A3 Writing HFPS PDCA Road Map
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1 A3 Writing HFPS PDCA Road Map Scientific Problem Solving Ruan C. Varney, CT, CQE, SSBB Henry Ford Health System Core of an improvement process
2 Objectives The Participants will be able to describe: What is an A3? A3 thinking process A3 Report Problem solve using PDCA cycles Exercise A3 writing in groups Presentation
3 What is an A3? Problem-Solving like telling a story Vital information- plan, data & solution 11x 17 size Communicated by fax Visual communication tool Team based problem solving using (Plan-Do-Check-Act) cycles Liker JK. The Toyota Way Field Böök: A Practical Guide for Implementing Toyota s 4P s. McGraw-Hill; 2006.
4 A3 Thinking A3 Thinking Concept of an Ideal state Exactly what customer needs The 4 Rules of work 1. Activities: Work clearly defined - Content, Sequence, Timing & Outcome On demand- when, where needed No waste, Defect Free Safe for allcustomers & suppliers Lee & Woll Reflections on the Idealized Design Planning Process CQM Journal, Spring Connections: The Hand off between customer & supplier, no ambiguity -Yes/No answer 3. Pathways: Information flow - Simple & Direct 4. Improvement: Made using PDCA cycles, by those who do the work, in real time Spear & Bowen Decoding the DNA of the Toyota Production System Harvard Business Review 1999
5 Core of an Improvement Process Core of an Improvement Process Shewhart or Deming cycle Study results What did we learn? Plan What change is needed? What data is needed? Act Observe the effects of the pilot Never ending Repeat: Plan,Do.... Check Do Carryout the change Pilot the decision
6 A3 Report A3 Report Plan Reason for Improvement Define the problem clearly & narrow down issue Consider customer s need Do-Check-Act Counter Measure Implement the agreed countermeasures that will correct the root cause of the problem Current Condition Collect data & analyze using Pareto charts, histograms Identify themes & customer requirements Write a clear & concise problem statement Problem Analysis Identify root cause of problem 5 why s, cause & effect diagrams Target Condition Develop measurable target for the problem Develop & agree on potential countermeasures Action Plan Details of new plan or intervention to reach the target Way things happen now Current state or the problem Implementation Plan Roll out the action plan with Who/ When/What/Where & How Results Confirm effectiveness Compare data with problem before and after using same indicators Standardization Assure that countermeasure is a part of daily work Create or revise the process if necessary Train & assign responsibility to monitor Future Plans Analyze & evaluate the remaining problems Review lessons learned What could be improved? Done differently? The better way of work Ideal state or solution
7 Reason for Improvement PLAN Define the problem clearly & narrow down the issue Identify the reason for working on it Activity Survey internal/external customers Interview staff Consider customer needs Example Transportation of lymphoma specimens from Radiology to Surgical Pathology (3-6th floor) is taking 4-5 hrs Requirement: Tissue must reach SP within 2 hrs of obtaining
8 Current Condition Current Condition PLAN Collect data on all aspects of problem Analyze & prioritize Activity Use Pareto charts, cause & effect diagrams Identify customer s requirements Write a clear problem statement Use data to establish the target
9 Gross Room Refrigerator Elevator Laboratory 6 th Floor Example Accessioning Specimen Drop Off Window Hematology LEAN Training Lab 2010 Refrigerator Main Elevator 6th Floor Surgical Pathology Pick up Rack Current State Specimen Delivery Path Chemistry Lab 6 th Floor = Radiology Tech =Chemistry Lab Tech = Pathologist = Accession Tech Radiology Specimen Drop Off Window HLA Lab
10 Time taken to travel from Radiology to Surgical Pathology Time taken to travel between Radilogy & Surgical Pathology Time Length H:M:S 10:00:00 5 month study- 45% delayed over 2 hrs 45% Over Two Hours 8:00:00 6:00:00 Elapsed Time 4:00:00 2:00:00 0:00:00 5/29/09 9:45 AM 6/1/09 9:59 AM 6/8/09 12:20 PM 6/12/09 10:35 AM 8/11/09 8:40 AM 8/11/09 9:30 AM 8/11/09 9:50 AM 8/24/09 2:14 PM 8/25/09 8:45 AM 8/25/09 12:45 PM 8/27/09 8:11 AM 8/31/09 11:11 AM 9/3/09 9:19 AM 9/10/09 8:00 AM 9/16/09 4:53 PM 10/2/09 10:49 AM 10/6/09 11:58 AM 10/9/09 7:55 AM 10/9/09 9:32 AM 10/15/09 7:54 AM Procedure Date and Time Average
11 Problem Analysis Problem Analysis PLAN Identify and verify the root cause of the problem Select RC with probable greatest impact Activity Ask 5 why s Perform cause and effect analysis Example Why are the spec. not transported on time? No one knew it had to be Why does no one know? Not identified as Rush or communicated Why not communicated or identified? No existing process in place Why no process? We ve always done it this way RCA- A) Identifiable as Rush B) Need a standardized process
12 Target Condition Target Condition PLAN Develop & agree on measurable target for problem (activity of improvement not perfection) Agree on potential countermeasures Activity Meet customer s valid requirement Select root causes with probable greatest impact Example Meet surgical pathology (customer s) requirement 100% of the time for all lymphoma specimens
13 Defining the Target Condition Ideal state PLAN Do-Check-Act Current condition Target condition
14 Action Plan Action Plan PLAN Develop the new plan & reach consensus Evaluate countermeasures Activity Is the plan doable? Does it make sense? Consider up & downstream effects Reach consensus from customers & suppliers Example - Identify the specimens by a visual sticker - Transport specimens directly to SP direct hand off
15 Visuals Aid Visuals Specimen Identified with Bright Yellow Stickers 2 Direct Hand off From Radiology to Surg. Path 1
16 Countermeasures DO Implement the agreed countermeasures Activity Evaluate does it make sense? Is it doable? Example Chain of custody Trackable
17 Implementation Plan Implementation Plan DO Roll out the action plan Activity Answers who, what, when & where Educate all involved of the expected outcome Example Specific Task Who By When Date Completed Education/Track Team leader- SP Immediately 1 week
18 Results Results & Metrics CHECK Confirm that the problem has decreased & the target has been met Activity Collect data before and after using same indicator Implement additional countermeasures if needed Example Happy customers & suppliers
19 Results Legend: =Terminator =Process =Predefined Process =Decision =Lymphoma Bx Cat Scan (CT) (3rd floor) CS Radiology Ultra Sound or Cat Scan US Ultra Sound (US) Example Eliminated unnecessary Motion Eliminated waiting Chemistry Cyto STAT? No Clinician Procedure (Bx,fluids,needles) No Tech. Assistant Transports to Core STAT Lab Drop Off (Delivery times not specified) Micro Yes Surgical Path Clinician Notifies Tech Assistant/ Initiate STAT Clinician Procedure (Bx,fluids,needles) Tech Assistant Apply STAT Label Tech Assistant Transports Lymph Node to Surg Path ASAP Sign-off Sign-off Sign-off Sign-Off
20 Standardization ACT Prevent the problem and its root cause from re-occurring Activity Assure the changes become part of the daily work Revise and/or post work/standards Train employees on the new process Assign responsibility to monitor results
21 Future Plans Future Plans Analyze & evaluate the remaining problems Review lessons learned Improved? Done differently? Never ending
22 Breakout- A3 Writing Breakout- A3 Writing Topic choice: 1. Defect identified- Waste Walk 2. Defect/situation from your own work place In your groups Develop a detailed A3 Report Appoint a group leader Present your A3 story
23 Take Home Lessons Take Home Lessons Brainstorm plan & solutions Involve all customers & suppliers to solve problem Investigate root causes to develop countermeasures Communicate & assign responsibility to sustain results Empower staff to continuously improve & reach for the ideal state Suggested: use one A3 report per problem
24 Don t Get Frustrated! Q & A?
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