Implementation of a transformational plan of care at a Veterans Affairs medical center

Abstract

Use of lean process improvement methodology and the A3 problem-solving process resulted in more efficient generation and implementation of ideas, consistent follow-up, and the ability to continuously reevaluate pharmacy service operations to ensure progress throughout the year.

The Hepatic Innovation Team Collaborative: A Successful Population-Based Approach to Hepatocellular Carcinoma Surveillance

“…The HIT Collaborative Leadership Team engaged regional teams in monthly calls and quarterly data reviews. These calls provided a forum for teams to share “best practices” and quality improvement work, using standard systems redesign tools [ 12 , 21 ]. The presentations and resources could be accessed on a SharePoint webpage between meetings.…”

Quality and Safety in Healthcare, Part XC

“…The term A3 refers to the nomenclature of a piece of paper that is 297 mm in width and 420 mm in length. This size was chosen because the dimensions were the largest that could be used by a standard fax machine and many printers and copiers of the time, so it could be distributed to many individuals in an organization 2–5 . The paper was then divided into certain sections to problem solve in a step-by-step manner.…”

“…The A3 uses the Plan-Do-Check-Act (PDCA) system for improvement. The A3 breaks down the "Plan" part of the PDCA into multiple components, which in 1 approach has 7 steps that may be summarized as follows: indicate the (1) problem, (2) background (including some details and perhaps some metrics), (3) current state (and include a drawing of this), ( 4) goal (which includes the hypothesis and the way in which the results can be measured) and be "SMART" ("specific, measurable, attainable, relevant, and timely"), (5) root cause analysis (by asking the question "why" 5 times or using the fishbone diagram approach), (6) desired "future state" (with a diagram), and (7) improvements required to reach the future state. 2 It can be helpful to evaluate the current and proposed future state with a SWOT (strengths, weaknesses, opportunities, and threats) analysis.…”

“…2 When steps 1 to 10 are completed, ideally there should also be an analysis of how well the process went and how to improve it in the future. 5 The Japanese term hansei refers to self-reflection, and in the TPS is "the continuous improvement practice of looking back and thinking about how a process or personal shortcoming can be improved." 17 Hansei meetings generally occur "at key milestones and at the end of a project to identify problems, develop countermeasures, and communicate improvements to the rest of the organization so mistakes are not repeated.…”

“…17 The A3 methodology is an excellent step-by-step way to find solutions to certain problems. [1][2][3]5,6 In addition to the PDCA cycle and the use of root cause analysis, sometimes interviews with stakeholders, driver diagrams, and process mapping, including value stream mapping, are used. 10,18 In a quality improvement, "a driver diagram is a visual display of a team's theory of what 'drives,' or contributes to, the achievement of a project aim" 19 or outcome.…”