Title: Fresh Eyes: Subject Start Date:
Owner: Team: Expert(s): Revision Date:
PDSA Revision #:
Coach:
Background / Current Conditions Analysis / Root Cause
PLAN
Countermeasures to Root Causes
DO
PLAN
Study (Planned vs. Actual Results)
STUDY
Problem Statement
Act/Adjust
ACT/ADJUST
Goals/Targets
Stakeholder
Signatures:
PDSA A3 TEMPLATE