Use this template for Quality Improvement Project (QIP) Part 1:
Your name:
1. Readiness for Change Score and significance: _______
1– 15 Not ready for change now Red _____
16– 30 Possibly ready for change Yellow _____
31 – 45 Ready for change Green _____
See Module 1 for Readiness for Change Survey
2. Quality Improvement Project Topic
Topic: __________________________________
Choose a topic based on a need identified from the Wheel of Life assessment (See Module 1)
3. Write a Short and Long-term goal
a. Short term SMART Goal (action oriented- active tense, positive language) written as clear and concise sentence addressing one behavior change. Must be written to complete in four-week time frame:
Goal should be S.M.A.R.T. – Specific, Measurable, Attainable, Realistic & Timeframe
___________________________________________________________
Example: I will eat at least one green vegetable at one meal every day for four weeks in order to improve my GI health.
b. Long term SMART Goal written as one clear and concise sentence:
___________________________________________________________
Example: I will include 2 green leafy vegetables at 2 out of 3 meal times everyday to improve my mental clarity and overall health over the course of 1 year.
See this reference: https://acewebcontent.azureedge.net/assets/education-resources/lifestyle/fitfacts/pdfs/fitfacts/itemid_2637.pdf
4. Evidenced Based Practice Resource
a. Is this an expert opinion from a website or is this a journal article?
b. Title of the article
c. How does this article apply to your SMART goal?
d. Summarize article content with a minimum of 5 sentences.
e. What was the purpose of the article?
f. What was the major takeaway from this resource?
g. When was it written (or date on website)? Must be within the past 10 years.
h. Cite Reference in APA format. Include article as attachment.
This site includes instructions on how to cite a reference in APA format: https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/ref
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Use this template for the first part of your Quality Improvement Project (QIP):
Your given name is:
1. Change Readiness Score and Importance:
1–15. Red isn’t ready for change right now.
16–30 years old Yellow
31–45. Prepared to make a change the color green
The Readiness for Change Survey is included in Module 1.
2. Project on Quality Improvement
Select a topic based on a need discovered during the Wheel of Life Assessment (See Module 1)
3. Create a short-term and long-term objective for yourself.
a. Temporary A SMART Goal (action-oriented, active tense, positive language) is a clear and brief sentence that addresses one behavior change. To be completed in the four-week time frame, the following must be written:
S.M.A.R.T. – Specific, Measurable, Attainable, Realistic, and Timebound – should be the goal.
Consider the following scenario:
