Applied Human Factors in Healthcare Programme2017 - 2018
Project Proposal
This document acts as a formal record of the agreement reached between AQuA and its member organisation regarding their participation in the above programme. This programme will support the attending teamsto apply their learning systematically to the pre-identified safety challenge/issuesfacing their health economies, communities or organisations.
For the purpose of this programme a team must contain a minimum of 5 members, all of whom are able to attend every session. If you cannot guarantee this please resubmit for a later programme when you are able to ensure full team attendance.
Name/Team/ Organisation / Date / Senior Sponsor(Director or sub-board level)
Project Information
In this section please explain why you wish to take part in the programme and what you hope to achieve from it.
Aim
Outcome(s)
Measurement for Improvement
How does this project link to your organisation’spriorities?
E.g.; A reduction of avoidable harm from falls
- CQUIN Requirement
- Trust safety strategy.
Names of other members of the project team
Please note teams should consist of at least 5 and not drop below 3 on any occasion / Job Title/Role: / Email:
Additional Information:
Intelligence/data to support evidence of programme
RCA findings/reports
Service user/staff surveys or feedback about issue
Attempts already made to improve safety issue
Previous Human Factors Training
Please list the previous human factors training that your team members or whole team has attended previously (specify by name those who attended)
E.g.;
- AQuA Introduction to Human Factors
- Attainability
- In-house programmes
Participants / organisations confirm they will: Please tick below
- attend / support attendance at each of the listed programme events
- co-operate with requests for activity related to workplace. (Coursework).
- accommodate on-site visitfrom other teams
- participate with programme support andimprovement coaching
- deliver a formal presentation as part of the final day and evidence improvements
- Share case study with wider audiences via AQuA website and programme tools (Please note we accept that some case studies may need to be adjusted for public sharing where necessary)
Signed (AQuA Programme Lead) :……………………………………………………………………..
Date:
Signed (Senior Sponsor): ……………………………………………………………………………….
Date:
Signed (Applicant / Project Lead): ……………………………………………………………………..
Date: