Success and Improvement Story Template

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Success and Improvement Story Template

A Cross-Cutting QIOSC Project From MedQIC and the Communications QIOSC

A success and improvement story tells about the challenges and rewards of implementing an improvement project in a real healthcare setting. A story should contain some or all of the following elements:

  • Stories with a focus on how a provider/agency/facility improved

  • How a QIO helped a provider/agency/facility plan or implement a project

  • Stories that discuss utilization of shared expertise/tools with a concrete outcome

  • Quotes from staff, senior leaders, patients, families about the outcome

  • Quality of Care stories with improvement in clinical measures

  • Quality of Life stories with improvement in qualitative measures

  • Providers willing to share their success by signing the Universal Permission Form

A success and improvement story is a feature-type story that includes a description of an individual project and the measures that were tracked. You do not have to fill out the template if you prefer to submit a story written in paragraph form. Use this template as a guide for relevant information as you write the story. For questions or assistance, please contact the South Dakota Foundation for Medical Care. You may download this template at under Home Health/Success Stories.

Title/Headline of Story

Example: Reducing Avoidable Hospitalizations of Heart Failure Patients


___General Improvement ___ Home Health ___Hospital ___ Nursing Home

___Physician Office ___Underserved

Permissions to Share

Story may be shared with:

Public, no restrictions (yes/no)?

Restricted to QIO program-only including (yes/no)?

AHQA, IHI, AHRQ, any other partners (yes/no)?

Other (specify)

A signed universal permission form must be submitted before publication.

Author Contact Information

Author Name


Org City and State

Phone Number

E-mail Address


Provide a date or, if applicable, a date range for the project

Organization Name and location

(eg, St. Vincent Charity Hospital Home Care, Cleveland, Ohio)

Description of provider

(eg, size/#staff/#annual episodes)

Short Description

Provide a brief description of the story. (Example: Agency reduced avoidable hospitalizations of chronic heart failure patients through improved patient education/increased phone monitoring/telehealth/utilization of interdisciplinary approach.)

Story text

This is where you place the text for the story. Expand this text box as necessary. The story could include a description of the identified need for improvement, how the team organized itself, goals, the strategies undertaken, challenges faced, results, etc.

List the MEASURES Tracked (give before and after results/numbers)

Show measurable improvement as a result of the program over a period of time

If applicable, please provide:

Provider Contact Information (optional)

(Information provided here will be listed on website at the end of the story.)

Contact name and credentials, Title, Organization, Phone number, E-mail address

Accompanying files

(Tools, Photos, Graphs showing measures tracked and results. Prefer .jpg format, resolution 72 dpi.)

Cut line for Photo (if submitted)

List full names left to right, front to back

Keywords for Search Engine

Page of

This material was prepared by the South Dakota Foundation for Medical Care, the Medicare Quality Improvement Organization for South Dakota, under contract with the Centers for Medicare and Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 8SOW-SD-1b-06-75

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