6.1 DISCUSSION OF RESULTS AND ANALYSIS

6.2 COMPARISON OF DATA ON BEFORE AND AFTER IMPLEMENTATION

6.3 SUMMARY OF RESULTS

6.4 BENEFITS OF THE STUDY

6.4.1 TANGIBLE BENEFITS OF THE STUDY

6.4.2 INTANGIBLE BENEFITS OF THE STUDY

6.5 SUMMARY OF DIFFICULTIES & LEARNING EXPERIENCES

STEP 7 STANDARDIZATION

7.1 STANDARDIZATION PLAN

7.2 DOCUMENTATION ON THE STANDARDIZATION OF ACTIVITIES

STEP 8 SELF EVALUATION AND FUTURE PLANS

8.1 GOOD AND BAD POINTS ENCOUNTERED THRU EACH 8 STEPS OF CQI

8.2 ASSESSMENT OF TEAM’S SKILLS IN APPLYING TOOLS AND TECHNIQUES

8.3 TEAM DEVELOPMENT PLAN OF THE STUDY

8.4 FUTURE PLANS AND RECOMMENDATIONS OF THE STUDY

8.5 FINAL APPROVAL OF THE CQI STUDY

APPENDIX

REFERENCES

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LIST OF TABLES

4
LIST OF FIGURES

5
APPROVAL SHEET

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ABSTRACT

7
DEFINITION OF TERMS

(Alphabetically arrange)

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INTRODUCTION OF THE STUDY

(State why you conducted/chosen the study, tackle the gaps, include methodology and references)

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 STEP 1

PROBLEM IDENTIFICATION AND PRIORITIZATION

1.1 NOMINATION OF PERCEIVED PROBLEMS IN THE WORKPLACE

LIST OF PERCEIVED PROBLEMS

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1.2 CATEGORY OF PERCEIVED PROBLEMS

LIST OF PERCEIVED PROBLEMS PROBLEM OR CAUSE

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1.3 CLASSIFICATION OF PROBLEMS

LIST OF CONTROLLABLE/INTERFACE PROBLEMS CONTROLLABLE UNCONTROLLABLE INTERFACE

(Do not include in the list the identified causes)

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1.4 VERIFICATION OF EXISTENCE OF THE PROBLEM

LIST OF CONTROLLABLE/INTERFACE PROBLEMS INITIAL DATA COLLECTED

(Do not include those under “Uncontrollable”)

1.5. SIGNIFICANCE OF THE CONTROLLABLE/INTERFACE PROBLEMS

LIST OF CONTROLLABLE/INTERFACE PROBLEMS INITIAL DATA COLLECTED SIGNIFICANCE

1.6 PRIORITIZATION OF THE PROBLEM

LIST OF SIGNIFICANT PROBLEMS CRITERIA TOTAL ACTION

TAKEN
(Include only the significant problem here) FREQUENCY IMPORTANCE FEASIBILITY
(Go or
No Go)

Legend: Disposition:
High - 5 points 10 and above- GO
Medium- 3 points 9 and below- NO GO
Low - 1 point

1.7 PRIORITY PROBLEM

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_________________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________

1.8 TENTATIVE PROBLEM STATEMENT

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________

STEP 2

UNDERSTANDING THE PRESENT SYSTEM

2.1. REVIEW THE CURRENT SYSTEM AND STANDARD.

Flowchart on __________________________________

PERSON RESPONSIBLE FLOWCHART DESCRIPTION

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2.2. DATA COLLECTION PLAN TO VALIDATE THE EXISTENCE OF THE PROBLEM

DATA COLLECTION PLAN

ON VALIDATION OF THE EXISTENCE OF THE PROBLEM

DATA HOW WILL WHEN WILL

DATA TO BE WHO WILL TOOLS FOR DATA
SOURCE AND DATA BE DATA BE
COLLECTED COLLECT DATA PRESENTATION
LOCATION COLLECTED COLLECTED

2.3 VALIDATION OF THE EXISTENCE OF THE PROBLEM

DATA COLLECTED

(You may present in graph or illustration if necessary)

2.3 FINAL PROBLEM STATEMENT

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_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________.

2.4. TENTATIVE OBJECTIVE STATEMENT

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________.

2.5 APPROVAL OF THE FINAL PROBLEM STATEMENT

Prepared by:

Authors

(Printed Name and Signature)

Reviewed by:

_____________________________

CQI Point Person

(Printed Name and Signature)

Approved by:

_________________________________

Department/Unit Head

(Printed Name and Signature)

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