A3 Thinking: A3 thinking is a structured technique of working through problems or opportunities for improvement. The ‘A3’ itself is literally just that: a piece of A3 paper summarising the logical thought processes that have been agreed by the team in defining the opportunity for improvement or solving the problem they face.

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A3 Thinking
Patient Safety Team
Lisa.smith@nhsiq.nhs.uk

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A3 Thinking
• What do we mean by A3 Thinking?
• Why do we use it?
• How do we use it?

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What is A3 Thinking?
• Structured thinking way - thinking deeply
• Follows a series of standard steps
• Rigorous application of PDSA cycle
• Output is a concise, consensed document - A3
Report (11 x 17 inch paper)

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PLAN
DOSTUDY
ACT
1. Is the problem statement
CLEAR and ACCURATE?
2. Has the SYSTEMIC
root cause(s) been
identified for all parts of process?
3. Has IRREVERSIBLE
CORRECTIVE ACTION(s)
been implemented for
ALL root causes?
4. Has a plan been identified
to verify the
EFFECTIVENESS
of all corrective actions?
5. Has a plan been identified
to STANDARDIZE and take
all lessons learned across
products, processes,
functional areas, etc.?
Understand the problem
Execute the PlanFollow-up
Standardize

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Why do we use A3 Thinking?
• Problem solving methodology:
– Visual
– Simple
– Logical
– Countermeasure, not containment (“Band aid”)
– Move towards Ideal System
• Document & share the learning
• Standardise new method

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How do we use A3 Thinking?
• Consensus on initial problem
perception…..
• A guide for:
– Understanding the problem
– Identifying the root cause
– Developing countermeasures
– Creating an action plan
• Good A3 report should convey
the problem & analysis of it
without any explanation

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Format
Title:
Problem:
Version: Date:
Author:
Current condition:
Target condition:
Root cause analysis:
Responsible: Team members:
Proposed countermeasures:
Plan:
Follow up:
Agreed by: Date:

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Format
Title:
Problem:
Version: Date:
Author:
Current condition:
Target condition:
Root cause analysis:
Responsible: Team members:
Proposed countermeasures:
Plan:
Follow up:
Agreed by: Date:
• Customer/patient value
• Basic problem
• What is happening?
(data/graphs, photos, current
state value stream map)
• Set SMART Goal
• Investigate why problem is
happening

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Fishbone / Cause & Effect
Checked possible Not cause of
Cause 1 problem
Checked possible Direct cause
Cause 2
Checked possible Contributory
Cause 3 cause
IDEA INVESTIGATIONS RESULT
idea
idea
idea
Investigate possible causes further (data
collection)
Identify possible causes

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5 Whys Analysis
Problem Root Cause Countermeasure
Why?
Why?
Why?
Why?
Why?
Reason
Reason
Reason
Reason

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Format
Title:
Problem:
Version: Date:
Author:
Current condition:
Target condition:
Root cause analysis:
Responsible: Team members:
Proposed countermeasures:
Plan:
Follow up:
Agreed by: Date:
• Investigate how to solve root
cause(s)
• Agree action plan
− What
− How
− Who
− When
• Is the problem solved?
• Has the goal been met?

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