There are many Lean tools available to use to improve a process. But oftentimes it’s difficult to select the appropriate one because the issue isn’t clearly defined. This leaves managers asking, “What tool is the most appropriate? How do I communicate the need for this process change? Is the issue worthy of a full Lean event such as kaizen or can I solve the problem in a different way?”
The A3 approach might be the way to go. What is A3? By most people’s definition it’s an international standard paper size similar to an 11 X 17 sheet of paper. But in Lean terminology, it’s more than that. It can be waste-free report writing, a continuous improvement activity, a form of visual management or a method of communication. However you decide to use the tool, there are six steps to the process:
Step 1: Identify a problem or need
There are few things both more fundamental and more frequently fouled than the problem statement. How you structure the problem statement determines your focus. Make sure your problem statement is actually about the current observable condition, not about a perceived solution, cause or what you want. Be descriptive, focus on the problem — not on solutions. Don’t combine multiple problems into one. Provide background information that’s essential to understanding the extent and importance of the problem, such as how the problem was discovered, why the problem is important to the organization’s goals, the various parties involved and the problem’s symptoms. The problem statement can also be referred to as the issue and the background.
Step 2: Define the current condition
This is not a sit-down exercise; it’s an activity. Go observe. See what’s actually happening. You want the as-is, not the supposed-to-be or the “my belief is” version of reality. The data used to develop the current condition diagram is collected through direct observation. This gives you an in-depth and detailed understanding of the current process as it’s actually performed – not how it should be done or how someone says it’s done. The data for describing the extent of the problem should also be actual data, not educated guesses. The power of direct observation is the objectivity of the information, void of emotion or assumption.
You should also create a visual representation of the current condition in a diagram. This helps the author come to a deeper understanding by forcing him or her to organize knowledge and learning gained from observation in a compact manner. In doing so, the diagram quickly and effectively communicates the core issues to others. By diagramming the system, problem-solving efforts are focused on the system rather than the people, resulting in a much more objective approach with less defensive posturing and finger-pointing.
Step 3: Complete a root cause analysis
Just like defining the current condition, this is not a sit-down exercise. Once at the workplace, while observing processes, you can utilize a method known as the “5 Whys.” This method provides a level of inquiry deep enough to get to the root cause of a problem by asking “Why?” five times. Each ‘Why’ question is dependent upon the answer to the previous question. It goes something like this:
My college-age son just received a failing grade on an advanced calculus exam. My assumption was that he’s in over his head by taking too difficult a course. But, I must get at the root cause for his failing grade before I can give him any advice on what to do.
Question 1: Why did you not score well on the quiz?
Answer: I didn’t study.
Question 2: Why did you not to study?
Answer: I overslept the morning of the quiz.
Question 3: Why did you oversleep?
Answer: I stayed up too late the night before.
Question 4: Why were you up so late?
Answer: I was socializing.
Question 5: Why were you socializing instead of thinking about your studies?
Clearly from this answer, I will take a different course of action than what I originally planned.
Step 4: Develop a target condition and countermeasures
Target condition is not the result you will achieve; it is an ideal state to strive for. We don’t just want to uncover solutions to problems; we want to design the work to create a new and better reality. Bad systems beat good people, and our job is to change the system. Countermeasures are how you will change the work in order to get to the ideal state.
When developing a target condition, you should strive to eliminate the work-arounds and re-work involved in the current condition. Create a graphic of the ideal state (remember why we use graphics rather than text from our current condition explanation). The ideal state should be defect free, no waste and safe for all.
Step 5: Create an implementation plan
At this point, we’ve determined our problem statement, drawn the current state of the issue, completed a root cause analysis of the problem, created our ideal future state and written countermeasures to help achieve the ideal state. Now we need to implement the countermeasures. The implementation plan outlines the steps that must be accomplished in order to realize the target condition. The A3 author lists the steps, when they need to be done, and who is responsible for completing them. When creating the implementation plan it’s important to specify the content, sequence, timing, location and outcome of each step.
Perhaps the most important part of the implementation plan is a pilot test. You must complete a real-time trial with front line employees to validate the new process and gain their feedback.
Step 6: Prepare a follow-up plan
The follow-up plan will insure sustainability and success over time by measuring the process and the outcome. Just as with the implementation plan, measuring and following up must be assigned to an owner on a frequency that is achievable. For example, if you’re measuring a process step that occurs 25 times each day and the measurement is done by direct observation, one person isn’t able to observe all 25 instances of the process. Select a sample size that’s both meaningful and achievable and report those results. Reporting the results is an important part of the sustainment. If we’re going to measure something or someone, we owe it to them to give the feedback in real time. This is best done at daily or shift huddles when staff who perform the process are present. Focus on the process and not the people and you’ll engage the staff in the new process as well as sustain the results.
About the author. As senior consulting director, Dan Littlefield uses his more than 30 years of health care experience to lead Lean, process improvement and transformational consulting engagements for Vizient members. His experience includes improving patient throughput and clinical outcomes across numerous health care disciplines including imaging, laboratory, nursing, pharmacy and ambulatory care clinics. Littlefield began his health care career as a nuclear pharmacist and has also served as director of operations with responsibility for 13 facilities. He has been a featured speaker at a variety of health care industry events.