Background Quality Improvement Team Information Form
CUSP Toolkit
Health care provider roles
Who should use this tool? Health care providers.
Please indicate people designated as <Insert Unit Type> Quality Improvement Team Members. Your team may not have people who serve in all of these roles.
These individuals from <Insert Unit Type> are members of the Quality Improvement Team.
| Name & Title | Role | Phone & Email Address |
|---|---|---|
| Content Specialist (e.g., Infectious Disease Physician, Intensive Care Physician) | ||
| <Insert Unit Type> Director | ||
| Hospital Patient Safety Officer or Chief Quality Officer | ||
| Nurse Champion | ||
| Nurse Educator | ||
| <Insert Unit Type> Nurse Manager | ||
| <Insert Unit Type> Nurses on team (list all) | ||
| <Insert Unit Type> Physicians on team (list all) | ||
| Respiratory Therapist | ||
| Senior Executive (Vice President or above) | ||
| Social Work, Support Staff (e.g., Technicians, Ward Clerks, Nurse's Aides) | ||
| Staff from Safety, Quality, or Risk Management Office | ||
| Unit Champion (Unit Team Lead) | ||
| Other Roles? (fill In below) |
We recommend redesigning this roster to meet the needs of your team and posting it in a prominent area.
