LeanHealthcare_A3examplesWhen faced with a painful problem, we often look for a ready-made solution.  The source of the solution may be:

  • A best practice as promoted by a journal, website, or conference presentation
  • A practice that successfully addressed a similar problem in another organization
  • A practice that successfully addressed a similar problem in your own organization

It is tempting to simply implement these solutions to address a problem.  However, immediate implementation of a best practice is sometimes counterproductive.  Best practice and its forebear, benchmarking, both divert attention from the people and the context, focusing entirely on the disembodied prescription or model, as though it can be implemented anywhere and get the same successful result.  A practice or program that works in one setting is not guaranteed to deliver the same results in a different setting.

This situation is an opportunity to apply A3 thinking, wherein we identify and validate the root cause of our problem prior to deciding on the solution (countermeasure).


A hospital was suffering from chronically low patient satisfaction scores for “noise at night” on multiple inpatient units. A pilot inpatient unit completed a pilot A3 to address the low score on their unit and serve as a model for other units. The A3 was a big success and “noise at night” scores on the pilot unit dramatically improved.

A second inpatient unit was anxious to emulate the gain achieved on the pilot unit. Keeping in line with the A3 problem solving process, the second unit conducted its own root cause analysis before adopting any solutions. The lead A3 problem solver on the second unit stood in an empty patient room at night with pencil and paper, and listened for noise – just as the pilot unit did.

The pilot unit identified equipment alarms and monitors as the primary sources of noise, and their solutions successfully addressed the noises, and scores improved. The second unit identified crying, yelling, and other human noises as a primary source of noise.

Their root cause was different than the pilot unit, therefore adopting solutions from the pilot unit would be counterproductive.  They needed solutions that addressed their own root causes. What was the key here? Completing the left side of the A3, and doing so independently of the best practice countermeasure and without prejudice toward the best practice.

In your situation, has blanket application of a best practice proven ineffective or even counterproductive? Let us know in the comments.

John DeVries, Senior Manager of Lean Healthcare and Process Improvement at HPPToday’s blog was written by John DeVries, senior manager with HPP.

John has more than 30 years of experience in Lean Healthcare, Six Sigma, continuous improvement, and productivity improvement.  As a Master Black Belt and deployment leader, he has led Lean and Six Sigma skills transfers to a large organizations resulting in widespread, breakthrough, strategic improvements.  John also has experience assisting healthcare facilities integrating Malcolm Baldrige-based organizational assessments, Lean and Six Sigma.

John holds a Bachelor of Science in Industrial and Systems Engineering from the University of Alabama, Huntsville.

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