A3 Problem Solving Template v1.2 (April 2015) by Henrik Knibe.docx

A3 Problem Solving Template v1.2 (April 2015) by Henrik
Kniberg and Tom Poppendieck
License: Creative Commons Attribute 4.0 International
Original link: http://www.crisp.se/lean/a3-template
Background PLAN
Current condition PLAN
Goal / Target Condition PLAN
Root Cause Analysis PLAN
Countermeasures (experiments) DO
Confirmation (results) CHECK
Follow up (actions) ACT
Owner:
Mentor:
Date:
A3: <problem statement>
http://www.crisp.se/henrik.kniberg/
http://www.poppendieck.com/people.htm
http://creativecommons.org/licenses/by/4.0/
http://www.crisp.se/lean/a3-template

Background PLAN
● Why is this important?
● Why should the reader care about this situation and be
motivated to participate in
improving?
Assessment Questions
1. Is there a clear theme for the problem report that reflects the
contents?
2. Is the topic relevant to the organization’s objectives?
3. Is there any other reason for working on this topic (e.g.
learning purposes)?
Current condition PLAN
● How do things work today?
● What is the problem?
● Baseline Metrics?
1. Is the current condition clear and logically depicted in a
visual manner?
2. How could the current condition be made clearer for the
audience?
3. Is the current condition depiction framing a problem or a
situation to be resolved?
4. What is the actual problem in the current condition?
5. Are the facts of the situation clear, or are there just

observations and opinions?
6. Is the problem quantified in some manner or is it too
qualitative?
● What outcomes are expected for what reasons?
● What changes in metrics can be plausibly expected?
1. Is there a clear goal or target?
2. What, specifically, is to be accomplished?
3. How will this goal be measured or evaluated?
4. What will improve, by how much, and when?
Root Cause Analysis PLAN
● What is the root cause(s) of the problem?
● Use a simple problem analysis tool (e.g. 5 why’s, fishbone
diagram, cause/effect diagram) to
show cause-and-effect relationships.
1. Is the analysis comprehensive at a broad level?
2. Is the analysis detailed enough and did it probe deeply
enough on the right issues?
3. Is there evidence of proper five-whys thinking about the true
cause?
4. Has cause and effect been demonstrated or linked in some
manner?
5. Are all the relevant factors considered (human, machine,
material, method, environment,
measurement, and so on?)
6. Do all those who will need to collaborate in implementing the

countermeasures agree on the
cause/effect reasoning?
● Proposed countermeasure(s) to address each candidate root
cause (this should be a series
of quick experiment to validate causal model analysis)
● Predicted result for each countermeasure
1. Are there clear countermeasure steps identified?
2. Do the countermeasures link to the root cause of the
problem?
3. Are the countermeasures focused on the right areas?
4. Who is responsible for doing what, by when (is “5 Why - 1
How” clear?)
5. Will these action items prevent recurrence of the problem?
6. Is the implementation order clear and reasonable?
7. How will the effects of the countermeasures be verified?
● Actual result of each countermeasure (experiment)
● How does the system actually behave with the
countermeasures that are being proposed for
implementation in place?
1. How will you measure the effectiveness of the
countermeasures?
2. Does the check item align with the previous goal statement?
3. Has actual performance moved in line with the goal

statement?
4. If performance has not improved, then why? What was
missed?
● What have we learned that does or does not improve the
situation?
● In the light of the learning, what should be done?
● How should the way we work or our standards be adjusted to
reflect what we learned?
● What do we need to learn next?
1. What is necessary to prevent recurrence of the problem?
2. What remains to be accomplished?
3. What other parts of the organization need to be informed of
this result?
4. How will this be standardized and communicated?
Owner: Leads the problem solving and maintains this A3 doc
Mentor: Guides and assesses the process
Date: Current version Date
A3: <problem statement>
GUIDE

Background PLAN
Games out of date, 2 years time to market
● Missed market windows ➔ revenue declining
● Demotivated teams ➔ key developers about to quit
● Overhead costs ➔ Time to develop games steadily increasing
due to declining technical quality
● Pressure to Work FASTER!
Current condition (value stream map) PLAN
● 8x faster cycle time
● 5x fewer escaped defects
● 20% improvement in revenue
Root Cause Analysis (cause-effect diagram) PLAN
1. Cross-functional teams - Graphics design through deployment
○ Predict 2x faster delivery
=> End dependencies - now spend 75% of time
waiting/negotiating
2. Abandon all but most promising 3 games in each queue. Do
ONE game at a time per cross-
functional team.
○ 4x faster delivery from reduced task switching

○ Eliminating queues will cut 1.3 years from schedule
3. Engage developers in playing games and selecting ideas
○ 30% more profit to par with best competitor
=> improved filtering on which games to develop
=> more fun games, more popular
1. Cross-functional teams
=> Half as much time waiting
2. One game at a time
=> Queues eliminated, time to complete game is 3-4 months (6-
8x faster)
=> Technical Debt is decreasing - escaped defects down by 2x
so far.
3. Engage developers in playing games and selecting ideas
=> One team taking to to play is producing more innovative
games.
=> Impact on profit is to be determined.
1. Consider more cross training of team members to reduce
waiting for expertise.
2. Reduce difficulty of integration and deployment steps
3. Improve processes for generating and selecting game ideas
a. Recruit talent if identifiable/available
b. Improve skills/process of best people already in company
c. Broaden both participation in selection and game playing
experience of everyone in the

company
4. Continue improvement of reused game components/engines to
improve development throughput
and reduce defects.
Owner: Lisa
Mentor: Henrik
Date: 18 May, 2009
A3: Slow game development
Concept
pres.
Resource
allocation
Graphics
design
Sound
design
Dev
Integrate
& deploy
Game backlog
Design-ready
games
Production-ready

games
Waste:
Value:
1 month 6 months 1 week 6 months 2 months 6 months
4 hours 1 day 1 month 3 weeks 1 month 3 weeks
3 months value add
25 months cycle time
= 12% process cycle
efficiency
WTF!
2 years?!
8 15 12
Idea Delivery
EXAM
PLE
Engineers not
proud of their work
Game quality
declining
Endless delays
& thrashing
Features cannot be

built by single team. X-
team dependencies.
Key engineers about
to quit
Declining sales
revenue
Games stale &
out of date
Taking ever longer to
complete a game
Queues
Tech Debt
increasing
Teams focus on
their own parts
only
Teams divided by
architecture No unified view of
priorities
Work in Progress
exceeds capacity
No Time to
Refactor
Defects

tolerated
Pressure from
business to work
faster
Company has not
grown people to
vet game ideas
Founder/CEO
no longer has
time to vet new
game ideas
Weak understanding
of market needs
Engineers don’t get to
play games
No
effective
selection
filter
Copying
competitors
games
Competitive
market
Too many
new game
ideas

Problem
Problem
Root cause
Root cause
Root cause
What is this?
It’s a template for A3 problem solving. Well, the first page is.
The second page
is a check list for the types of questions you should be asking
when using it.
The third page is a real-life example from a software product
development
context. The fourth page is this here FAQ.
A3? What the heck is A3?
“A3 thinking” is a problem solving approach. It is pretty central
to Toyota and
other companies with a Lean mindset. Especially useful for
systemic problems,
the kind of nasty, thorny problems that just keep coming back
despite your best
efforts to solve them..
How does it work?
A3 problem solving is about understanding the problem first,

before
jumping to solutions. For systemic problems, the obvious
solution is often the
wrong one, because it just addresses the symptoms rather than
the underlying
problem.
Use the template to guide yourself through a series of questions
to make sure
you understand the problem properly before thinking about the
solution. The
left column is all about the problem, and how you would
recognized when you’
ve solved it. The right column is all about the solution (or more
specifically,
experiments that you think might solve the problem).
The A3 also serves as a high-level journal, or log, of your
problem solving
initiative.
But why is it called A3? isn’t that a paper size?
Yeah, it’s named after the A3 paper size (297x420mm). The
idea is that you
should constrain yourself to that space, because it forces you to
express
yourself briefly and visually. And that increases the likelihood
that people will
read and maintain the doc.
So A3 problem solving isn’t really about the paper. It’s about
the problem
solving approach. But the A3 doc is there as a guide to keep you
focused on
the right questions, and keep the content short and sweet.

Do I have to follow it strictly?
No, feel free to tweak the headings and questions as needed.
Just keep in
mind that the left half of the page should normally be devoted
to understanding
the problem, and the right side devoted to solving & following
up. That way you
get a good balance between analyzing and acting.
Should I print it or use it electronically?
Take your pick. Sometimes a physical paper is best. Sometimes
a shared
google doc is best. Sometimes it’s best to start on paper and
then transcribe to
the google doc. Sometimes it’s best to start in the google doc
and then print on
paper. Experiment and find what works best for you!
What is the “owner” and “mentor”
The owner is the person (or team) who is primarily driving the
problem-solving
effort, and making sure the ball doesn’t get dropped. The
mentor is a person
well-versed in A3 thinking, who is helping the owner learn this
technique by
guiding him/her through the process.
Is this a one-off document, or a living document?
A problem solving A3 is a living document. Go back and update
it as you gain
better understanding of the problem, and document your
experiments.
Give it a shot! These types of lightweight tools can be
surprisingly effective
when applied appropriately.

FAQ
Understanding
the problem &
desired state.
Experimenting
to solve the
problem
http://en.wikipedia.org/wiki/A3_Problem_Solving
Check-In Kiosk
Eval Class of 2014
Aslie (Ashlie) Burnett-Project Facilitator
Overview
Michael E. DeBakey Veterans Affairs Hospital has been a
leader in quality care since the 1930s, by serving, honoring,
providing care to the men and women who are America’s
Veterans. We have upgraded the facility and enriched

technology to better meet the needs of our veterans- we are now
excited to introduce a first-ever check-in kiosk .
Reason for Action:
Define
Date Chartered:Start Date:Target Completion
Date:02/03/201402/05/20146/09/2014Improvement Team
Members:Phone/Contact InformationLarry WilkersonValerie
Williams, Education Coordinator Joycelyn Westbrooks, Clinical
Nurse EducatorBelt Advisor: (YB requires GB, GB requires
BB)YellowProcess Owner:Aslie Burnett and EVAL
TeamSponsor:Adam Walmus Opportunity/Problem Statement:
(support with data; why is this improvement necessary?)
Problem Statement
Every day MEDVAMC is receiving complaints from Veterans.
The Veterans are dissatisfied with extended wait time in long
lines at the check-in process within the clinics, resulting in a
negative impact on the hospital performance reports.
Business Case
The delay affects the customer's gratification, institutional
status in the waiting area of the hospital corrective actions from
higher authorities in reply to client criticisms and puts extra
pressure on internal clients.
Aim Statement: (should flow from the opportunity statement,
SMART)By June 09, 2014, the Emerging VA leaders will
introduce the self-service check-in kiosk, improve user
understanding, reduce wait time in long lines, and increase the
kiosk check-in process by 20% or more. The Veterans will
report increased satisfaction of their check-in experience
through the utilization of the innovative technology.
Scope: Improving the check-in process for patients through

innovative technology (Self-service check-in Kiosk).
Start: When the Veteran arrives to the clinic
Stops: When the Veteran is called to the back to see a provider.
Constraints: Resistance from Veterans using the Kiosk
3
Current State/Initial state
Kiosk Interaction/Transaction for (February)
Kiosk Interaction by Kiosk Date Range: 02/01/2014 to
02/28/2014InteractionsHouston Dental Houston
DermatologyHouston Eye353472476Kiosk Interaction by Kiosk
Date Range: 02/01/2014 to 02/28/2014Transactions Houston
Dental Houston DermatologyHouston Eye362483526
Patient Arrive
Welcoming patients and advising how to use the check in Kiosk
Check-in using Kiosk
Wait in the waiting room
Pick up patient
Improve the timeliness of the check-in process

Improve patient satisfaction
Improve check-in experience
Educate the Veterans
6
Column1
Low MoralPatient Access/Wait Time Dental ElgibilityStaff
Shortage/Burnout
SIPOC DiagramSuppliersInputsProcesses Outputs
ConsumersCheck-In Kiosk and Employees
Check-in Kiosk
And Employees
Check-in kiosk and Employees

Check-in Kiosk and Employees
Phone orders
Training & Educating
Training & Educating

Training & Educating Patient arrives to clinic and walks up to
the check-in kiosk
Patient touch the kiosk screen to begin check-in process
Appointment check-in or view future appointment.
I do not have ID or scan card or swipe card.
Please enter birthday or confirm or edit.
Question: Is this your name?
Update demographic
Insurance verification
Confirm appointment
Todays appointment do you want to print
Optional to print future appointments Checking in veterans.
Through increase visibility, education, and repetitive
instructions, the KIOSK Check-in will be the premier
innovation for veterans access to care.
Improve check- in experience
Improve patient Satisfaction
Improve timeliness of check-in

Patients, & Patients families
Patients & Patients families
SIPOC Analysis and Map Chart
Strength
Labor reductions
Weakness
Opportunity
Kiosk already available

Threat
Increased patient complaints
Wait time reduction
Convenience
Customization
Visual impaired
Improve accuracy of demographic data
Improve customer service
Software Development
Maintenance
Space constraints
Employees not trained on Vet Link software

Employee refusal to utilize the Kiosk & Vet link system
Incorporate surveys
Alleviate language barriers
Employee burnout
Patients opt-into civilian care
Veteran refusal to utilize kiosk system
Hire more staff
Offer copayment capabilities
Best Practices for Implementing Kiosk

System Selection
Select a kiosk with the physical location in mind.
Considering more than one kiosk per area/department.
Take advantages of branding opportunities.
Deployment
Start in areas with high numbers of frequency.
Start with check-in/ insurance verification.
Use a greeter during the initial rollout.

Choose an obvious and convenient location.
Enable as many languages as reasonable.
Policies and Procedures
Make use of the patient kiosk optional.
Assign basic oversight responsibilities.
1
3
2

10
CTQ’s
New system to reduce
Veteran Check-in Wait time.
To create KIOSK enthusiasm and grow confidence by increasing
users understanding of its functionality, purpose and benefit.
Older Veteran
Younger Veteran
The key target state in following this approach is to address the
time wastage.
Hence, ultimately, the patient checking in time and their leaving
time shall be accounted for upon completion of this project.
Communication with the public and patients regarding the
dental healthcare wait/access time will promote awareness on
the issues leading to delays in the healthcare system.
The offering of incentives and rewards to performing employees
will promote their attitude towards work. Hence, physicians will
offer quality service to patients leading to a satisfied customer
base.
Careful scheduling and planning in all departments is essential
e.g. good arrangement of dental equipment will lead to reduced
wait/access times.

Effective community-based dental services will offer quality
service to patients leading to lower wait times in the dental
healthcare, and efficient management of dental emergency
platforms.
11
Gap Analysis Problem Statement: Gap How to Address
The implementation step involves ensuring that all the
recommended strategies are effective in the dental care unit in
the healthcare facility involved
Holding us back-Dental Eligibility, Leadership not motivating
staff, shortage of staff
Root cause analysis – not being properly educated, leadership
implementing change without staff perspective or views , HR
delays
12
Cont. Gap analysis
Still applying the 5 whys
Low moral-root cause analysis was lack of communication

Dental eligibility –root cause analysis is poor communication
13
Solution
s approach
Incentives offered to competent employees may include award
recognition and compensatory time.
Adopting a kiosk check in system will aid reduce wait time in
long lines
Open access clinics will help the patients acquire specialized
dental care
Patients can benefit from receiving appointment slots made on
that same day.
Extended hours to patients will help ease the work load and wait
time for the subsequent days.

14
Rapid Experiments PDSA’s
Feb 6, 2014- June 09, 2014
Description of the PDSA (What is the plan or action you are
testing)
Who, What, Where, When, How (who is leading the PDSA,
What data or information are they to collect, how , and when
)What is the expected outcome of the PDSA?Actual PDSA Trial
Results
Data
(baseline and results)What are the next actions?Kiosk
Interaction vs. Transactions
Who: Aslie Burnett, Lead MSA, The entire EVAL Team,
Valerie Williams, Education Coordinator, Joycelyn Westbrooks,
and Larry Wilkerson, What: Kiosk interaction/transaction report
How: By collection of the data listed above.Improve kiosk
check-in by 20% within 90 days
PDSA results:
Improved by 44% within 90 days
Weekly huddles and Monthly classroom meetings Review data
weekly to identify outcomes.
Reduce wait time in long lineWho: Same as above

What: 100% review and follow-up of the VOC survey
How: By collection of the data listed above.A reduction in the
overall check- in time by 15% within 90 days Improved wait
time in long lines by 60% within 90 days
Weekly huddles and monthly classroom meetings. Review data
Improve users understanding of Self-Service check-in kiosk
Who: Same as above
What: 100% review of VOC survey
How: By collection of the data listed above.Improving users
understanding by 50% within 90 days Faster and easier to check
in 75% within 90 days
Weekly huddles and monthly classroom meetings. Review data
Increase satisfaction of check-in experience Same as above
What: 100% review of VOC survey
How: By collection of the data listed aboveImproving customer
satisfaction by 25% within 90 days Increase patient satisfaction

by 90%Review data and identify outcomes.
Completion Plan What WhoBy WhenStandard work
documentedKendra Price-Mayes & Larry Wilkerson
03/4/2019Communication plan ExecutedAslie Burnett & ‘The
EVAL Team’04/6/2019Education Plan ExecutedAslie Burnett &
The ‘EVAL Team’05/15/2019Audit plan Executed Larry
Wilkerson06/01/2019
The completion plan was not on track.
In order to for this to executed by the stated dates to enable
sustainment with 90 days
Leading measures:
Communicate new processes
Educated or provide training of new processes
Audit: internal/external reviews
Project Plan

Define phase 5/01/2014 to 5/31/2014
Measure phase 04/01/2014 to 04/31/2014
Analyze step 03/01/2014 to 03/31/2014
Improve stage 04/01/2014 to 05/01/2014
Control phase 06/01/2014
16
Confirmed State
MetricCurrent
(February 2014)Target
(May 2014)Actual
(March 2014) Actual
(April 2014)Actual
(May 2014) Kiosk Interactions vs. Transactions (Hou
Dental)5%20%376/388489/493670/679Kiosk Transactions vs.
Transactions (Hou Eye)10%20%518/526675/684926/947Kiosk
Interactions Vs. Transactions (Hou Dermatology)
11%20%525/532684/693938/965
Increase kiosk check- in by 37%
Increase kiosk check-in by 44%
Month 1

Month 2
Month 3
Increase kiosk check- in by 25%
Confirmed State
Despite the effectiveness in addressing time wastage in this
facility, the management should examine this proposal and
implement its recommendations as a means of improving its
dental care provision.
However, this project became effective in addressing the time
wastage and enabled the clients to have efficient and
satisfactory services.
Implementation is a learning and continuous process.
Management should have an eye out for new and better
implementation opportunities.

Be more vigilant in offering community-based services if
Veteran meets eligibility criteria
17
Kiosk Interactions vs Transactions
Kiosk Check-In's Transactions
Dental Clinic
Dermatology Clinic
Eye Clinic
Kiosk interaction by kiosk
Date Range:5/01/2014 to 5/31/2014 Kiosk
Interactions Transactions
Houston Dental 670 679
Houston Dermatology 938 965
Houston Eye 926 947

Date Range: 04/01/2014 to 04/31/2014 Kiosk
Houston Eye 675 684
Date Range: 03/01/2014 to 03/31/2014 Kiosk
Houston Eye 518 526
18
Kiosk Interaction April
04/31/2014Interations Houston Dental Houston
DermatologyHouston Eye 489684675Kiosk Interaction by Kiosk
Dental Houston DermatologyHouston Eye 493693684
Kiosk Interaction March

Kiosk Interaction May
Kiosk Interaction by Kiosk Date Range:5/01/2014 to
5/31/2014Interations Houston DentalHouston
DermatologyHouston Eye 670938926Kiosk Interaction by Kiosk
Date Range:5/01/2014 to 5/31/2014Transactions Houston
DentalHouston DermatologyHouston Eye 679965947
Kiosk Interaction February

Confirmed State
This lean management proposal was effective based on the
following reasons:
Patient who checked in with receptionist were interviewed to
learn about their awareness level of the new self-service check
in option
Patients who checked in with a kiosk were asked about their
experience using this tool.
The vast majority of member who checked in using the kiosk
has a successful experience with over 75 percent of members
feeling that checking in through kiosk is faster than check in
through a receptionist
About 60 percent of members report that the reason they used
the kiosk was because the line was shorter
More than 90 percent of members who used a kiosk to check in
are able to do so successfully without needing any assistance

and the same number also report that they felt comfortable with
level of privacy it offered by the kiosk.
Kiosk interactions report: Displayed Kiosk interactions vs
Transactions
19
Insights-box analysis
The plan was to create confidence and eagerness by showcasing
our new method of checking in veterans. Through increase
visibility, education, and repetitive instruction, the KIOSK
Check-in will be the premier innovation for veterans' access.
20
There are several reasons projects need to be started effectively
and the entire steps focused on to promote sustainability.
For this case, I experienced an issue with wastage and this

project endeavored to address it effectively.
I ensured that the piolet areas successfully used my project to
improve customer satisfactions, increase utilization of
innovation technology, and reduce wait time by checking into
the kiosk. In the future I love to implement wayfinding
technology on the kiosk check in system.
I noted the that the project implementation is successful
depends on the steps that the project manager takes in the
former stages and my team worked on all stages effectively.

A3 Problem Solving Template v1.2 (April 2015) by Henrik Knibe.docx

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