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Performance Improvement (PI) Plan and Template


This guide is a planning template for health care professionals working with long-term care patients to improve and sustain performance improvement strategies. The template can be customized through forms and analytical tools to apply in settings such as nursing and skilled nursing facilities, subacute care facilities, assisted living facilities and programs, residential care settings, and adult medical day health care services. The exhibits, forms, and tools include:
  • Design, Measure, Assess, Improve, and Control (DMAIC) Tool
  • Plan, Do, Check, Act (PDCA) Tool
  • Fishbone diagram
  • Root cause analysis (RCA)
  • Cause and effect map
  • Failure mode and effects analysis (FMEA)
  • Strategic, Measurable, Achievable, Relevant, Timely (SMART) Tool
  • Pareto analysis chart (PAC)
Links to the Tool:
This tool is available at: (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.)


Health Care Association of New Jersey

Funding Sources

Health Care Association of New Jersey

QualityTool Topic

quality improvement strategies


  • Release Date: 11/2009
  • Original Summary: 06/2010
Disclaimer: The inclusion of a tool in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality or Westat of the tool or of the submitter or developer of the tool. Read more.
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Last updated: December 18, 2013.