A3 Thinking
Denver Health Lean Training
Created by:
Katie Stanek, Lean Facilitator
©
2012
Denver Health and Hospital Authority. All Rights Reserved
What is A3 Thinking?
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A3
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Metric nomenclature for a paper size, equal to 11” x 17”
A3 Thinking
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Consensus building process utilizing a systematic,
documented methodology
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Communication tool that follows a
logical and standard structure
©
2012
Denver Health and Hospital Authority. All Rights Reserved
Why Promote A3 Thinking?
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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
©
2012
Denver Health and Hospital Authority. All Rights Reserved
How to Achieve A3 Thinking?
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Do an A3 for all types of activities
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Strategic planning
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Problem solving/Decision making

Sharing good ideas/Proposing change
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Value Stream Analysis/Rapid Improvement Events
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Reporting progress/Policy deployment
©
2012
Denver Health and Hospital Authority. All Rights Reserved
Creating an A3
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Define the purpose
Tell the story visually and logically
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Beginning – Strategy/Problem identification - Reason for
Action
Middle – Gap analysis, Solution Approach, Rapid
Experiments
End – Completion Plans, Confirmed State
Updating A3s - “living document”
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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)
©
2012
Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________
Date Started:_______Current Date:_________
Team:___________________________
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
©
2012
Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________
Date Started:_______Current Date:_________
1. Reason for Action
Team:___________________________
Executive Sponsor:
Process Owner:
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?
©
2012
Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________
Date Started:_______Current Date:_________
Team:___________________________
Executive Sponsor:
Process Owner:
1. Reason for Action
4. Gap Analysis
7. Completion Plans
2. Initial State
5. Solution Approach
8. Confirmed State
6. Rapid Experiments
9. Insight
Describe attributes of the initial
state – Quantitative & Qualitative
Graphically present picture of
Initial State
3. Target State
©
2012
Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________
Date Started:_______Current Date:_________
Team:___________________________
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
Describe attributes of the target
state – Quantitative & Qualitative
Graphically present picture of
Target State
Are metrics defined and achievable?
©
2012
Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________
Date Started:_______Current Date:_________
1. Reason for Action
Team:___________________________
Executive Sponsor:
4. Gap Analysis
Process Owner:
7. Completion Plans
What holds us back from the
Target State?
What are the root causes of these
road blocks?
2. Initial State
5. Solution Approach
8. Confirmed State
3. Target State
6. Rapid Experiments
9. Insight
©
2012
Denver Health and Hospital Authority. All Rights Reserved
Gap Analysis
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Affinity diagrams
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Scatter diagrams
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Pareto charts
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5 Whys
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Fishbone diagrams
©
2012
Denver Health and Hospital Authority. All Rights Reserved
Fishbone
Major Problem
or Issue
People
Procedures
Communication
Policy
Patients &
Families
©
2012
Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________
Date Started:_______Current Date:_________
Team:___________________________
Executive Sponsor:
Process Owner:
1. Reason for Action
4. Gap Analysis
7. Completion Plans
2. Initial State
5. Solution Approach
8. Confirmed State
Does solution approach link well
with the root cause identified in
the Gap Analysis?
Does the Solution Approach
express the hypothesis to be
validated or adjusted through
Rapid Experiments?
3. Target State
6. Rapid Experiments
9. Insight
©
2012
Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________
Date Started:_______Current Date:_________
Team:___________________________
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
Expect the Solution Approach to
not be perfect- Run the tests of
change!
Are Rapid Experiments achieving
desired results and learning?
©
2012
Denver Health and Hospital Authority. All Rights Reserved
Rapid Experiments
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Observe what works
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Observe what doesn’t work yet
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Record the new process performance
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Collect data based on observation
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Document issues and begin to resolve problems
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Do not talk or think yourself out of trying new ideas
©
2012
Denver Health and Hospital Authority. All Rights Reserved
Start Making Meaningful Change
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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
©
2012
Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________
Date Started:_______Current Date:_________
1. Reason for Action
Team:___________________________
Executive Sponsor:
4. Gap Analysis
Process Owner:
7. Completion Plans
Is Completion Plan in place with
names, dates, & outcomes?
Is Completion Plan on track?
2. Initial State
5. Solution Approach
8. Confirmed State
3. Target State
6. Rapid Experiments
9. Insight
©
2012
Denver Health and Hospital Authority. All Rights Reserved
Completion Plans
Action Item
Responsible
©
Date Completed
2012
Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________
Date Started:_______Current Date:_________
Team:___________________________
Executive Sponsor:
Process Owner:
1. Reason for Action
4. Gap Analysis
7. Completion Plans
2. Initial State
5. Solution Approach
8. Confirmed State
Are Confirmed State metrics in
place and do they validate the
target state?
Does confirmed state show what
“good” looks like in a way that
cannot be misunderstood?
3. Target State
6. Rapid Experiments
9. Insight
©
2012
Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________
Date Started:_______Current Date:_________
Team:___________________________
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. Insights
Do insights show key lessons
learned and identify future
opportunities?
©
2012
Denver Health and Hospital Authority. All Rights Reserved
Questions?
©
2012
Denver Health and Hospital Authority. All Rights Reserved
A3 Activity

Pick a problem in your area
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Complete the A3
©
2012
Denver Health and Hospital Authority. All Rights Reserved
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A3 Thinking Training