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A3 Thinking
Denver Health Lean Training
Created by:
Katie Stanek, Lean Facilitator
©2012Denver Health and Hospital Authority. All Rights Reserved
©2012Denver Health and Hospital Authority. All Rights Reserved
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
©2012Denver Health and Hospital Authority. All Rights Reserved
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
©2012Denver Health and Hospital Authority. All Rights Reserved
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
©2012Denver Health and Hospital Authority. All Rights Reserved
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)
©2012Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________
Team:___________________________Team:___________________________
Executive Sponsor: Process Owner: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
©2012Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________
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?
Team:___________________________Team:___________________________
Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:
©2012Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________
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 initialstate – Quantitative & Qualitative
Graphically present picture of Initial State
Team:___________________________Team:___________________________
Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:
©2012Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________
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 targetstate – Quantitative & Qualitative
Graphically present picture of Target State
Are metrics defined and achievable?
Team:___________________________Team:___________________________
Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:
©2012Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________
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 theseroad blocks?
Team:___________________________Team:___________________________
Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:
©2012Denver Health and Hospital Authority. All Rights Reserved
Gap Analysis
Affinity diagrams
Scatter diagrams
Pareto charts
5 Whys
Fishbone diagrams
©2012Denver Health and Hospital Authority. All Rights Reserved
Fishbone
People Procedures
Policy
Communication
Patients & Families
Major Problem or Issue
©2012Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________
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 wellwith the root cause identified inthe Gap Analysis?
Does the Solution Approachexpress the hypothesis to be validated or adjusted throughRapid Experiments?
Team:___________________________Team:___________________________
Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:
©2012Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________
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
Expect the Solution Approach tonot be perfect- Run the tests of change!
Are Rapid Experiments achieving desired results and learning?
Team:___________________________Team:___________________________
Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:
©2012Denver Health and Hospital Authority. All Rights Reserved
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
©2012Denver Health and Hospital Authority. All Rights Reserved
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
©2012Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________
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 withnames, dates, & outcomes?
Is Completion Plan on track?
Team:___________________________Team:___________________________
Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:
©2012Denver Health and Hospital Authority. All Rights Reserved
Completion Plans
Action Item Responsible Date Completed
©2012Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________
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 thatcannot be misunderstood?
Team:___________________________Team:___________________________
Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:
©2012Denver Health and Hospital Authority. All Rights Reserved
TITLE:_________________________________ TITLE:_________________________________ Date Started:_______Current Date:_________ Date Started:_______Current Date:_________
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
Do insights show key lessons learned and identify future opportunities?
Team:___________________________Team:___________________________
Executive Sponsor: Process Owner:Executive Sponsor: Process Owner:
©2012Denver Health and Hospital Authority. All Rights Reserved
Questions?
©2012Denver Health and Hospital Authority. All Rights Reserved
A3 Activity
Pick a problem in your area
Complete the A3