Gap Analysis and Data-Driven Planning Form

Column

1

Column 2

Column

3

Column

4

Column

5

Source

Gap you found

(Use actual data from your audits and surveys)

Best Practice Strategies

(Action-oriented strategies you found in the literature to address the gap, with citation)

Barriers

(What barriers might you run into if you implemented this best practice strategy?)

Plan for Overcoming Barriers

Care Audit:

Complete at least 5 gaps with different best practice strategies to address the gap.

1.

2.

3.

4.

5.

Patient/client Survey and Patient experience Tracer

At least 3 gaps with different best practice strategies to address the gap.

1.

2.

3.

Team Survey:

At least 1 gap with different best practice strategies to address the team gap.

1.

Disparity:

At least 1 gap that addresses disparity.

1.