Action Planning Tool for the AHRQ Surveys on Patient Safety Culture

Action Plan for the AHRQ Surveys on Patient Safety Culture

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Date last updated:

Defining Your Goals and Selecting Your Initiative

No. Question Answer
1 What areas do you want to focus on for improvement?  
2 What are your goals?  
3 What initiative will you implement?  
Notes or Comments

Planning Your Initiative

No. Question Answer
4 Who will be affected and how?  
5 Who can lead the initiative?  
6 What resources will be needed? Types of Staff and Required Time Estimated Costs
   
Supplies, Materials, Equipment, and Other Resources Needed Estimated Costs
   
Notes or Comments
7 What are possible barriers and how can they be overcome? Barriers Strategies For Overcoming Barriers
1.  
2.  
8 How will you measure progress and success? Process Measures Staff Responsible
   
Outcome Measures Staff Responsible
   
Notes or Comments

Timeline

No. Question Task/Milestone Start Date End Date
9 What is the timeline?      
     
     
     
     
     
     

Communicating Your Action Plan

No. Question Answer
10 How will you share your action plan and with whom?  
Notes or Comments

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Page last reviewed December 2015
Page originally created December 2015
Internet Citation: Action Plan for the AHRQ Surveys on Patient Safety Culture. Content last reviewed December 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/planningtool4.html