In World War I, it was common knowledge among Officers that during trench warfare fatal head wounds were caused by bullets or hard blows directly to the head. It wasn’t until the day after a severe artillery battle, when the French Intendant General August-Louis Adrian visited the wounded that he was told by a recovering soldier that many in his troop were killed by small, slower velocity fragments. When asked how he survived, the soldier replied that he put a metal mess bowl on his head. Inspired by the story, General Adrian created a metal bowl to be worn under a soldier’s cap. This metal bowl later evolved to become the soldier’s metal helmet that we all recognize today. So what does this have to do with A3 and patient safety you ask? Plenty!
Every Hospital Administrator today is very concerned about lowering costs; improving efficiency and safety. Even with new government priorities these trends continue. A solution is needed, one that uses an easy, inexpensive, and most of all effective tool. This solution must be a proven method that can be applied to any problem in any area of the hospital and consistently yield success. And, like the soldier who described his comrades dying from fragments and not bullets, so too can healthcare workers be trained to use this method to solve problems in their work area and not by the Officers far removed from the trenches.
So, what is this method? It’s the “A3 Method” and the tool is the “A3 Report”, named after the A3 size of 11” X 17” paper still used by many to workup these reports today. This problem-solving method and tool have been so successful that they have been the driving force behind many organization wide transformations, including our acute care hospitals. There is no need for expensive software, complicated technology or even complex training. The A3 Report uses an established outline design on a sheet of paper that guides the person making the report through a few key steps toward resolving the problem they experience in their daily work, all the while effortlessly employing the scientific method.
The A3 Report outline below is a typical A3 format which contains: a title for the report; relevant background information; description of the current situation or process using drawings and icons; description of the cause, which by utilizing the 5 whys, will uncover the root cause of the problem; another drawing containing the ideal condition; the user has space to suggest an alternate process, just like the soldier suggesting the use of a metal mess bowl; a brief plan on how to implement this ideal condition, a brief plan to ensure the ideal condition was achieved and space to measure the results.
It sounds simple enough, but we have found that if shortcuts are used, the process yields poor results. Although this method and this tool can quickly solve problems, it would be a mistake to think of the A3 method as a short-term strategy, it is not. In order to successfully implement the A3 method in all our hospitals, it required dedicated leadership at the highest levels of the hospital and our corporate office. It required a change in organizational behavior at all levels. It changed many from feeling powerless to empowered, from being overlooked to being valued – everyone, a part of the team.
There are those who say that in today’s healthcare environment everyone is already too busy and that this tool requires too much time. However, the truth is that as problems are corrected and processes made more efficient, re-work, work-arounds and errors will be eliminated, leaving more time available for A3’s.
The beauty of the A3 method is that since services interact with other services in long value chains, when implemented and supported, the results expand ever broader until the entire organization improves and everyone benefits, most importantly our patients.
For more information on A3 see: “Understanding A3 Thinking: A Critical Component of Toyota’s PDCA Management System” by Durward K and Art Smalley.