So what’s the problem – A3 thinking

If you don’t know what an “A3” is, don’t worry. When I started at University of Michigan Health System, I didn’t either.  When I first saw an A3 meeting on my calendar, I asked “What group is that?”

Plan, do, check, act. PDCA on white isolated background. 3d

There were so many groups with different acronyms!  Turned out it was a meeting with a few colleagues to update our status report on major UMHS IT initiatives. We were using an A3 format for our report.

So what is an A3? It is a tool used as part of Plan-Do-Check-Act (PDCA).  The A3 name actually comes from the paper size (11 x 17 sheet) that tells a story laid out from the upper left-hand side to the lower right.

Telling the story of a problem on an A3 includes looking at the background (why and what), describing its current condition (where things stand), and doing a root cause analysis. And then, establishing goals and targets, proposing countermeasures, making an action plan and determining success metrics.  

We naturally want to go to solutions or countermeasures first. We are fixers and jump to solutions. But without understanding the problem and the root cause, how can you begin to solve it? A3 thinking means structured problem solving. It is a process that can gain alignment and agreement within an organization and solve problems.

As managers we spend much of our time putting out fires. We see a problem and jump to a conclusion. As leaders, we need to develop a problem solving culture in our organizations.  And we need to address the unevenness and variance in processes.

Early on at UMHS, I went to the Managing to Learn program which teaches A3 thinking. Since then, I’ve done A3s and encouraged my leadership team to do the same. I emphasize that A3 thinking and true problem solving is what matters, not filling out a form. I’ve sent a number of my leaders to the same program. But A3 thinking is not something you train on once and then consider yourself an expert.  Far from it! Structured problem solving and incorporating A3 thinking into your work takes time and practice.

This week, I attended a Partners Managers’ Workshop at the Lean Enterprise Institute (LEI) with one of my executive directors, Brian Kwapis. I’ve tapped him to help lead the lean efforts within our department so we are on this path together.  The workshop covered our changing leadership roles, modern management compared to lean management, strategy deployment, lean transformation model and A3 thinking.

Prior to the workshop, we were supposed to identify a problem to work on while there. Brian and I joked that there is no shortage of problems yet it was hard to choose one that would be best for this training opportunity. We did choose one and independently drafted our A3s. In the final session of the program, we paired up to compare notes and do a deeper dive on the problem. We agreed on the next steps for when we got back to the office.

Our new UMHS Chief Human Resources Officer, Joe Fournier, attended the training this week as well. His HR leadership role is critical to our overall lean journey at UMHS.  We also had two medical directors there from our Chelsea and Dexter health centers, Dr. Jill Fenske and Dr. Katie Harmes. And Dr. David Brown, Interim Associate Vice President and Interim Associate Dean for Health Equity and Inclusion, also attended.  Drs. Fenske and Harmes worked on a common problem involving how orders are handled at patient checkout.  Their taking this much time away from their clinics is a sign of the strong commitment that our ambulatory care services has to our lean journey.

The UMHS problems were very different from those brought by the other workshop attendees. Yet, we all used the common A3 approach.  The other participants were from a major grocery store chain and it was fascinating to learn about some of the problems they deal with such as freshness of produce and bakery productivity. But using A3 thinking, even I could serve as a coach to help them think through these problems.

In previous blog posts on lean, I’ve discussed our overall lean journey, the importance of going to the “gemba”, and our recently launched leadership huddles.  As my lean coach, Margie Hagene, likes to say, “You need to develop the muscle”.  The A3 thinking muscle is one more that we are developing on this journey.

And as John Shook, CEO at LEI, reminded us in his wrap up talk on the lean transformation model, “Any event is only as good as the follow-up”.  So it’s back to the office to apply what we’ve learned and share with others.


Michigan Quality System

UM Virtual Lean Resource Center 

Lean Enterprise Institute

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