Template for Tracking QI Projects

The following template was put together to assist local health departments (LHDs) in tracking QI projects that are occurring within the agency.
The template can be adapted based on LHD and specific QI project needs and is intended to be updated on a frequent basis throughout the
project period.
 Quality Improvement Project Tracking Template
Local Health Department Name

QI Project Title Division and/or

Program Name:
QI Team Leader Name: Accreditation MPR/Indicator #, if
Applicable:
Contact Information Last Date Plan
(phone/email): was Updated:
1. 2. Measure(s) 3. Baseline 4. Root Cause(s) 5. Action(s) 6. Goal(s) 7. Time Frame 8. Evaluation
Problem/ Result Process
Process to
Improve
Measure(s) to be Enter the State the underlying For each identified root cause, Describe, in Provide the time frame Describe the evaluation
addressed. baseline result root cause(s) for the describe the specific actions measurable terms, for the implementation process that your Division
for the difference between the your Division will take to the goal to be of all improvement will use to ensure that
performance of desired level of achieve improvement in the achieved for the action(s) listed. The measureable
each measure. performance of each measure. Actions may include associated begin (B) date performance
measure. modifying specific protocols, measure (e.g., “To represents the earliest improvement is achieved.
processes, procedures, or increase our date of all activities to
internal LHD systems as needed baseline be implemented, while
to obtain a change. measurement of the end (E) date
30% to 70%.) represents the date of
the latest activity to be
implemented for the
associated measure.