Intervention Project Form

Thank you very much for sharing your project with the RCRC community!

We hope this template will be helpful as you develop a report for your stakeholders as well. We will include de-identified results in the RCRC Intervention Database, after getting your final approval. You will have the opportunity to either 1) save your form in order to add more information as it becomes available or 2) submit it for the RCRC to review for certification and/or entry into the RCRC Intervention Database.
To submit or save your form, skip to the last page using the progress bar above.

Project
Name

First Name Last Name
Email
example@example.com
Date Completed

- Month - Day Year
Date
Project Lead

First Name Last Name
Project Title
Start Date

- Month - Day Year
Date
End Date

- Month - Day Year
Date
Funder(s)
To submit or save your form, skip to the last page using the progress bar above.

Background
What was the setting for this change project?
What was the challenge the organization was facing
Why did RC seem to be a good tool or framework to use? How did this RC initiative align with the organization’s goals?
What were the objectives and hoped for outcomes?
To submit or save your form, skip to the last page using the progress bar above.

Implementation Process
Who led/sponsored the project?
What implementation strategy was used to drive the RC initiative? (e.g. project management methodology, PDCA approach)
Which stakeholders were involved?
How did they/you build support?
To submit or save your form, skip to the last page using the progress bar above.

Interventions
What were the interventions?
Relational interventions - methods used to reveal patterns and build new relationships
Work process interventions - methods used for improving the work (lean, PDSA, etc.)
Structural interventions - new structures that were implemented to support new ways of communicating and relating
How were participants involved in developing these interventions?
How many rounds of RC survey data were collected?
How many people were surveyed in each round, and how many responded? (feel free to cut and paste your RCA report tables here or upload them below)
Optional: Upload your RCA Report tables. If you need a deidentified report, please contact RC Analytics.

Upload

Cancel of
How were the results presented to participants (please specify which results were share and with whom)?
How did you ensure confidentiality of RC results in a way that was adequate to the needs of the participants?
To submit or save your form, skip to the last page using the progress bar above.

Resources Used
Which resources were used?
Internal resources: Staff, time for non-project specific staff
External resource costs: Contracts, etc.
To submit or save your form, skip to the last page using the progress bar above.

Findings
Please provide a 1-3 paragraph narrative summary of the intervention results.
What were the initial RC results? How did they change? (please include quantitative data and any statistical tests you may have conducted - feel free to cut and paste our upload some of your RC Analytics tables and figures)
Optional: Supporting Documents. If you need a deidentified report, please contact RC Analytics.

Upload

Cancel of
Please indicate any other outcomes you tracked or measured. Check all that apply:

Process Outcomes Client/patient experience outcomes Worker experience/satisfaction outcomes Health outcomes Economic outcomes
Which changes were observed on each outcome? (please include any statistical tests you may have conducted)
What key messages were heard in the feedback sessions? Did they reflect the survey findings?
To submit or save your form, skip to the last page using the progress bar above.

Evaluative Assessment
To what extent was RC considered appropriate and relevant to the needs of participating teams?
In which ways did the initiative achieve its objectives?
To what extent was the initiative delivered as planned?
To submit or save your form, skip to the last page using the progress bar above.

Lessons Learned and Recommendations
What worked well?
What could be improved next time?
What did you learn from this project about the process of planning and/or conducting interventions?
What next steps do you recommend for this organization?
To submit or save your form, skip to the last page using the progress bar above.

Dissemination
Has information about this project been shared in any public forum, such as a conference, webinar or a journal article? If yes, please include information on how it can be retrieved.
Was this intervention part of a research project?

Yes No
To submit or save your form, skip to the last page using the progress bar above.

Research Methods (for research projects only)
What were your research questions?
Which of the following best describes your study design?

Cluster Randomized Control Trial Individual Randomized Control Trial Stepped Wedge Interrupted Time Series Controlled Before After Simple Before After Observational Study
Was there a comparison group (used to compare against the intervention group)? If yes, please describe how the comparison group was selected.
What were your research findings?
Please share anything you learned from this project about research methods.
To submit or save your form, skip to the last page using the progress bar above.

Supplemental Materials (optional)
Please upload any additional files that you would like to share
To submit or save your form, skip to the last page using the progress bar above.

Next Steps
What would you like to do next? *

Save this form as a draft for you to continue to edit before submitting (you will receive a link to edit your form) Submit this form to the RCRC Intervention Database Submit this form as your application to become an RC Certified Professional and add it to the RCRC Intervention Database
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Thank you very much for sharing your project with the RCRC community!