What it's like to be in a3 class

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What’s it like to be in
A3 Class?

Mark A. Watson Center for Operations Excellence
Process Improvement Through People Development
Organizational Commitment
• Very Powerful tool
• Supported by
Administration
• Important initiative for
the organization
• Our Commitment
• Efficiencies gained as the result of a Lean Six Sigma
project will not result in layoffs

A3 is for Anyone!
• Highly engaged and committed
• Use the Lean tools to analyze and make changes
• “Those who do the work change the work”

Process Improvement
Through
People Development

A3 and DMAIC
Define
Measure
Analyze
Improve
Control
•Define and Scope your project
• Background Information, Problem Statement, SMART Goal
• Process Mapping
• Data Collection
• DOWNTIME
• Fishbone Diagrams
• 5 Whys
• Spaghetti Diagrams
• Lean Toolkit
• Standard Work, 5S
• Control Planning and Sustaining Your Gain!

What you can expect in this course?
• You can solve an opportunity for improvement in your work area (or
perhaps even outside of it)
• Knowing how to work with your Process Owner to solve
opportunities
• You’ll have a new method to approach problems and solve them
• Empower you to tackle long standing issues
• Your trainer/coach will be available to help you with your project
• You’ll learn how to move through speed bumps that pop up in your
project

What is expected of you in the course?
• Show up at each class session or at least notify
the trainer when you can not
• Be a part of the discussion and activities
• Continually be working on your project
throughout the program
• Report out at the end of your project

The Essence of Lean
•Lean is a culture of continuous improvement aimed at
identifying and eliminating waste
•All work processes must be controlled, constantly modified,
and improved by the people who do the work
•Lean is about PEOPLE!

• By eliminating waste, our processes can take:
• Less time
• Less effort
• Less space
• Less equipment
• Less material
• Less money
What is Lean?

Value
• Value is always defined by the customer. It is any item, activity or service
for which the customer would be willing to pay for.
Waste
• Any activity that consumes resources but creates no value and they are
activities that the customer would not gladly want to pay for if they knew
they were happening.
The Essence of Lean
Gemba
• Japanese term meaning the place where all
activities are actually taking place.

• The term “A3” refers to the paper size (11 x 17) used for problem-
solving, proposals, plans, and project reviews
• The A3 document is used by the A3 candidate as s/he goes through
the A3 program
• However, more than just a paper size, it…
• Fosters dialog
• Provides a standard way of communicating
• Gives insight into stakeholder alignment
• Aides in project management
• Tells the story of the project
What is the A3?

A3 Project Selection
• Ideally, it addresses an issue identified in huddle
• Has to be a process that touches your department
• Has to be a process you are involved with
• Has to occur multiple times per week or day,
not seasonal
• Must be measurable
• Should not focus on technology or staffing
solutions
• Keep the strategic plan in the background
of your project

Working on your project
• You’ll have approximately 4 weeks after the end of class to finish the
project and graduate with your class mates
• Keeping your stakeholders up to date and involved in the project will
be important
• Meeting with your coach weekly helps to
keep the project going
• Be willing to try new ideas out even
though at first you may not think they will
work

Project Report Out. . .What to Expect?
• Who attends? Hospital Administration, Board Members, previous A3
Graduates, COE Members, etc. . .they all love to see the work and
improvements you’ve done!
• You will be given four minutes to present
your project
• Come and practice. It will be a great help!
• Recruit your co-workers and those who
helped and supported you! Or anyone
who wants to see what this is all about 

A couple A3 examples

Inaccurate Dressing Cards
Burn Center
Maryke Bard BSN, RN, CEN
Process Owner: Christine Sadie BSN, RN
August 10, 2009
16
Center for Operations Excellence
A3 Project Report Out

17
• Problem Statement:
• When dressing cards are inaccurate, Burn dressings are
opened for dressing changes and not used which causes
excessive waste of supplies and cost to the Burn Unit.
• Goal Statement:
• Reduce the amount of inaccurate dressing cards from
48% to 30% by August 10th, 2009.
Define

21
Improve
1.Pre 5S in the Burn Dressing Room

22
Improve
1.Post 5S in the Burn Dressing Room

23
Improve
1.Completed a 5S in the Burn Dressing Room.
2.Minimized amount of burn dressings being
opened prior to dressing changes.
3.Developed new process for keeping dressing
card and charge sheet with dressings and
prompting immediate updating of card.
4.Developed and educated all staff on standard
work instructions for setting up dressings,
updating card, and 5S of Burn Dressing Room.

24
Results
1.Direct savings of $18,673 from reduction of
Burn dressings wasted.
2.Reduction of 168 items from Burn Dressing
Room inventory resulting in a savings of $197
to the unit
3.Reduction of Burn dressing card inaccuracies
of 8%

25
Control
Follow Up Plan
1. Collect data on wasted Burn dressings for 3 days twice a
quarter for 6 months.
2. Maintain visual management of 5S area at the end of each
shift by Burn Center staff.
Next A3 Project: Standardizing Burn dressing card, Maintaining
bandage scissors, Updating dressing change white board…

Filling Holes in Provider
Clinic
Endocrinology
Participant: Donna Green
Process Owner: Milva Holley
Coach: Chris Weisbrod
26

27
• Cancelled appointments are leaving holes in clinic
Schedule creating longer wait time to be seen
• Goal Statement:
• Reduce number of unfilled appointment slots due to
cancels from 10 a week to 5 by August 5 2011
Define

30
Improve
1.Developed standard work instructions for
filling slots
2.Updated Wait list
3.All PSRs attended Excel training for wait list
4.Developed flow that allows continuous focus
on filling appointment slots

32
Results
The
Improvement
Pre
Metric
Post
Metric
Financial
Impact
Potential
Revenue
%
Improved
To fill cancelled
appt slots
3/week 11/week Hard
$2,530
$29,900 266%

33
Control
Next A3 Project: New Patient Scheduling

Process Improvement Through People Development TM
Accessibility to Critical
Airway Supplies in the ED
Department of Pediatric Emergency
Medicine
Participant: Nirali Patel MD, James Lee MD &
Osama El-Assal MD
Process Owner: ED
34

Process Improvement Through People Development TM 35
• Delayed airway resuscitation can lead to significant
morbidity and mortality in critically- ill or injured patients.
• Critical airway supplies are in various locations, away
from the patient’s airway causing delay in care.
• Goal Statement:
• Reduce the time and steps to obtaining critical airway
supplies from 3 minutes to 1.5 minutes, or 50% time
reduction.
• Improve accuracy and consistency of obtaining supplies
among PEM physicians.
Define

• Trained ED personnel consumed on average
150.6 seconds to locate critical airway supplies
and equipments.
• No one was able to obtain all the supplies needed
at various stages of resuscitation correctly.
• There was significant motion to locate various
supplies between different treatment rooms.
Measure

Analyze
ManMethodMaterial
Who stacks
all equipments?
No protocol
No defined space
Not enough
Equipments
Measurement Machine Environment
Treatment room
Layout
Delay in time
Lots of steps
Not enough
equipment

Improve
List of Improvement Activities:
1. Created a cart containing all critical airway equipments and
supplies in one mobile unit.
2. Decreased time to obtaining critical airway supplies from
150.6 seconds to 55.2 seconds, with 63% time reduction.
3. Increased accuracy of obtaining correct equipments from 0
to 100%.

Critical Airway Cart & Pathway.

Time Reduction After Creating
Mobile Airway Unit
0
50
100
150
200
250
300
350
S1 S2 S3 S4 S5
After
Before
TimeinSeconds
Subjects

Results
The
Improvement
Pre
Metric
Post
Metric
NVAT in
Hours
Savings Potential
Revenue
%
Improved
Time
Accuracy
150.6 S.
0%
55.2 S.
100%
NA Hard
Soft
NA
NA
63%
100%

Control
Follow Up Plan
Next A3 Project: Maintenance of skills with PEM faculty through
Simulation
Metric Frequency Who What to do if not
in control
Time, and
accuracy
Monthly ED Fellows Re evaluate

Next Steps

Next Steps
• If you are interested in signing up, please contact Jennifer Hoge in
the COE!
Jennifer Hoge
330-543-4771
jhoge@chmca.org

What it's like to be in a3 class

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