1. Denver Health Lean Training Created by: Katie Stanek, Lean Facilitator
A3 Thinking
Denver Health Lean Training
Created by:
Katie Stanek, Lean Facilitator
2012
Denver Health and Hospital Authority. All Rights Reserved

2. What is A3 Thinking? A3
Metric nomenclature for a paper size, equal to 11” x 17”
A3 Thinking
Consensus building process utilizing a systematic, documented methodology
Communication tool that follows a
logical and standard structure
A3 – doesn’t stand for anything – it is the size of the paper (11x17) – Way to represent process of identifying and solving a problem on one piece of paper. At Toyota, they thought that if you could do this on one piece of paper, you thought process was more structured and focused
At DH, we talk about A3 thinking a lot. Problem solving process and communication tool. We move through the 9 boxes to help us define, examine, and solve a problem.
We use the A3 document to represent the process we went through and communicate it to others.

3. Why Promote A3 Thinking? 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
A3 Thinking is one of the most important tools you will learn in this class and a DH. You can use it to define and address problems at any level or of any size. You can use it in your professional and your personal life.
A3 helps keep the PDCA cycle going, it organizes and focuses thinking, promotes transparency and visibility, is a way to communicate to others about your process.

4. How to Achieve A3 Thinking?
Do an A3 for all types of activities
Strategic planning
Problem solving/Decision making
Sharing good ideas/Proposing change
Value Stream Analysis/Rapid Improvement Events
Reporting progress/Policy deployment
Here at DH, we use A3 thinking for all of these activities:
Strategic planning
Decision making
Proposing changes
VSA and RIE (and any other Lean events)
A3 thinking is really PDCA thinking

5. Creating an A3 Define the purpose
Tell the story visually and logically
Beginning – Strategy/Problem identification - Reason for Action
Middle – Gap analysis, Solution Approach, Rapid Experiments
End – Completion Plans, Confirmed State
Updating A3s - “living document”
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)
You start an A3 with a definition of the problem – the Reason for Action.
As you progress through the A3, it guides you to look at your current situation, where you want to be, what the Gaps are and how you will address them. Then you experiment with the solutions proposed and find the best one. You write a completion plan for how you will implement the solution and a confirmed state (measurements of your process – before, after and on-going)
A3 is a living document. We use it as a way to guide us through our A3 thinking, to communicate our progress, and to help us sustain our changes.

6. Team:___________________________ Executive Sponsor: Process Owner:
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
The first step in creating an A3 is to state the Reason for Action.
NEXT SLIDE

7. What is the burning platform? What is the chief complaint?
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
Why are we doing this?
What is the burning platform?
What is the chief complaint?
The Reason for Action is the burning platform – why are we addressing this issue, why did we bring this team together, what is our biggest problem? Tie the Reason for Action into your strategic goals.
Specificity is key here. R4A – guides the rest of the A3, it scopes the problem and solutions and helps keep the team focused.

8. Describe attributes of the initial state – Quantitative & Qualitative
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 initial
state – Quantitative & Qualitative
Graphically present picture of
Initial State
Initial State – tells us where we are right now. Defines our current situation, both qualitatively and quantitatively.
Sometimes we ask teams to represent their current state with a picture.

9. Describe attributes of the target state – Quantitative & Qualitative
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
Target State – This is where we want to be once we’ve implemented our solutions. Also qualitative and quantitative in nature. We also sometimes represent our Target State in picture format.
Describe attributes of the target
state – Quantitative & Qualitative
Graphically present picture of
Target State
Are metrics defined and achievable?

10. What holds us back from the Target State?
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
What holds us back from the
Target State?
What are the root causes of these
road blocks?
Gap Analysis – Why doesn’t box 3 (Target State) match box 2 (Initial State)?
This is where we conduct our Root Cause Analysis – Fishbone or Cause and Effect Diagrams, Affinity Diagrams, 5 Whys. RCA is so important because if you don’t identify and address the root cause or causes, you will not create lasting improvements, and you will likely find yourself conducting another event or going through another A3 process on the same problem later.

11. Gap Analysis Affinity diagrams Scatter diagrams Pareto charts 5 Whys
Fishbone diagrams
Here are some of the tools we use as part of the Gap Analysis:
Affinity: A tool that gathers large amounts of language data (ideas, opinions, issues) and organizes them into groupings based on their natural relationships
Used: Sift through large volumes of data; Encourage new patterns of thinking
Scatter: a type of mathematical diagram using Cartesian Coordinates to display values for two variables for a set of data
Pareto: 80/20 rule – 80 percent of problems come from 20% of causes. The purpose of the Pareto chart is to highlight the most important among a (typically large) set of factors .
Fishbone/Cause and Effect/Ishikawa: identifies many possible causes for a problem and categorizes them
5 Whys: Identify an issue – keep asking why until you get to the root of the issue.

12. Fishbone Major Problem or Issue People Procedures Policy Patients &
Communication
“Head” of the fish is the problem statement
“Bones” of the fish are broad categories of where the issues come from – People, Place, Policy, Procedure or Man, Method, Machine, Material, Mother Nature or come up with your own categories
And more specific statements related to each of the categories
Policy
Patients &
Families

13. Does solution approach link well with the root cause identified in
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
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?
Solution Approach – If/Then statements that show how we are going to address the gaps and root causes to get us to our target state.
Also guides our rapid experiments – what and how will we test our changes?

14. Expect the Solution Approach to
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
This is where you get to test if your solution approach is correct and accurate. Success doesn’t and shouldn’t always come with the first experiment.
You may have to experiment, come back together and talk about the experiment, make changes, and then experiment again. You may have to go back to your root causes and make sure you’ve identified them entirely and correctly.
Expect the Solution Approach to
not be perfect- Run the tests of change!
Are Rapid Experiments achieving
desired results and learning?

15. Rapid Experiments Observe what works Observe what doesn’t work yet
Record the new process performance
Collect data based on observation
Document issues and begin to resolve problems
Do not talk or think yourself out of trying new ideas
Go into the Gemba and test out your solution approach.
What works and what doesn’t, measure new process to see how it works, make tweaks and try those – should be doing LOTS of experimenting.

16. Start Making Meaningful Change
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
It’s good to get out in the Gemba testing your new process and talking to people who work there. Many times teams want to just sit in the room and keep talking about changes instead of testing them, but the key is to see what works, gather feedback from your customer(s) and ensure you’re creating the right improvements.

17. Is Completion Plan in place with names, dates, & outcomes?
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
Is Completion Plan in place with
names, dates, & outcomes?
Is Completion Plan on track?
Completion Plan – Action plan for how you did/will implement your solution approach.
Use this in 30/60/90 day follow-up meetings – are we on track?

18. Completion Plans Action Item Responsible Date Completed Action Item
Responsible Party
Date Completed, or when it will be completed

19. Are Confirmed State metrics in place and do they validate the
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
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?
Confirmed State – Does box 8 match box 3? It should.
Make sure metrics here are clear and easily measureable. Should have baselines and targets for each measure and be consistently measuring your process and tracking against goals.

20. Do insights show key lessons learned and identify future
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
Key lessons learned while examining this process more closely.
Do insights show key lessons
learned and identify future
opportunities?

21. Questions?

22. A3 Activity
Pick a problem in your area
Complete the A3