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Background / Current Conditions Analysis / Root Cause

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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

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