Introducing the A3 – part 7: what to do, what to avoid

In this post I make specific suggestions that you may want to take into account as you prepare to develop, or are developing, an A3 to address a process issue.

Practical reminders in A3 development

  1. Define your scope! Start out right. Don’t go off on an “improvement” of a fuzzy or too broad issue.  What not to do is as important as what to focus on.
  2. Keep a narrow focus, think weeks rather than years to implement.  An A3 should truly be modest in scope, so do not go for fixes that may require 250 people across 6 departments over 5 years, or it will all blow up on you in the root cause and implementation phases. Rather, think 3-4 people over a few weeks/months as suitable for a typical A3, with a relatively narrow focus.
  3. If the problem is too big, break it up, and address the various sub-problems with individual A3s.  While you can have an “umbrella A3”, a good analyst will draw on various tools in his/her toolbox (ex. Value Stream Mapping, or VSM). Not everything is a nail, so don’t just hammer away with single-minded focus if all you have is a screwdriver.
  4. Don’t go it alone, get input from stakeholders!  Involve whoever needs to be a participant early. Don’t wait.  PI work is not to be done in isolation, and the A3 is no exception.  Don’t work away in your cubicle without periodically sharing insights with stakeholders and getting feedback.
  5. It bears repeating, you need to get buy-in from the end user/customer from the start.  This means active participation by them, not just a perfunctory nod and passive, hands-off behavior.  This is not always easy but, without it, fixes will be hard to implement, there will be no user ownership, and hence no long-term sustainability of the implemented fixes.  Occasionally, you may need to get your manager involved.
  6. Be methodical. Do not jump to the fixes immediately. Resist the urge to move too fast because “I know what’s wrong.”  You may well not know.  That’s what the analysis/root cause section is there for. Develop the A3 systematically. Don’t skip steps.
  7. Don’t stress over notational devices. But, not being a graphic artiste is not an excuse for communicating unclearly. Using terms incorrectly or being vague means chances of adoption of your fix plummet.  Get to know a few notational symbols really well, not just what they mean but where and when they are most applicable. Practice!
  8. Being unable to articulate things with the required clarity may also mean you don’t understand things as well as you think you do.  Be patient, be humble, be persistent.
  9. Learn to estimate and give (justified) ballpark figures.  Money isn’t the only measure of things, but it is a measure.  Think of costs in terms of potential savings that can be allocated to better patient care.
  10. Do not hide behind the fact that you don’t have the latest dollar figure for something, or that patient safety is “unquantifiable”.  Lingering patient safety issues can be described in terms of getting a bad reputation — itself leading to potential lawsuits, losing accreditation, missing out on revenue, rumors disruptive to morale and leading to excessive staff turnover (and rehiring/retraining costs), etc.
  11. Keep in mind that financial trends are just that. As such, they may not be apparent except over an extended time-frame. This means you may need to revisit an issue accordingly.
  12. Keep things in perspective. Avoid tunnel vision. Raise your eyes from your immediate environment, and look around.  What are other hospitals doing? If you don’t know (and you should), do some research. Yes, this means the library and/or relevant websites, including those dealing with best practices/standards.
  13. Don’t treat the A3 as “another yucky documentation task”, as it is first and foremost a thinking aid and, second, a means for effective, succinct communication and documentation.
  14. Understand that writing/rewriting/re-rewriting the A3 is normal. The pencil is important, the eraser even more so, so use them both.  Rewrites may be needed to state something more clearly or succinctly, or to document a new insight you’ve had.  Note: Hemingway thought poorly of “the first draft of anything” (look up the quote).  Remember this, and realize you’re not him.
  15. The immediacy of hand-writing and sketching puts the emphasis on the A3’s content rather than its appearance.  Get in touch with your inner kid again!




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