There are many Lean tools available to use to improve a process.  But often times it is difficult to select the appropriate one because the issue is not clearly defined.  This leaves managers asking “What tool is the most appropriate? How do I communicate the need for this process change?  Is the issue worthy of a full Lean event such as Kaizen or can I solve the problem in a different way?”

The A3 approach might be the way to go.  What is A3?  By most people’s definition it is an international standard paper size similar to an 11 X 17 sheet of paper.  But in Lean terminology, it is more than that.  It can be waste-free report writing, a continuous improvement activity, a form of visual management, or a method of communication.  However you decide to use the tool, there are 6 steps to the process:

Step 1: Identify a Problem or Need

Step 2: Define the Current Condition

Step 3: Root Cause Analysis

Step 4: Target Condition and Countermeasures

Step 5: Implementation Plan

Step 6: Follow-Up Plan

Today’s blog will cover Step 1, Identifying a Problem or Need, or, the Problem Statement, with the other steps discussed in future posts.

There are few things both more fundamental and more frequently fouled than the problem statement. How you structure the problem statement determines your focus. Make sure your problem statement is actually about the current observable condition, not about a perceived solution, cause, or what you want.  Be descriptive, focus on the problem—not solutions. Do not combine multiple problems into one and provide background information that is essential to understanding the extent and importance of the problem—such as, how the problem was discovered, why the problem is important to the organization’s goals, the various parties involved, and the problem symptoms.  The problem statement could also be referred to as the issue and the background.


A problem statement in healthcare might look like this:

Phlebotomy draws by nursing staff often result in the wrong tube being used.  The problem started about 12 months ago when the laboratory issued 4 different reference guides and did not include photos.  This has resulted in re-draws of 25% and an increase in TAT of 50%.

Or this:

Denial correspondence from insurance companies is received by mail.  Processing this correspondence requires manual transportation of the paper information across 4 buildings.  This consumes the resources of 9 FTE’s resulting in TAT of 9-11 days, which is 125% greater than the dept. goal of 4 days.

Seems simple enough right?  The goal is to ensure that your problem does not suffer an identity crisis because it was not accurately defined.  Staying true to this one concept will keep your problem solving efforts on track and ensure success.

Stay tuned as we walk through each step in A3 problem solving? How do you structure your problem statements? How do you prevent jumping to conclusions?


Today’s blog was written by Dan Littlefield, Director at HPP.

Dan has 30 years of healthcare experience in many clinical and leadership roles. He leads Lean and process improvement consulting engagements for HPP.  His experience includes deploying Lean across numerous healthcare disciplines including Imaging, Laboratory, Nursing, Pharmacy, and Physician Offices.  Dan began his healthcare career as a nuclear pharmacist and has also severed as Director of Operations, responsible for 13 facilities.  He has been a featured speaker at a variety of healthcare industry events.

Dan holds a Master’s Degree in Business Administration from the University of Pittsburgh, Bachelor’s Degree in Pharmacy from Purdue University and a Specialty Certification in Nuclear Pharmacy from Butler University.

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