1 Start 2 Complete

Please rate the overall impact in your practice or professional role that resulted from participation in this series. *

	Not at all	Minimal	Moderate	Significant	Substantial
To what extent did you improve your ability to provide high-quality care or perform your professional responsibilities?	To what extent did you improve your ability to provide high-quality care or perform your professional responsibilities? - Not at all	To what extent did you improve your ability to provide high-quality care or perform your professional responsibilities? - Minimal	To what extent did you improve your ability to provide high-quality care or perform your professional responsibilities? - Moderate	To what extent did you improve your ability to provide high-quality care or perform your professional responsibilities? - Significant	To what extent did you improve your ability to provide high-quality care or perform your professional responsibilities? - Substantial

Please rate the level of change in your practice or professional role that resulted from participation in this series. *

	Not at all	Minimal	Moderate	Significant	Substantial
I implemented new or enhanced technical, procedural, or clinical skills in my practice or role.	I implemented new or enhanced technical, procedural, or clinical skills in my practice or role. - Not at all	I implemented new or enhanced technical, procedural, or clinical skills in my practice or role. - Minimal	I implemented new or enhanced technical, procedural, or clinical skills in my practice or role. - Moderate	I implemented new or enhanced technical, procedural, or clinical skills in my practice or role. - Significant	I implemented new or enhanced technical, procedural, or clinical skills in my practice or role. - Substantial
I contributed to or supported quality, safety, performance, or healthcare system improvement initiatives.	I contributed to or supported quality, safety, performance, or healthcare system improvement initiatives. - Not at all	I contributed to or supported quality, safety, performance, or healthcare system improvement initiatives. - Minimal	I contributed to or supported quality, safety, performance, or healthcare system improvement initiatives. - Moderate	I contributed to or supported quality, safety, performance, or healthcare system improvement initiatives. - Significant	I contributed to or supported quality, safety, performance, or healthcare system improvement initiatives. - Substantial
I used quality data to guide changes in my practice or role.	I used quality data to guide changes in my practice or role. - Not at all	I used quality data to guide changes in my practice or role. - Minimal	I used quality data to guide changes in my practice or role. - Moderate	I used quality data to guide changes in my practice or role. - Significant	I used quality data to guide changes in my practice or role. - Substantial
I implemented new or enhanced strategies to prevent and manage complications, adverse events, or medical errors	I implemented new or enhanced strategies to prevent and manage complications, adverse events, or medical errors - Not at all	I implemented new or enhanced strategies to prevent and manage complications, adverse events, or medical errors - Minimal	I implemented new or enhanced strategies to prevent and manage complications, adverse events, or medical errors - Moderate	I implemented new or enhanced strategies to prevent and manage complications, adverse events, or medical errors - Significant	I implemented new or enhanced strategies to prevent and manage complications, adverse events, or medical errors - Substantial
I considered cost when making care or practice decisions.	I considered cost when making care or practice decisions. - Not at all	I considered cost when making care or practice decisions. - Minimal	I considered cost when making care or practice decisions. - Moderate	I considered cost when making care or practice decisions. - Significant	I considered cost when making care or practice decisions. - Substantial
I incorporated practices that support equitable and patient-centered care (e.g., considering a patient's preferences, goals, cultural). background, health literacy, language needs, or barriers to care).	I incorporated practices that support equitable and patient-centered care (e.g., considering a patient's preferences, goals, cultural). background, health literacy, language needs, or barriers to care). - Not at all	I incorporated practices that support equitable and patient-centered care (e.g., considering a patient's preferences, goals, cultural). background, health literacy, language needs, or barriers to care). - Minimal	I incorporated practices that support equitable and patient-centered care (e.g., considering a patient's preferences, goals, cultural). background, health literacy, language needs, or barriers to care). - Moderate	I incorporated practices that support equitable and patient-centered care (e.g., considering a patient's preferences, goals, cultural). background, health literacy, language needs, or barriers to care). - Significant	I incorporated practices that support equitable and patient-centered care (e.g., considering a patient's preferences, goals, cultural). background, health literacy, language needs, or barriers to care). - Substantial

Rate the level of impact in your role as a member of an IP team that resulted from participation in this series. *

	Not at all	Minimal	Moderate	Significant	Substantial
I collaborated with members of my IP team when making care or practice decisions.	I collaborated with members of my IP team when making care or practice decisions. - Not at all	I collaborated with members of my IP team when making care or practice decisions. - Minimal	I collaborated with members of my IP team when making care or practice decisions. - Moderate	I collaborated with members of my IP team when making care or practice decisions. - Significant	I collaborated with members of my IP team when making care or practice decisions. - Substantial
I communicated with members of my IP team regarding patient care or professional practice.	I communicated with members of my IP team regarding patient care or professional practice. - Not at all	I communicated with members of my IP team regarding patient care or professional practice. - Minimal	I communicated with members of my IP team regarding patient care or professional practice. - Moderate	I communicated with members of my IP team regarding patient care or professional practice. - Significant	I communicated with members of my IP team regarding patient care or professional practice. - Substantial
I considered the roles and responsibilities of IP team members when making care or practice decisions.	I considered the roles and responsibilities of IP team members when making care or practice decisions. - Not at all	I considered the roles and responsibilities of IP team members when making care or practice decisions. - Minimal	I considered the roles and responsibilities of IP team members when making care or practice decisions. - Moderate	I considered the roles and responsibilities of IP team members when making care or practice decisions. - Significant	I considered the roles and responsibilities of IP team members when making care or practice decisions. - Substantial
I involved patients and families in shared decision-making, when appropriate to my role.	I involved patients and families in shared decision-making, when appropriate to my role. - Not at all	I involved patients and families in shared decision-making, when appropriate to my role. - Minimal	I involved patients and families in shared decision-making, when appropriate to my role. - Moderate	I involved patients and families in shared decision-making, when appropriate to my role. - Significant	I involved patients and families in shared decision-making, when appropriate to my role. - Substantial

Please describe at least one specific change you made in your practice or professional role as a result of participating in this series. *

What barriers, if any, limited your ability to implement or sustain changes in your practice or professional role? (Select all that apply)

No anticipated barriers to adopting new strategies or implementing a change in practice.

Individual Barriers

Individual Barriers

Additional experience and/or education needed

Uncertainty about whether changes will improve patient care

Discomfort with change (e.g., uncertainty, frustration)

 Not feeling valued as part of the healthcare team

Team Barriers

Team Barriers

Lack of collaboration or effective communication among the healthcare team.

Not understanding the roles, responsibilities, expertise and divers experiences of the healthcare team

Challenging to include patient family in decision-making

Patient or family attitudes, beliefs, or goals (e.g., lack of adherence)

Lack of leadership or support

Organizational/System/External Barriers

Limited time for patient interactions (e.g., brief appointments)

Limited time available to implement changes (e.g., workload demands, staff shortages)

Limited access to necessary tools for implementing change (e.g., supplies, technology)

Patient socioeconomic or social needs factors (e.g., insurance, transportation, housing, affordability)

Organizational structure does not support IP teams

Lack of, or ineffective institutional policies/ guidelines

Other, please describe:

Organizational/System/External Barriers Other, please describe:

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