A3 Reports

The A3 report is so named because it is written on an A3 sized paper (metric equivalent of 11” x 17”). The report flows from top to bottom on the left-hand side, then top to bottom on the right-hand side. Every report starts with a descriptive title. The title indicates the problem being addressed. The title should focus on the problem, and not advocate a particular solution. The A3 report participants describe any pertinent background information that is essential to understanding the extent and importance of the problem. Items that might be included in this section are how the problem was discovered, why the problem is important to the organization’s goals, the various parties involved, the problem symptoms, past performance or experience, organization structure, and so forth.

Current Condition

The author draws a diagram that depicts how the system that produced the problem currently works. Problems are highlighted on the diagram with storm bursts. Also, the author should quantify the extent of the problem (e.g., percent defects, hours of downtime, etc.), and display this information graphically or numerically somewhere in the current condition. The diagrams should be neatly drawn, and readily understandable to any knowledgeable reader.

The act of drawing a diagram enables deeper understanding by helping the author organize knowledge and learning gained from observation compactly. Second, the diagram quickly and effectively communicates the core issues to others. The graphical medium can contain a very dense amount of information, and yet readers can pick it up quickly because of the pictorial representation. Thirdly, by diagramming the system, problem-solving efforts are focused on the system rather than the people.

Root Cause Analysis

As a participant comes to understand the current condition in a deep and meaningful way, it becomes imperative that s/he comes to understand the root cause of the problem symptoms shown as storm bursts in the current condition diagram. Failing to address the deeply rooted seed of the problem means it will likely recur.

Target Condition

Now that the problem-solver has a keen understanding of how the work currently gets done, and has a good grasp of the root cause(s) of the problems experienced with the system, s/he is now ready to consider how the system might be improved. Lean Healthcare identifies these improvements as countermeasures because it implies that; a) One is countering a specific problem, and b) it is what we will use now until we discover an even better countermeasure. The countermeasures address the Root Cause(s) while conforming to the A3 design principles. The goal is to move the organization closer to an ideal state of providing exactly what the customer (patient) needs, safely, when needed, in precisely the right quantity, and without waste. With countermeasures in mind, the participants draw a diagram of the target or Future condition; that is, a diagram of how the envisioned system will work with the countermeasures in place.

Implementation Plan

The implementation plan outlines the steps that must be accomplished in order to realize the target condition. The author lists the steps, when they need to be done, and who is responsible. Since implementation is an activity, it should conform to the activity design principle (i.e., specify the content, sequence, timing, and outcome).

Follow-up Plan

How will the participants know that the new system is actually better than the old? The follow-up plan indicates how and when the Team Leader (or other designate) will measure the improvement of the system or the results of a specific test. It should include a realistic and quantified prediction of how the new system will perform. The prediction should be as accurate as possible, based upon the participants deep understanding of the work and the countermeasures planned

Results Report

LEAN Healthcare problem-solvers draft a status report to report on follow-up results. It is fairly extensive, including a list of shortcomings and plans to address them.