A3 Thinking

Denver Health Lean Training

Created by:

Katie Stanek, Lean Facilitator

©2012Denver Health and Hospital Authority. All Rights Reserved

©2012Denver Health and Hospital Authority. All Rights Reserved

What is A3 Thinking? A3

Metric nomenclature for a paper size, equal to 11” x 17”

A3 Thinking

Consensus building process utilizing a systematic,

documented methodology

Communication tool that follows a

logical and standard structure

©2012Denver Health and Hospital Authority. All Rights Reserved

Why Promote A3 Thinking?

A structured cycle of improvement A framework for organizing thinking & work

For individuals and teams Promotes transparency of issues, problems and

thinking Makes work and opportunities visible Tells the story

©2012Denver Health and Hospital Authority. All Rights Reserved

How to Achieve A3 Thinking?

Do an A3 for all types of activities Strategic planning

Problem solving/Decision making

Sharing good ideas/Proposing change

Value Stream Analysis/Rapid Improvement Events

Reporting progress/Policy deployment

©2012Denver Health and Hospital Authority. All Rights Reserved

Creating an A3 Define the purpose Tell the story visually and logically

Beginning – Strategy/Problem identification - Reason for Action

Middle – Gap analysis, Solution Approach, Rapid Experiments

End – Completion Plans, Confirmed State

Updating A3s - “living document” At the Start (Proposal, comparison with similar events, charter

etc.) During the process (to maintain consensus, get support,

guidance or verify the actions/hypothesis) When completed (to communicate and celebrate success)

©2012Denver Health and Hospital Authority. All Rights Reserved

TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________

Team:___________________________Team:___________________________

Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:

1. Reason for Action 4. Gap Analysis 7. Completion Plans

     

2. Initial State 5. Solution Approach 8. Confirmed State

     

3. Target State 6. Rapid Experiments 9. Insight

     

©2012Denver Health and Hospital Authority. All Rights Reserved

TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________

1. Reason for Action 4. Gap Analysis 7. Completion Plans

     

2. Initial State 5. Solution Approach 8. Confirmed State

     

3. Target State 6. Rapid Experiments 9. Insight

     

Why are we doing this?What is the burning platform?What is the chief complaint?

Team:___________________________Team:___________________________

Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:

©2012Denver Health and Hospital Authority. All Rights Reserved

TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________

1. Reason for Action 4. Gap Analysis 7. Completion Plans

     

2. Initial State 5. Solution Approach 8. Confirmed State

     

3. Target State 6. Rapid Experiments 9. Insight

     

Describe attributes of the initialstate – Quantitative & Qualitative

Graphically present picture of Initial State

Team:___________________________Team:___________________________

Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:

©2012Denver Health and Hospital Authority. All Rights Reserved

TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________

1. Reason for Action 4. Gap Analysis 7. Completion Plans

     

2. Initial State 5. Solution Approach 8. Confirmed State

     

3. Target State 6. Rapid Experiments 9. Insight

     

Describe attributes of the targetstate – Quantitative & Qualitative

Graphically present picture of Target State

Are metrics defined and achievable?

Team:___________________________Team:___________________________

Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:

©2012Denver Health and Hospital Authority. All Rights Reserved

TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________

1. Reason for Action 4. Gap Analysis 7. Completion Plans

     

2. Initial State 5. Solution Approach 8. Confirmed State

     

3. Target State 6. Rapid Experiments 9. Insight

     

What holds us back from the Target State?

What are the root causes of theseroad blocks?

Team:___________________________Team:___________________________

Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:

©2012Denver Health and Hospital Authority. All Rights Reserved

Gap Analysis

Affinity diagrams

Scatter diagrams

Pareto charts

5 Whys

Fishbone diagrams

©2012Denver Health and Hospital Authority. All Rights Reserved

Fishbone

People Procedures

Policy

Communication

Patients & Families

Major Problem or Issue

©2012Denver Health and Hospital Authority. All Rights Reserved

TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________

1. Reason for Action 4. Gap Analysis 7. Completion Plans

     

2. Initial State 5. Solution Approach 8. Confirmed State

     

3. Target State 6. Rapid Experiments 9. Insight

     

Does solution approach link wellwith the root cause identified inthe Gap Analysis?

Does the Solution Approachexpress the hypothesis to be validated or adjusted throughRapid Experiments?

Team:___________________________Team:___________________________

Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:

©2012Denver Health and Hospital Authority. All Rights Reserved

TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________

1. Reason for Action 4. Gap Analysis 7. Completion Plans

     

2. Initial State 5. Solution Approach 8. Confirmed State

     

3. Target State 6. Rapid Experiments 9. Insight

     

Expect the Solution Approach tonot be perfect- Run the tests of change!

Are Rapid Experiments achieving desired results and learning?

Team:___________________________Team:___________________________

Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:

©2012Denver Health and Hospital Authority. All Rights Reserved

Rapid Experiments

Observe what works

Observe what doesn’t work yet

Record the new process performance

Collect data based on observation

Document issues and begin to resolve problems

Do not talk or think yourself out of trying new ideas

©2012Denver Health and Hospital Authority. All Rights Reserved

Start Making Meaningful Change There is no time like the present Don’t over analyze Resist the temptation for delayed implementation “until we

make things perfect” Seek buy-in from people in work area by explaining why

we are making change (Reason for Action) and by asking them their thoughts on improvement

Break into smaller sub groups to get many things done quicker

©2012Denver Health and Hospital Authority. All Rights Reserved

TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________

1. Reason for Action 4. Gap Analysis 7. Completion Plans

     

2. Initial State 5. Solution Approach 8. Confirmed State

     

3. Target State 6. Rapid Experiments 9. Insight

     

Is Completion Plan in place withnames, dates, & outcomes?

Is Completion Plan on track?

Team:___________________________Team:___________________________

Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:

©2012Denver Health and Hospital Authority. All Rights Reserved

Completion Plans

Action Item Responsible Date Completed

©2012Denver Health and Hospital Authority. All Rights Reserved

TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________

1. Reason for Action 4. Gap Analysis 7. Completion Plans

     

2. Initial State 5. Solution Approach 8. Confirmed State

     

3. Target State 6. Rapid Experiments 9. Insight

     

Are Confirmed State metrics in place and do they validate the target state?

Does confirmed state show what“good” looks like in a way thatcannot be misunderstood?

Team:___________________________Team:___________________________

Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:

©2012Denver Health and Hospital Authority. All Rights Reserved

TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________

1. Reason for Action 4. Gap Analysis 7. Completion Plans

     

2. Initial State 5. Solution Approach 8. Confirmed State

     

3. Target State 6. Rapid Experiments 9. Insights

     

Do insights show key lessons learned and identify future opportunities?

Team:___________________________Team:___________________________

Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:

©2012Denver Health and Hospital Authority. All Rights Reserved

Questions?

©2012Denver Health and Hospital Authority. All Rights Reserved

A3 Activity

Pick a problem in your area

Complete the A3