Sample Implementation Planning Template
Sample Implementation Planning Template
Activity
Start
Date
Target
Finish
Date
To be
carried
out by
Status/Comments
2.11
Procure and install hand hygiene products
and equipment
3.0
Implementation
3.1
Launch program and communications
plan
3.2
Feed baseline data and analysis back to
health care providers
3.3
Distribute posters and promotional
materials
3.4
Develop process for distribution of patient
pamphlets
3.5
Educate and provide practical training for
health care providers
3.6
Install lotion
3.7
Hold regular review meetings
4.0
Follow up evaluation
4.1
Complete senior and middle managers
perception survey (follow-up)
4.2
Complete health care providers
perception survey (follow-up)
4.3
Complete unit structure survey (follow-up)
4.4
Complete hand hygiene observations
(follow-up)
4.5
Complete health care providers
knowledge survey (follow-up)
4.6
Complete facility Situation Analysis
(follow-up)
4.7
Collect MRSA and VRE HAIs
4.8
Collect cost information
4.9
Input data
4.10
Analyze data
5.0
Ongoing action plan and review cycle
5.1
Review all results
Page 3/4
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