Entry Form 2017 PQA

Entry Form

Your entry must be received no later than midnight, Pacific Time, July 31, 2017.Attach this form to your PQA Cover Sheet using the PQA Entry System; do not submit your entry form via email or hard copy.

For details on entry requirements, refer to the PQA Entry Guide. Entries that do not meet all requirements cannot be considered.

Project Title

Use same name that you use on the Entry Cover Sheet. Do not include hospital name in title.

Project Details:

Impact:

  1. Describe the problem this project was designed to solve. (200 words or less)
  1. Describe the project’s impact on quality: safety, effectiveness, and efficiency, including impact on costs or financial performance. (200 words or less)

Improvement Process:

  1. Explain the project aim and improvement goals. Use this suggested format:
  1. To decrease/increase what?
  2. By how much?
  3. Within what timeframe?
  1. Describe the methodology used to achievethe implemented improvements. (200 words or less)
  1. Explain the key measures and how those measures were calculated. (Note: statistical process control charts and/or other data graphics included in the Results section should depict measures.)
  1. Describe the changes that were tested and assess the effectiveness of each major change.
  • Include the project key driver diagram, if any
  1. Describe how you involved family members in developing and/or implementing this process and the impact on the success of this project. If family was not involved, please explain.

Resources:

  1. Describe how CHA programs, products or services were involved in the project, if any. (CHA improvement collaborative, PHIS database, Prospect database, Child Health PSO, etc.)
  1. Describe other industry data/resources, including participation in a collaborative or network,if any.
  1. What are the basic requirements for implementation? (For example, required technology, FTEs, external consultants, financial investment).

Results:

Eligible entries must demonstrate at least six months of improved results.

  1. Explain your results and provide graphs showing performance on key measures. Include key statistical analysis of results.
  • The graphs should be annotated to indicate when changes were made.
  1. Estimate the financial impact (revenue and/or expenses) of the project to your hospital. How was financial impact assessed or calculated? For example:
  • Were costs reduced?
  • Did revenue increase?
  • Was the project cost-effective?
  • Was there a return on investment?

Spread / Lessons Learned:

  1. Did you spread this project beyond its original scope? If so, describe your approach and the associated impact on outcomes.
  1. How did you involve other departments in the development, execution and/or spread of this project? (e.g., IT, Quality & Safety, Marketing, Education, etc.)
  1. What are the most important lessons learned that would benefit other organizations if they applied your project/improvement within their hospital?

Why This Project?

  1. In 250 words or less, why should your project be a Pediatric Quality Award winner? This is your opportunity to spotlight unique aspects of your project, its impact on your organization, or other information you’d like the judges to know.

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