In the early stages of a Lean Healthcare transformation, as Lean Healthcare organizations begin to use such resource-intensive tools as value stream mapping and week-long improvement events, they begin to recognize their potential.  Enthusiasm builds. Chests puff out. Heads swell. They begin to inflate the scope of the problems solved by these tools until they are beyond the team’s ability to achieve improvement within a week’s time. Inevitably the team ends up with an insurmountable list of “action” items and become demotivated as daily work catches up and limits or halts progress on their assignments.

Bigger is not always better.  Improvement tools (including A3s) are often over-scoped, meaning the problem is too big for the tool.  As leadership is exposed to initial Lean success, often their eyes get to be bigger than their stomachs – they begin to believe projects will be more successful if the scope is bigger, not fully understanding the limits and requirements of the tools being used.

Often, organizations simply have to test this theory until they find out that bigger isn’t always better (stumbling once or twice can be a valuable way to learn).

A successfully-scoped and executed rapid improvement event would allow the team to test most, if not all, of their ideas limiting post event follow-up to 30 days.  This improves the team’s ability to effectively complete a small number of action items while doing their full time job and focus on the sustainment of the changes in the early weeks to follow the actual event week. If a problem feels like it is too big, it probably is, and may be more appropriately solved through a series of rapid improvement events or a combination of events and A3s.

The A3 tool is sometimes thought of as a quick-fix tool used to for “drilling” down into the variation of a problem  and that it should be used when something needs immediate attention.  Typical A3 projects are smaller in scope, with the problem impacting two to four people in the same department or function. The total estimated time spent to implement an A3 is approximately 48 to 72 hours.   Some appropriate example projects include the reduction of medication scanning errors in the emergency department, or reduction of maintenance response time to nursing work orders.

These samples are more specific and targeted to an area whereas “fixing med reconciliation” or “improve communication” with an A3 would be like trying to solve world peace with a couple of team meetings.

As Lean Healthcare organizations grow and develop, sizing projects with the appropriate tool should become a skill that is almost second nature.  You will recognize how important it is for the team and the project to be successful.  Oversizing creates frustration for the team members and the sponsors as a result of not achieving the expected results.  In selecting projects for the appropriate lean tool, bigger is definitely not always better.


This week’s blog was written by Linda Duvall, Director with HPP.

Linda leads Lean Healthcare transformation engagements for HPP. She has nearly 30 years of experience in business leadership, program management and lean transformation.  Prior to joining HPP, she worked for Vanguard Health Systems as a process improvement specialist providing leadership and support for regional and hospital level process improvement teams.  Linda holds a Bachelor’s degree in Industrial Engineering from the University of Evansville.

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