[MUSIC] So now let's talk about building your A3. As we mentioned, A3s can be in many formats. Looking at a traditional A3 with the Plan on the left hand side, Do-Study-Act on the right hand side, you'll see familiar content areas. First one being the background. Next is current condition, the goal, and then root cause analysis. Those are all on the left hand side, and this is important for understanding the problem. The Do-Study-Act will come later, once we have a better understanding of the root causes of the problem. Many who are also using Six Sigma and the DMAIC framework, Define, Measure, Analyze, Improve, and Control. The PDSA maps really well to DMAIC. So the plan of PDSA really is the define, measure, analyze in the DMAIC framework. And the Do-Study-Act is really the improved, control side of DMAIC, so they can be very complementary. So when we start with this left hand side in the plan section, we want to understand what is the problem? So how do we know it's a problem? How big of a problem is it? And what will happen if we don't fix this? Is this really worth our time? We need to have the answers to that. Also, what is our target condition? Who should be on our improvement team? And how will we measure whether our improvements make a difference? What is going to be our metric? We also want data or information. And so we need to find out, do we have data on the current problem? Will we need to go and collect information? If we have information, can we trust the data? And so, collecting data is another big piece of the plan side of the plan, Do-Study-Act. And then, when we have data, we want to also understand what the data is telling us about root causes. In this section, it's really important to remember what W Edwards Deming says. If you can't describe what you're doing as a process, you don't know what you're doing. And so it will be really important to make sure you go to where the work takes place and perform some of those tools that we have that help us understand the process. And you'll learn more about these in a future module. These are some of the tools, a process map, the seven ways, a value stream map, and spaghetti map are among the tools that help you understand the process. Additionally, DOMOWIT, the seven wastes of healthcare we'll go over in a future module as well. They're all listed here for you, but these seven wastes can also be a good place to look for ways to improve upon a process. And identify something that might be a barrier to good performance. With root cause analysis digging deeper, we can also use Pareto Diagram, the Five Why's, the Fishbone Diagram, and also Fault Tree. The Pareto Diagram is simply a bar chart that lists in the order of occurrence. Which are the causes for our failures or defects in the process? So that can be a powerful tool to help focus. Another is the Five Why's. So to be able to ask five why's to arrive at a failure mode in a process. Such as patients arriving for procedures without having fasted. And in this scenario then we would ask, why do patients arrive without fasting? And the answer might be, patients are unaware that they were supposed to fast. And we might ask, why are patients unaware? And in answering that question, we might learn that the pre-procedure information was not received by the patient in time. And digging deeper, we find that it was not sent to the right address. And so you just continue to ask why and dig down to the root cause of that problem, to better understand what interventions might help avoid that in the future. And again, the Fishbone Diagram, and that is also a powerful tool to help organize some of the failure modes and barriers to good performance. So on the right side of the A3, we do the Do-Study-Act part of PDSA or the improve control of DMAIC. And it's important here to engage the team in finding what root causes are we going to go after? And what are the interventions we're going to try? Very important for having an effective project. And a good outcome of a project to engage stakeholders and team members in designing those interventions. That will help with sustainability as well. So some common pitfalls in using the A3. A big one is jumping to solutions. We know that that happens just as a natural part of being human that we sometimes lose objectivity. And we think we know the answer and we want to jump to that solution without following the process. Another is for someone to complete the A3 independently. So to go to sit down at your desk and write out the complete A3, without really following the problem solving process and engaging a team. And again, generating solutions that are not targeted at root causes. Often projects fail because people will get excited about some ideas that are good ideas. But in fact, they don't really tie well to the problem that's being addressed.