Diabetes Quality Improvement (QI) Primer Evaluation Form
for Module 2: Determining Root Causes and Designing Change Ideas
Please select the option that best describes your profession:
Endocrinologist
Registered Nurse
Registered Dietician
Diabetes Educator
Other Physician
Phamacist
Medical Trainee/Resident
Other
Please rate the overall quality of this module
1
2
3
4
5
Very Poor
Very good
1 is Very Poor, 5 is Very good
Please evaluate the following statements:
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
This program enhanced my knowledge of quality improvement
1
2
3
4
5
The program was presented in a way that was easy to understand
6
7
8
9
10
This program was useful for my practice.
11
12
13
14
15
There was a sufficient amount of interactivity in each module.
16
17
18
19
20
Please evaluate the following statements: this program effectively taught me how to:
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
diagnose
the root cause of a quality problem
21
22
23
24
25
review
four QI diagnostic tools
26
27
28
29
30
Develop
a theory that matches change concepts to root causes of a quality problem
31
32
33
34
35
Design
a driver diagram of your quality improvement theory
36
37
38
39
40
Describe
a plan-do-study-act (PDSA) cycle
41
42
43
44
45
Please reflect on what you learned from this program
How do you plan to incorporate what you learned from this program into your practice?
What are some areas of this program that could use improvement?
Further comments:
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