Example Forms and Templates
The following are samples of typical Collaborative materials.

• Collaborative Handbook
• PDSA Worksheet
• Plan-Do-Study-Act (PDSA) Reporting Template
• PDSA by Next Friday Worksheet
• Template for Senior Leader Report
• Example of a Senior Leader Report
• Template for Run Charts
• Examples of Run Charts
• Using Microsoft Excel to Customize a Spreadsheet
• Sample Memorandum of Agreement (MOA) Information
  The QIO is not required to have a MOA with their participating hospital, but it is recommended. Note that the sample calls for an Attachment A, which would be the Statement of Confidentiality and Accountability for Collaborators specific to your QIO.
• Learning Table
• Addendum to the Learning Table

• Overview of a Collaborative, Jane Burgman, RN, CAH-C Project Manager
• The Model for Improvement, Kathryn Bunt, Qualis Health
• A Hospital's Experience, a description of the experiences of the Saint Alphonsus Medical Center team that participated in the Surgical Site Infection Prevention Collaborative
• M. Hindmarsh, Learning Session 2
• Database

Qualis Health Collaborative Database, version 2
This Microsoft Access database developed by Qualis Health allows QIOs to better track and evaluate data from IHI and IHI-like BTS Collaboratives. This tool helps you more efficiently track the status of team participation and progress, offer better coaching and feedback to teams, and facilitate communication through easier access to team contact information. This version has the same database structure as version 1, but has improved forms for easier navigation. Dummy records have been included to help the user understand its use. The database may be used for any topic, not just surgical infection prevention. It is compatible with Access 97 or 2000.

Note: The database is a large file. For ease and speed of download, it has been compressed using WinZip®. If you do not have the WinZip program, you can purchase it or download a free evaluation version at http://www.winzip.com/downwzeval.htm.

Documents featuring the symbol are formatted as Adobe Acrobat® PDF files. If you do not have the Adobe Acrobat reader, you can download it FREE from the Adobe website.