A3 Problem Solving

Seeking to Understand Problems, Big and Small

Lisa Segerstrom
10/02/2018
What does A3 Mean?
De-Mystifying a simple tool
 The A3 Method
• A3 simply refers to a paper size (11x17 aka A3).

• Mainstay of the Toyota Production System for:

• Proposals
• Status Reports
• Problem Solving

A3 is an approach to problem solving that grew out of Lean Manufacturing at

Toyota. The A3 report condenses project information onto a single page in an
easy-to-read, graphical format. This A3 template provides sections for describing
background information, current conditions, root cause analysis, target
conditions, implementation plan, and follow-up.
Why Use A3?
• Basic methodology to:
• Identify problem, gap, or need
• Understand current state
• Develop simple target
• Understand root cause
• Brainstorm or identify countermeasures
• Create action plan
• Check results of corrective actions or improvements
• Sustain results
Same Idea, Different Templates
No standard template – your organization or department
may have preferred template.
 A3 Report: Project name
Project mission statement Solution
What is the team trying to accomplish? • Describe recommendations of team
• Show diagram or map of new process
• Measurable targets to achieve within determined timeframes

Background
• Problem background
• Why the problem needed to be fixed Implementation plan
• Importance of identifying solution • Use a diagram if possible
• Who is responsible for which tasks?
• What resources are required?
• What targets have been identified? Timeline for achieving?
Original state/problem statement • How regularly will the improvement team connect while the
• Use a diagram if possible change is underway?
• Show where the problems exist with Kaizen bursts, i.e. graphic
indicators of opportunities for improvement
• Extent of the problem (e.g., metrics or measures of success that
are below target)
Graph results
Show improvement over time

Problem analysis 10
• Why does the problem exist?
• Does asking “why?” five times help identify the root cause?
• What influences caused the problem?
0

Sustain
Team Implementing a project doesn’t guarantee long-term success. How
Executive sponsor: does the team plan to continue to make the improvement part of daily
Champion: practice, long after the “project” as ended? Determine metrics to
Team lead(s): track, feedback loops for staff, and maintain regular A3 updates to
Project team: List names and departments share with the team and supporting leadership.

Source: AMA. Practice transformation series: starting lean healthcare. 2015.

 Project Lead: Project Team:
A3 Project Title Project Champion(s):
Date Updated:

1) Problem Statement: (description of the problem and its effect) 5) Solutions: (action plan and findings of tested solutions)
Root Cause Tested Solution Responsible Due Finding

2) Current State: (depiction of the current state, its processes, and problem(s)

Best Practices/Literature Search:

6) Check: (Summary of the solutions’ results, overall goal success, and any supporting metrics)

3) Goal: (how will we know the project is successful; standard/basis for

comparison)

Goal & Metrics Baseline Target Current

4) Root Cause Analysis: (investigation depicting the problems’ root causes)
Goal

Supporting Metric

Supporting Metric

7) Act: (Action taken as a result of the Check, and the plan to sustain results)

*A3 is a UCLA Operating System 11x17 template used to document and communicate complex problem-solving using the Plan Do Check Act (PDCA) method: Steps 1-4 (Plan), Step 5 (Do), Step 6 (Check), Step 7(Act)
A3 PROBLEM SOLVING TOOL: Contact:
Date:

<Title> <Name> <date>

BACKGROUND / BUSINESS CASE SOLUTIONS
• What issue or problem do we need to solve? What solutions will solve the root causes? (Tools: Brainstorming and Affinity Diagram)
• Why is this issue important to solve now? • What solutions are best and we should recommend?
• What benefits do we anticipate from solving the problem (e.g., quality, timeliness, cost,  Tool for a few primary options: Impact/Difficulty Matrix
customer/employee satisfaction)?  Tool for many options: Criteria Decision Matrix
 Consider including an evaluation of the status quo (no change) option
STAKEHOLDERS • What impacts (positive and negative) may result from implementing the solutions? (Tool:
• Who are internal and external customers? Impact Wheel, FMEA)
• Who are team members that will complete the A3 Problem Solving Tool? • How will we mitigate or resolve negative impacts?
• What communication or stakeholder engagement is needed? (Tool: Communication Plan)
CURRENT CONDITION • What training is needed?
• What do we know? What customer, process, program data/measures do we have on the
problem (location, patterns, trends, frequency, factors)? Answer questions like: What ACTION ITEMS
errors are occurring? Who is making the errors? Where are the errors occurring? When are
the errors occurring? How are the errors occurring? Task Owner Proposed Actual
• What don’t we know and need to find out? We may need to develop a Data Collection Plan Date Date
that includes: The information/data we need to collect, who will collect the data, data
sources, who will prepare the visuals (bar chart, trend, pie chart), when and who will be sent
the data.
• What is the Problem Statement? What specific performance measure needs to improve?
We need to understand the scope and nature of the problem before we can create a
problem statement. More analysis may be needed if the team cannot write a problem
statement.
 Example: Reduce/Increase the number/percent of <?> from <current level> to
<desired level> by <date>. • What tasks or actions do we need to take? Who will be responsible for the task? When
should the task be completed? (Tools: Action Plan, Gantt Chart)
• What support and resources are needed for each task?

ANALYSIS/ROOT CAUSES METRICS/FOLLOW-UP

• What are root causes? Why are the errors occurring? • What metrics will we use to track progress and performance? How will we validate results?
 If the root cause is not obvious, use a root cause analysis tool. Use the simplest • How and when will we check progress and performance (e.g., daily, weekly, 30, 60, 90-
tool to show cause-and-effect down to the root cause(s). The root cause should be days)?
specific – not vague like “poor communication”. • What processes will we use to enable, assure, and sustain success?
 Tools: 5 Whys, Fishbone diagram, or Affinity and Relations diagrams • How will we communicate results and share what we learn with others?
• Does our data verify the root causes? – a team may need to collect additional data to
verify the root cause(s)
A3 TITLE: Owner: Sponsor/Manager: Version #: DATE:

Problem Statement (Describe the Problem) Implementation Plan/Countermeasures/Outcome

WHAT will be done By WHOM By WHEN What was the OUTCOME

Historical Trend/Background (Current State of the Situation)

Root Cause Analysis

Target/Goal(s) Summary/Wrap-Up/Next Steps

Benefits of Using A3 Fishbone
• Unlike many other quality improvement tools, it doesn’t require
much instruction or orientation to the process – it’s fairly intuitive.
• Helps focus on process issues or common human error rather than
individual performance.
• Helps shift focus from symptoms of defect to causes of defect.
• Helpful when data isn’t available to identify exact root causes.
• Can help identify other process issues that can be relatively
hidden.
• Allows for identification of all possible causes.
• Allows for clear visual representation of the problem and causes
and process used to come to improvement actions.
A Word of Caution
• When using the cause and effect or fishbone for
problem solving, identified causes are based on
perception and should not be considered quantitative
analysis. It is best suited for problems that do not have
hard data to use to discover causes.
• Some potential causes identified during the exercise
will be worthy of further analysis or verification.
• It is possible to focus on solving problems that
ultimately have little effect on the problem.
• Best when the exercise involves representatives of all
stakeholders.
How to Use A3/Fishbone
• Clearly identify your problem – what are the “bookends”.
• Consider impact to patients as a compelling argument to
get attention to the problem.
• Make sure there is appropriate leadership support for
working on this problem.
• Identify stakeholders – this exercise is best when all
stakeholders have a representative at the table (think
outside the box about who this might be).
• Identify a facilitator and, if resources allow, a note-taker.
(My preference is for both not to be direct stakeholders)
• Schedule an appropriate space and amount of time
(typically at least 90 minutes).
The Nuts and Bolts of Facilitating Fishbone Problem Solving
• Provide a paper copy of the template to everyone but use a whiteboard
or flip chart to capture potential causes.
• Facilitate effective brainstorming – no idea is bad or criticized, all offered
causes are recorded and included.
• Ask probing questions to dig deeper into potential causes and to clarify.
• Instruct the group to ignore the categories (Human, Training, Equipment,
Policy/Procedure, Process, Equipment)
• These are suggestions and can by modified as necessary including excluding
some or adding others. (there is no set number required)
• Trying to categorize causes as they are shared will derail your facilitation as
well as limit participants ability to think about all potential causes.
• Once all possible causes seem to be exhausted, ask the group to identify
which of the causes seem to be the most important to solve first (ask if
any need additional data or validation).
• Transfer everything to the template after the session and send to
everyone to review for accuracy.
Problem-Solving Story

January 24, 2014

Example: Two patient ID
The ‘Do’s’ and ‘Don’ts’ of Effective Brainstorming
Easy Enough, But Now What?
• As with any quality improvement project, you want to have a
solid work plan, method for assessing if the improvements have
had the desired effects (or not), and a plan for sustaining
improvements.
• Once you have completed Step 4 with a high level action plan,
create a more detailed work plan for actions/improvements that
are complex, multi-phased, involve multiple departments, or
require significant resource.
• Use your organizations preferred tool. Should, at a minimum,
include:
• One person responsible for completing or overseeing completion
of each task
• Target date for completion for each task
A3 TITLE: Owner: Sponsor/Manager: Version #: DATE:

Problem Statement (Describe the Problem) Implementation Plan/Countermeasures/Outcome

• We experienced 50 patient identification errors last month with the majority being
WHAT will be done By WHOM By WHEN What was the OUTCOME
mislabeled or unlabeled specimens. This can result in delayed diagnosis, wrong
diagnosis, or patients having to come for repeat testing which is dissatisfying for Each detailed action step Name Target Date
them and costly for us.

Historical Trend/Background (Current State of the Situation)

We experienced an unexpected increase in the number of mislabeled or unlabeled
specimens last month. We brought together stakeholders from the nursing staff, lab,
and medical staff to complete A3 problem solving to better understand what may be
contributing to these defects. We prioritized our findings to focus on:
• Ensuring all patients are wearing identification bands.
• Increasing font size on specimen labels to make it easier to see.
• Replacing current specimen labels with a new product that better adheres to
containers
• Improving staff training, clarifying expectations, and developing process to monitor
practice.
Root Cause Analysis

Target/Goal(s) Summary/Wrap-Up/Next Steps

• We will continue to monitor defects as we make these improvements to be sure
• At least 50% reduction in two-patient identification errors in Q4
they are having the desired effect.