Use of Cascading A3 for Systemwide Improvement

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From the course by Johns Hopkins University

Planning a Patient Safety or Quality Improvement Project (Patient Safety III)

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Johns Hopkins University

Planning a Patient Safety or Quality Improvement Project (Patient Safety III)

42 ratings

Course 3 of 7 in the Specialization Patient Safety

This course provides students with a set of tools and methodologies to plan and initiate a Problem Solving or Quality Improvement project. The first module presents methods for selecting, scoping and structuring a project before it is even initiated. It also introduces the project classifications of implementation and discovery. The second module describes the A3 problem solving methodology and the tool itself. Further in that same module, the student is shown tools to identify problems in flow, defects, and waste and to discover causes, brainstorm, and prioritize interventions. Module 3 shows a methodology within the implementation class. These methods are designed to overcome emotional and organizational barriers to translating evidence-based interventions into practice. The fourth and last module looks at one more way to approach improvement projects in the discovery class. These tools are specifically for new, out-of-the-box design thinking.

From the lesson

A3 Thinking

In this module, you will be introduced to the process and format of A3 problem solving. You will learn the key components of an A3 for to define and start an improvement project to maximize your chances of success. Additionally, a set of tools will be covered that are commonly used in the actual improvement project, which will identify underlying process issues and their root causes.

What is A3 Problem Solving?6:27

Building Your A35:40

Purpose and Methodology of Identifying Waste8:29

Structured Brainstorming8:23

Fault Tree Analysis5:12

Process Mapping5:12

Value Stream Mapping (VSM)7:21

Improving Physical Flow In Processes6:43

Use of Cascading A3 for Systemwide Improvement3:37

Meet the Instructors

Bob Hody

[MUSIC]

Another powerful use of the A3 is the use of the A3 to communicate and

operationalize strategic priorities across an organization.

This is referred to as a cascading A3 and is depicted here.

The top level is the strategy.

So what is the goal that we're trying to achieve together?

And the second and third tiers, then,

are the problem solving tiers that are cascaded down across the organization.

And then also, information flows back up.

The advantages to the cascading A3 is that it promotes alignment up, down and

across the organization.

Everyone's clear on what we are trying to achieve.

It also provides that opportunity for dialog and feedback.

So as we learn as we go, we're able to communicate that through the A3.

It also encourages collaboration and shared learning.

So when we share our A3s across the organization, we're learning together.

Here is an example of the cascading strategy deployment at Johns Hopkins

health system to improve performance on targeted core measures.

The top level A3, shows you the strategic priority of achieving greater than or

equal to 96% performance on targeted core measures.

At the second tier, the middle tier, we then have

how we are performing on those targeted core measures across the health system.

Additionally, we have the third level,

the third tier, which is the entity level performance.

So this is a deeper dive into how we are performing locally

on that targeted core measure.

The arrows then, depict the communication that occurs.

So the lower tier at the local level,

at the front line where they're working to improve their performance,

they're sharing that information up at the system level and we're learning together

of what some of the barriers are and also what are some of the bright spots

that we can learn from each other on how to improve our performance.

That then gets communicated out to the leadership level.

One example is the urinary catheter removal workgroup.

You'll see here the A3 for the urinary catheter removal.

And the left hand side, again,

showing the metric that we're all working toward improving.

And on the right-hand side we show, also, some of the root causes that we've

identified, as well as our action plan to improve.

Another example is Global Immunization Core Measure.

And here we see that we have performance across the health system.

On the bottom left you see that we're able to pull all the entities up

to higher performance.

On the right-hand side, on the top level there, you see where we're sharing across

the organization ,what is being done at the different entities,

how they are addressing their own root causes and

sharing that across the health system to pull our performance up across the system.

Additionally, we saw the same thing with urinary catheter removal.

By sharing together our learning of what was working and

what was not working, we're able to pull all the entities up over the line and

achieve that greater than 96% performance on the core measures.

All of this work then culminated in the recognition as a top

performer on key quality performance measures for The Joint Commission.

And it also was published in The Joint Commission Journal on Quality and

Patient Safety.

This was evidence for

us that cascading A3 is an effective means to drive system wide improvement.

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