Silver QI in Action - booking form

Details of your QI initiative i.e. what is the problem that you're trying to fix? *

Who or what does it impact? Why is it important? You will be testing out changes during your project - how will you measure whether any changes have resulted in an improvement?

Do you have baseline data that evidences the problem? *

Please email your data to us upon submission of this form. If you do not yet have baseline data please speak to a member of our team before proceeding to book on the programme.

YES - I have baseline data

Full name: *

Work email: *

Contact no.: *

Job title: *

Staff group: *

Division: *

Specialty: *

If other, please specify:

Bronze Intro to QI - date attended/to attend: *

(Please note that the Bronze is a mandatory prerequisite to the Silver)

Manager or sponsor email address: *

Project team members joining you on the workshops: *

please note all team members will first need to have completed the Bronze.

What is the main improvement focus of the project? *

Patient safety
Health and safety
Clinical effectiveness
Patient experience
Staff experience
Customer experience
Sustainability (environmental)
Sustainability (financial)

Will services other than your own be impacted by the project? *

Yes
No

Which cohort would you like to join:

*

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Silver QI in Action - booking form