negative service interactions by 50% in 60 days.”
Clear goals are highly motivating, and articulating a
prediction facilitates effective learning.
Finally, set the leadership guidelines. Guidelines
are the “guardrails” for executing the project; they
represent boundaries or constraints that cannot be
violated. For example, the leadership guidelines for a
project focused on cost reduction might specify that
the project should identify an innovation that reduces cost without making trade-offs in quality.
Execution Plan The next step is running the experiment. In the upper portion of the Execution
Plan box of the A3 form, lay out a plan for implementing your proposed design. Be sure that the
plan is broken into a set of clear and distinct activities (for example, have the invoice form reprinted
with the general ledger code or hold a daily meeting
to review quality issues) and that each activity has
both an owner and a delivery date.
Now execute your plan and meet your target.
But, even as you start executing, you are not done
engaging in conscious learning. Instead, you want
to make sure that you are not only solving the problem but also absorbing all the associated lessons.
Track each activity relative to its due date and note
those activities that fall behind. These gaps can also
be the subject of structured problem-solving. During this phase, interim project reports should be
simple: The owner of the action should report
whether that element is ahead of or behind schedule, what has been learned in the latest set of
activities, and what help he or she may need.
In the Track Results section of the form, measure
progress toward your goal. For example, if the overall
target is to reduce the number of poor service interactions by 50% in 60 days, then set intermediate goals,
perhaps weekly, based on your intervention plan. Put
these intermediate targets in the first column of the
Track Results section and then measure your progress
against them. Also, make sure that you continue to
track the results for an extended period after you have
met your target. You want results that stick.
Once the project is complete, document what
you learned in the What Did We Learn and What’s
Next section. Here you should both outline the main
lessons from the project and articulate the new
opportunities that your project revealed. If you
exceeded your predictions, what does that tell you
about future possibilities? In contrast, falling short
of your target may reveal parts of the work system
that you don’t understand as well as you thought.
Finally, and perhaps most importantly, what prob-
lem are you going to tackle next? A well-functioning
process, whether in manufacturing, customer ser-
vice, or new product development, is the product of
numerous small changes, and fixing one real prob-
lem often reveals many additional pressing issues.
Close out your A3 by outlining the next problem you
and your organization need to solve.
A Case Study in a Hospital
How does this process work in practice? To illustrate, we describe a recent case where one of the
authors, a hospital executive who had been introduced to the basics of problem formulation and
structured problem-solving, used the techniques to
improve organizational performance.
Todd Astor and his team transplant human lungs at
Massachusetts General Hospital in Boston, Massachusetts. Although the lung transplant procedure is highly
complex, its complexity pales in comparison to managing the recipient’s health after the transplant. The
human body often responds to the transplanted organs in dangerous ways. A big part of Todd’s job is
staying in close contact with his patients and carefully
managing the complicated suite of medicines needed
to suppress the body’s natural immune response.
Several times a week Todd’s lung transplant unit
has a clinic in which transplant recipients come to be
evaluated and receive any necessary adjustments in
their treatment. Each clinic session lasts for three
hours and utilizes three dedicated exam rooms. Based
on the evaluation criteria of Todd’s hospital, that
should allow him to see 27 patients (three per hour in
each room). But at the outset of the project, the team
was able to see an average of seven patients per clinic
session. Running the clinic at less than 30% of its ideal
capacity potentially compromised care — patients
might have to wait longer to be evaluated — and had
significant revenue implications for the hospital. With
a few iterations, Todd’s challenge led to the following
problem statement and supporting background:
The post-lung transplant outpatient clinic session has an average volume of 7 patients, even