Healthcare Operations Diagnostic Evaluation Form
Use this form to evaluate healthcare operations workflows, identify bottlenecks, and capture improvement priorities. Do not include medical or sensitive health information.
Operational Context
Facility or Department Name
*
Main Service Area / Department Being Evaluated
*
Please Select
Emergency Department
Inpatient Unit
Outpatient Clinic
Operating Room
Radiology
Laboratory
Pharmacy
Administrative Services
Other
Evaluator Role / Title
*
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Diagnostic Review
Primary Operations Issue Category
*
Scheduling
Intake
Staffing
Communication
Documentation Workflow
Reporting
Inventory/Supplies
Billing Workflow
Facility Coordination
Other
Workflow Efficiency Rating
*
Inefficient
1
2
3
4
5
6
7
8
9
Highly Efficient
10
1 is Inefficient, 10 is Highly Efficient
Current Bottleneck Description
Top 3 Improvement Priorities
*
Scheduling
Intake
Staffing
Communication
Documentation Workflow
Reporting
Inventory/Supplies
Billing Workflow
Facility Coordination
Other
Action Planning
Recommended Next Steps / Corrective Actions
*
Target Implementation Timeframe
*
Please Select
Immediately
30 days
60 days
90 days
Submit
Should be Empty: