a3 thinking nhsiq 2014

© NHS Improving Quality 2014

A3 Thinking

Patient Safety TeamLisa.smith@nhsiq.nhs.uk

© NHS Improving Quality 2014

A3 Thinking

• What do we mean by A3 Thinking?• Why do we use it?• How do we use it?

© NHS Improving Quality 2014

What is A3 Thinking?

• Structured thinking way - thinking deeply• Follows a series of standard steps• Rigorous application of PDSA cycle

• Output is a concise, consensed document - A3 Report (11 x 17 inch paper)

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PLAN

DOSTUDY

ACT

1. Is the problem statementCLEAR and ACCURATE?

2. Has the SYSTEMICroot cause(s) been

identified for all parts of process?

3. Has IRREVERSIBLECORRECTIVE ACTION(s)been implemented forALL root causes?

4. Has a plan been identifiedto verify theEFFECTIVENESSof all corrective actions?

5. Has a plan been identifiedto STANDARDIZE and takeall lessons learned across

products, processes, functional areas, etc.?

Understand the problem

Execute the PlanFollow-up

Standardize

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Why do we use A3 Thinking?

• Problem solving methodology:– Visual– Simple– Logical– Countermeasure, not containment (“Band aid”)

– Move towards Ideal System• Document & share the learning• Standardise new method

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How do we use A3 Thinking?• Consensus on initial problem

perception…..• A guide for:

– Understanding the problem– Identifying the root cause– Developing countermeasures– Creating an action plan

• Good A3 report should convey the problem & analysis of it without any explanation

© NHS Improving Quality 2014

FormatTitle:

Problem:

Version: Date:Author:

Current condition:

Target condition:

Root cause analysis:

Responsible: Team members:

Proposed countermeasures:

Plan:

Follow up:

Agreed by: Date:

© NHS Improving Quality 2014

FormatTitle:

Problem:

Version: Date:Author:

Current condition:

Target condition:

Root cause analysis:

Responsible: Team members:

Proposed countermeasures:

Plan:

Follow up:

Agreed by: Date:

• Customer/patient value• Basic problem

• What is happening? (data/graphs, photos, current state value stream map)

• Set SMART Goal

• Investigate why problem is happening

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Fishbone / Cause & Effect

Checked possible Not cause of Cause 1 problem

Checked possible Direct cause Cause 2

Checked possible ContributoryCause 3 cause

IDEA INVESTIGATIONS RESULT

idea

idea

idea

Investigate possible causes further (data collection)

Identify possible causes

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5 Whys Analysis

Problem Root Cause Countermeasure

Why?

Why?

Why?

Why?

Why?

Reason

Reason

Reason

Reason

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FormatTitle:

Problem:

Version: Date:Author:

Current condition:

Target condition:

Root cause analysis:

Responsible: Team members:

Proposed countermeasures:

Plan:

Follow up:

Agreed by: Date:

• Investigate how to solve root cause(s)

• Agree action plan− What− How− Who− When

• Is the problem solved?• Has the goal been met?

© NHS Improving Quality 2014

© NHS Improving Quality 2014