Continuous Improvement Department Intake Request Form

Continuous Improvement Department

Intake Request Form

The UCSF Health Continuous Improvement Department (CI Dept) is an internal organizational resource that supports and facilitates the transformation of UCSF Health into a Continuous Improvement enterprise. The CI Dept partners with administrative, operational, and clinical leaders across UCSF to solve strategic organizational problems, reinforce a culture of continuous process improvement and innovate care delivery.

Requestor Name*

Which senior leader is supporting this request?*

Department/Unit/Team*

Did an Improvement Advisor help complete this form?

If yes, please include name.

Background*

Why this? Why now? What would happen if nothing changed?

Problem Statement*

Please describe the problem as you experience it today (not the cause or a solution). What is the urgency?

Target Performance*

What target measures, conditions, experiences would indicate success? Metric 1 Metric 2 Metric 3

Time Frame*

When do you want to start? Or By when do you need to demonstrate results?

How does the issue connect with defined priorities*

Strategic priority for current fiscal year

IAP goal for this year

Engagement action plan

Skill building and individual/team development

Other - please explain

Please define*

Optional: Upload supporting documentation

i.e. A3, project charter, etc.

Drag and drop files here or

Send me a copy of my responses

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