awareness: sbs tool - a3 thinking · 2014. 8. 22. · a3 is the name for a metric paper size,...

®Simpler ®Simpler

…Building Strategic Advantage through Enterprise Wide Improvement…

Tool

TechniquesBeliefs

© 1996-2006 Simpler Business System® 11.0© Simpler Consulting, Inc 1996-2006 ALL RIGHTS RESERVED

For the Express Use of Simpler Members and Simpler Clients

Awareness:SBS Tool -A3 Thinking

2 ®Simpler ®Simpler

Tool

TechniquesBeliefs

© 1996-2006 Simpler Business System® 11.0© Simpler Consulting, Inc 1996-2006 ALL RIGHTS RESERVEDFor the Express Use of Simpler Members and Simpler Clients.

Quality-checks-as-we-goBy the end of this module we will have covered…….The A3 thinking approachThe 9 steps required through a worked exampleShown other example A3’s

Good


Tool

TechniquesBeliefs


What is A3 Thinking?A Toyota invented problem solving method

Executed on a single sheet of A3 sized piece of paper

A3 is the name for a metric paper size, similar to 11” x 17”

A3 ThinkingForces consensus building

Unifies culture around a simplesystematic, methodology

Becomes also a communication toolthat follows a logical narrative

Builds over years as organization learning

The essence distilled on to one A3 sheet

Context:

Link to Future State Map and/orTPOC/Mission A3

Problem statement (ref. PPS):

Scope and boundary (start/finish)

Therefore:

Improvements are required to:

a.

b.

c.

d.

Associate one of the true north metrics to each improvement requirement.Draw graph; in first session ID at least the axis, existing targets & status.

a. Morale b. Quality

c. Time d. Cost

Set break through goals for each of the above metrics in support of the Future State


c. Time d. Expected Benefit = £ ____

Seek to show the tools and logic used to determine direct causes of problems and true root cause. Recommended approach; show fish bone or affinity diagram with:- Problem Statement from box 1 in head.- a, b, c & d improvement requirements as “rib” titles.- Primary Root Causes (the 5th W hy) on the branches.- Prioritise Root Causes by numbering them; where 1 = highest impact, etc.The top 6 carried down in order to the Solution box 5 below…

- If VSA then add Current State Summary box..

Max 3 Actions W IP/person30-90d break through focus.Last Column is Status - use RAG (Red, Amber Green)Good events have no to do list!


c. Time d. Actual Benefit = £ _____

This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state

Actions W hat went well?

Consider; ProcessTeamLeaderSenseiCulture & Behaviour

W hat helped? W hat hindered?

W hat did not go well?

W hat are the fundamental lessons of the event and the improvement cycle?

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

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

3. Target State 6. Rapid Experiments 9. Insights

Reflections:

Reflections:

Reflections: Reflections:

Reflections:

Reflections:Root Causes: If true root cause not clear then reviewabove.

Reflections:

No GoGo No GoGo No GoGo



W hat did you learn and what are you going to do as a result? AND SO W HAT?

Follow up Action

Actual Effect

Anticipated Effect

Experiment

2 3 4 5 6 7 8 91

SM

SimplerTeam Members Do not progress beyond box 3 without established Quorum in place.Guideline = 1/3 from team, 1/3 wild cards & 1/3 customer.

Start Date:Current Date:End Date:

Title: Start W ith The Title Then Complete The Title Box

Process Owner: Sponsor: Do boxes 1-3 with Sponsor

Facilitator Sensei

If actual effect = anticipate then proceed to box 7 if not then return to box 4:

OO1d200 daysA B C dSet up One Stop Clinic to reduce1

CEFSCurrent StateAffectingSolutionCause/Priority

RAG

DueOwnerTTAction

Add logo







Explanation of last 5 columns:- Affecting - If major affect on deliverable then use CAPITAL, if minor then lower case.- Current State = data point that describes current performance in terms used in boxes 2 & 3.- FS = Future state prediction (e.g. 1 day) - EASE O = Easy ? = Medium Ease X = Difficult.- COST O = High Cost ? = Medium Cost X = Low Cost

Context:




Therefore:


a.

b.

c.

d.



c. Time d. Cost




Seek to show the tools and logic used to determine direct causes of problems and true root cause. Recommended approach; show fish bone or affinity diagram with:- Problem Statement from box 1 in head.- a, b, c & d improvement requirements as “rib” titles.- Primary Root Causes (the 5th W hy) on the branches.- Prioritise Root Causes by numbering them; where 1 = highest impact, etc.The top 6 carried down in order to the Solution box 5 below…


Max 3 Actions W IP/person30-90d break through focus.Last Column is Status - use RAG (Red, Amber Green)Good events have no to do list!




Actions W hat went well?


W hat helped? W hat hindered?






Reflections:

Reflections:


Reflections:


Reflections:





Follow up Action

Actual Effect

Anticipated Effect

Experiment

2 3 4 5 6 7 8 91

SM



Title: Start W ith The Title Then Complete The Title Box


Facilitator Sensei




RAG

DueOwnerTTAction RAG

DueOwnerTTAction

Add logo









Tool

TechniquesBeliefs


Why Promote A3 Thinking?A structured cycle of improvementA framework for organizing thinking

For individuals and teamsEliminates the waste of debating methodreveals to issues, problems and thinkingMakes problem solving visualTells a Story – like a story board for a film

The A3 should “tell the story”


Tool

TechniquesBeliefs


How to Achieve A3 Thinking?The process must be inclusive as possible

Hand drawn vs. ComputerPictures vs. text

Work step-by-step Work with consensusDistill thoughts to fit each box Capture the essence Tell the story without the need for ‘interpretation’

Why is story telling one of the most effective ways of building culture ?


Tool

TechniquesBeliefs


Where does it apply?

A3’s work for all types of activitiesStrategic Planning

Problem Solving/Decision Making

Sharing ideas/Proposing Change

Value Stream Analysis

Rapid Improvement Events

A3 should become the default way of making improvement


Tool

TechniquesBeliefs


Starting an A3

A Typical A3 life cycle is 12 months!

Context:




Therefore:


a.

b.

c.

d.



c. Time d. Cost




Seek to show the tools and logic used to determine direct causes of problems and true root cause. Recommended approach; show fish bone or affinity diagram with:- Problem Statement from box 1 in head.- a, b, c & d improvement requirements as “rib” titles.- Primary Root Causes (the 5th Why) on the branches.- Prioritise Root Causes by numbering them; where 1 = highest impact, etc.The top 6 carried down in order to the Solution box 5 below…


Max 3 Actions WIP/person30-90d break through focus.Last Column is Status - use RAG (Red, Amber Green)Good events have no to do list!




Actions What went well?


What helped? What hindered?

What did not go well?

What are the fundamental lessons of the event and the improvement cycle?




Reflections:

Reflections:


Reflections:


Reflections:




What did you learn and what are you going to do as a result? AND SO WHAT?

Follow up Action

Actual Effect

Anticipated Effect

Experiment

2 3 4 5 6 7 8 91

SM



Title: Start With The Title Then Complete The Title Box


Facilitator Sensei




RAG

DueOwnerTTAction

Add logo








Context:




Therefore:


a.

b.

c.

d.



c. Time d. Cost


















Reflections:

Reflections:


Reflections:


Reflections:





Follow up Action

Actual Effect

Anticipated Effect

Experiment

2 3 4 5 6 7 8 91

SM





Facilitator Sensei




RAG


DueOwnerTTAction

Add logo








1.1. Fill in Title Fill in Title Name (Dept, Division, Name (Dept, Division, Product/Service) Product/Service) (Activity, Mission, Transformation) (Activity, Mission, Transformation)

2.2. Fill in Start Date Fill in Start Date (Start of A3)(Start of A3)

3.3. Fill in Current Date Fill in Current Date (Date and Rev)(Date and Rev)

4.4. Record the Team membersRecord the Team members

5.5. Select the review teamSelect the review team(team that will support(team that will supportthe A3 team with relevant the A3 team with relevant knowledge & guidance)knowledge & guidance)


Tool

TechniquesBeliefs


Box 1 – Reason for action

A Typical A3 life cycle is 12 months!

•• Reason for Action Reason for Action

•• Chief Complaint orChief Complaint or

•• Problem StatementProblem Statement

•• Pick appropriate levelPick appropriate levelNote:Note:It is important when It is important when doing it for a real internal doing it for a real internal issue that we note whichissue that we note whichlevel of focus the A3 relateslevel of focus the A3 relatesto:to:--

•• ActivitiesActivities

•• MissionsMissions

•• TransformationalTransformational

The VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SMR (113) and income.

Therefore the event themesare:

a. Too many visits: focus is to reduce # of visits to the clinic.

b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.

c. Too many have temp access: focus is to reduce % of population with temp. access.

d. Demand > Capacity: focus is to meet demand.

a. # Visits (Morale)b. Time to get Date (Timeliness)

c. Temp v Def Access (Quality)

a. Morale

c. Timed. Increased activity= £ 375K net profit pa




Actions (Follow Up Req’d!)

1. Invite appropriate people

for discussion @ that time.

2. Manage more closely the

agenda for week

3. Make agenda available

before event in normal

“lingo” - clarify Day 4!

4. Involve Team Leader in

Simpler/Trans. Team calls

5. Plan to Run the Process

every time - it drives the

change in one week!

What went well?

Excellent Buy in from attendees.

Clinic trial (“run the process”)

FUN WEEK!

Agreed Future Process.

Stuck to itinerary.

What helped?

Tosh’s support and insight!

What hindered?

Discussions going off track.

Transient clinic: did not find a way

To make change visible/physical.


Not always one voice in the room!

Lack of Clinical Input (nursing &

Anaesthetist).

Lack of direction at times.





Reflections:

Reflections:

Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.

Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!

Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.

Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!

Root Causes: Ad hoc current process makes

Resource co-ordination impossible!

Reflections:




The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...

Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.

Follow up Action

Actual Effect

Anticipated Effect

Experiment

2 3 4 5 6 7 8 91

SM

Simpler

Team Members Left to Right; Steve Hart (GM),


Title: Renal One Stop ClinicProcess Owner: Breeda McManus & JP Nolan

Sponsor: Zafar Chawdhery & Alistair Chesser

Facilitators: Jane Holmes & Andy Fleming

Sensei: Steve Garnett

??OnNot on callA b DEstablish “on call” translator to Rota

?OFullNo supportDAgree level required with Pt Services

O?1000% YieldA b CRedesign Pt Info. Collection process

?X010 complaints/wkA b C DRapid Redesign Event on Transport

OOYesNo auth.A B C dRegister & authorise Clinic

OO1d200 daysA B C DSet up One Stop Clinic to reduce

CEFSCurrent StateAffecting Themes

SolutionCause/Priority

30/7JP2hEnsure all docs. Prepared for first clinic.

30/7D J L1dEstablish Info. Centre to manage problems arising.

30/7DC1hConfirm Rota for August

30/7ZC1hAgree Surgical/ Anestheticprotocols.

30/7EW1hAgree Pt. Info

30/7JP4hIdentify Pts for first clinic

RAG

DueOwnerTTAction

Barts &The London

400 miles traveled by patients often using BartsTransport!

The process starts with DGH referral and ends with a date for surgery.

Visi

ts to

clin

ic

8

2006/07

Many visits ˜ many miles NOK Patient Morale!

X

X X

Flow

Tim

e /d

ays

200

Typically ˜ 8 Months to get surgery!

X

2006/07

%

Acce

ss T

ype

58%

42%

Lines Def. Access

d. Throughput (Cost)

Thro

ughp

ut/w

eek

2006/07

The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…

a. # Visits (Morale)

Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!

b. Time to get Date (Timeliness)

Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acc

ess

Type

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO

The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):

Why?

5th Why?

Another event!

IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.

THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.

THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.

IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!

The VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SMR (113) and income.

Therefore the event themesare:

a. Too many visits: focus is to reduce # of visits to the clinic.

b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.



a. # Visits (Morale)b. Time to get Date (Timeliness)


a. Morale

c. Timed. Increased activity= £ 375K net profit pa






for discussion @ that time.


agenda for week








change in one week!

What went well?


Clinic trial (“run the process”)

FUN WEEK!


Stuck to itinerary.

What helped?


What hindered?


Transient clinic: did not find a way




Lack of Clinical Input (nursing &

Anaesthetist).

Lack of direction at times.





Reflections:

Reflections:

Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.

Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!

Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.

Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!



Reflections:






Follow up Action

Actual Effect

Anticipated Effect

Experiment

2 3 4 5 6 7 8 91

SM

Simpler

Team Members Left to Right; Steve Hart (GM),




Facilitators: Jane Holmes & Andy Fleming





?X010 complaints/wkA b C DRapid Redesign Event on Transport

OOYesNo auth.A B C dRegister & authorise Clinic









30/7JP4hIdentify Pts for first clinic

RAG

DueOwnerTTAction

Barts &The London

400 miles traveled by patients often using BartsTransport!


Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acce

ss T

ype

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!

b. Time to get Date (Timeliness)

Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acc

ess

Type

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO

The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):

Why?

5th Why?

Another event!

IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.

THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.

THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.

IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!


Tool

TechniquesBeliefs


Box 2 – The Initial StateThe VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SM R (113) and income.

Therefore the event them esare:

a. Too many visits: focus is to reduce # of visits to the clin ic.

b. F low Time too long: focus is to reduce time from referral to getting a date for surgery.



a. # Visits (Morale)b. T ime to get Date (T imeliness)


a. Morale

c. T imed. Increased activity= £ 375K net profit pa


c. T ime d. Actual Benefit = £ _____




for d iscussion @ that time.


agenda for week








change in one week!

W hat went well?


Clinic tria l (“run the process”)

FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?


Transient clinic: d id not find a way




Lack of C lin ical Input (nursing &

Anaesthetist).

Lack of d irection at times.





Reflections:

Reflections:

Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The orig inal VSA target was moderatedas it became clear that the higher target would require a third clinic.

Reflections:The Bar charts showed effic iency could jump from 55% to 83% and capacity from 6 to 8 com plex Pts if Vein Mapping is moved into process flow!

Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is d ifficult or h igh cost; hence the transport solution should be the subject of another event.

Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between in itial and targeted state!



Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler

Team Members Left to R ight; Steve Hart (GM),




Facilitators: Jane Holmes & Andy F leming





?X010 com plaints/wkA b C DRapid Redesign Event on Transport

OOYesNo auth.A B C dRegister & authorise Clin ic









30/7JP4hIdentify Pts for first clin ic

RAG

DueOwnerTTAction

Barts &The London

400 m iles traveled by patients often using BartsTransport!


Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!

b. T ime to get Date (T imeliness)

Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO

The cause of problems creating gap between in itia l & target state in themes a,b,c & d (ref box 1,2&3):

Why?

5th W hy?

Another event!

IN BOX 8 W E TRAC K AN D SHOW THE BEN EFIT /RESULTS.

THE FIRST UPDATE IS DUE 3RD AUGU ST 2007 FOLLOW INGFIRST RUN OF ONE STOP CLINIC .

THE GRAPHS COPY ACROSS FROM BOX TW O AN D THREE.

IF W E ARE NOT MEETING THE TARGETS W E NEED TO GOB AC K TO BOX 4 TO UNDERSTAN D W HY - AN EFFECTIVEINFO. CENTRE W ILL EASE THIS TASK !

The VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SM R (113) and income.








a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!





2.Graphically Present Initial State2.Graphically Present Initial State•• What is happening now?What is happening now?

•• Express the situation in time and unitsExpress the situation in time and units

•• Use data that can later Use data that can later ‘‘prove the caseprove the case’’


Tool

TechniquesBeliefs


Box 3 – The Target StateThe VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SM R (113) and income.








a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!













a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!





3.Graphically Present Target Condition3.Graphically Present Target Condition•• Agree targets to add to initial state Agree targets to add to initial state

graphsgraphs•• Be sure to record required target not Be sure to record required target not

what we what we ‘‘thinkthink’’ we can achievewe can achieve•• Wherever possible use voiceWherever possible use voice--ofof--thethe--

customercustomer


Tool

TechniquesBeliefs


Box 4 – Gap AnalysisThe VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SM R (113) and income.








a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!













a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!





4.Gap Analysis4.Gap Analysis

Identify all possible causes for the situationIdentify all possible causes for the situation

Cause and Effect Diagrams help hereCause and Effect Diagrams help here

Conduct investigations find Conduct investigations find ‘‘root causeroot cause’’

Use Basic where necessary the 7 basic Quality Tools (ex. Use Basic where necessary the 7 basic Quality Tools (ex. Pareto, Affinity Diagrams, Scatter Diagrams, Trend, 5 Pareto, Affinity Diagrams, Scatter Diagrams, Trend, 5 Whys) Whys)


Tool

TechniquesBeliefs


Box 5 – Solution approachThe VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SM R (113) and income.








a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!













a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!





5. Solution Approach5. Solution Approach

e.g. VSA, RIE, VVS, 6e.g. VSA, RIE, VVS, 6--Sigma, 3P (7 Alternatives), Sigma, 3P (7 Alternatives), (i.e. Known proven solutions from the SBS toolbox)(i.e. Known proven solutions from the SBS toolbox)


Tool

TechniquesBeliefs


Box 6 – Rapid ExperimentsThe VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SM R (113) and income.








a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!













a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!





6. Rapid Experiments6. Rapid Experiments

What happened when we tried stuff?What happened when we tried stuff?Did it work?Did it work?

Conclusion? Conclusion?


Tool

TechniquesBeliefs


Box 7 – Completion PlanThe VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SM R (113) and income.








a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!













a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!





7. Completion Plans7. Completion Plans

List Activities by Projects, Events, DoList Activities by Projects, Events, Do--its, and stopits, and stop--its its List List ‘‘Who and WhenWho and When’’ and track progressand track progress


Tool

TechniquesBeliefs


Box 8 – Confirmed StateThe VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SM R (113) and income.








a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!













a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!





8. Confirmed State8. Confirmed State

Relates all the way back to target condition. Relates all the way back to target condition. Have we achieved and close the gap?Have we achieved and close the gap?Does box 8 = box 3Does box 8 = box 3


Tool

TechniquesBeliefs


Box 9 – InsightsThe VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SM R (113) and income.








a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!













a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!





9. Insights9. Insights

Lessons Learned / breakthroughs / reflectionsLessons Learned / breakthroughs / reflections

What new things have we learned?What new things have we learned?


Tool

TechniquesBeliefs


A3 Link to the Activity Improvement Cycle

Not just an event report: standard work for prep, execution and Not just an event report: standard work for prep, execution and sustainmentsustainment

Prep PhasePrep Phase Execution PhaseExecution PhaseSustainment PhaseSustainment Phase

Formally Launch Cycle

Formally Launch Cycle

Set up A3 Header

Set up A3 Header

Complete A3 Boxes 1, 2 & 3

Complete A3 Boxes 1, 2 & 3

SPONSOR AGREES TO PROCEED?

SPONSOR AGREES TO PROCEED?Confirm

Team

Confirm Team

Train Team

Train Team

SENSEI REVIEW

SENSEI REVIEW

SENSEI REVIEW

SENSEI REVIEW

Complete A3 Boxes 4 & 5


Complete A3 Boxes 6

Complete A3 Boxes 6

Complete A3 Boxes 7

Complete A3 Boxes 7



Update TPOC/M

ission VSA

Update TPOC/M

ission VSA

Review/Update Box 7, 8 & 9

Review/Update Box 7, 8 & 9SENSEI REVIEW

SENSEI REVIEW

SENSEI REVIEW SENSEI REVIEW

SPONSOR SIGN OFF

SPONSOR SIGN OFF

& PULSE

& PULSE

--33 --22 --11

Team Leveling Review

Team Leveling Review

D1D1 D2D2 D3D3 D4D4 D5D5

Out brief using A3

Out brief using A3

WIP slot

WIP slot

available?

available?


Tool

TechniquesBeliefs


A3’s as a Management Process(example)

EnterprizeTPOC

CVSAA3

CashOneVSA A3

Wealth VSA A3

MortgageVSA A3

RIE 1 A3 RIE 2 A3 RIE 3 A3 RIE 1 A3 RIE 2 A3 RIE 3 A3 RIE 1 A3 RIE 2 A3 RIE 3 A3

Unit TrustVSA A3

RIE A3 RIE A3 RIE A3

LocationTPOC

A3

EVSAA3

DivisionalTPOC

A3

Owned by MDUpdated 6 Monthly with Simpler

Owned by AKUpdated monthly with BJUpdated quarterly with Sensei

Owned by “Process Owner”Updated monthly with BJ

Owned by “Process Owner”Updated weekly with Lean Team

1

2

3

4

NB: All A3’s live andused to drive improvementuntil target conditions aremet

Event complete Target met


Tool

TechniquesBeliefs


Healthcare ‘model’ exampleThe VSA highlighted patients typically visit the Renal clinic 8 times, taking 201 days to obtain a date for surgery. Consequently 42% of patients need temporary access impacting SM R (113) and income.








a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!













a. Morale









agenda for week








change in one week!

W hat went well?



FUN W EEK!


Stuck to itinerary.

W hat helped?


W hat hindered?







Anaesthetist).






Reflections:

Reflections:







Reflections:






Follow up Action

Actual Effect

Anticipated E ffect

Experim ent

2 3 4 5 6 7 8 91

SM

S im pler





















RAG

DueOwnerTTAction

Barts &The London



Visi

ts to

clin

ic

8

2006/07


X

X X

Flow

Tim

e /d

ays

200


X

2006/07

%

Acc

ess

Type

58%

42%

Lines Def. Access


Thro

ughp

ut/w

eek

2006/07



Visi

ts to

clin

ic

8

1

O

3

134 Pts pa

2006 Aug 07 onwards

X

X

Step Change!


Flow

Tim

e /d

ays

O200

1 X

X

Step Change!


%

Acce

ss T

ype

80%

Lines Def. Access

20%

High SMR

Thro

ughp

ut/w

eek

O12

6

3

X

X

2006 Aug 07 onwards

20/7 1/8 1/9 onwards

500 Pts paO


Why?

5th W hy?

Another event!






Tool

TechniquesBeliefs


Context:




Therefore:


a.

b.

c.

d.



c. Time d. Cost


















Reflections:

Reflections:


Reflections:


Reflections:




What did you learn and what are you going to do as a result? AND SO W HAT?

Follow up Action

Actual Effect

Anticipated Effect

Experiment

2 3 4 5 6 7 8 91

SM





Facilitator Sensei




RAG

DueOwnerTTAction

Add logo








Context:




Therefore:


a.

b.

c.

d.



c. Time d. Cost


















Reflections:

Reflections:


Reflections:


Reflections:





Follow up Action

Actual Effect

Anticipated Effect

Experiment

2 3 4 5 6 7 8 91

SM





Facilitator Sensei




RAG


DueOwnerTTAction

Add logo








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