Robust Process Improvement Through A3 Thinking

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John BeallBy John J. Beall

As a medical professional, you are probably not new to the phrase “process improvement.” In your own organization you have probably participated in a process improvement project, and hopefully the experience was rewarding and allowed you to replicate it within your own area of responsibility. Do you remember what process you used? Maybe a variation Deming’s FOCUS-PDCA (Plan-Do-Check-Act)? Or maybe you were lucky enough to have a certified Lean Six Sigma Green Belt or Black Belt in your organization that helped guide your project through the DMAIC (Define, Measure, Analyze, Improve and Control) process? Either way, once you were done with the process did you feel that it only solved for large problems and that there wasn’t any use in going through all of these steps to try and get the quick fixes done? Well, you are not alone; this same thing happened to the US Army and the Medical Command (MEDCOM).

In 2006, the Department of Defense was mandated by Congress to implement some form of a Continuous Process Improvement (CPI) program. The Army and Navy decided on Lean Six Sigma, and the Air Force chose the Air Force Smart Operations (AFSO) 21 (Lean). In 2015, the Army identified that it had spent years emphasizing the use of Lean Six Sigma projects for complex problems but that they were missing the widespread use of Lean tools for everyday improvement. Incidentally, the Air Force found that they needed to start using Lean Six Sigma in their systems.

We solved this by implementing the Eight Step Problem Solving Process (1. Clarify the Problem; 2. Break Down the Problem; 3. Set the Target; 4. Analyze the Root Cause; 5. Develop Countermeasures; 6. Implement Countermeasures; 7. Monitor Results and Process; 8. Standardize and Share Success) and the A3 Problem Solving Template into what we call the “Lean Leader Course.” We were so successful in implementing this that we increased from 5 classes in 2015 to 26 courses offered in 2016. In April 2017, Headquarters Department of the Army Office of the Business Transformation elevated the course to an Army-wide certification program.

During my session at the AHRA Spring Conference I hope that you will learn a little about the A3 problem-solving process, which was first used by Toyota, and how A3 problem-solving fits into organizations that are on their journey to becoming a High Reliability Organization. I will show you how Army Medicine has started using A3 to complement their process improvement program and created the Lean Leader Course. You will also come out of the session with another tool for your “Process Improvement Toolkit” as we will discuss and demonstrate the link between A3 Thinking, Lean Six Sigma, and PDCA. Lastly, the attendees will break up into groups and receive scenarios and try to employ the A3 problem-solving that they just received.

To learn more about A3 Thinking and problem solving while participating in some practical exercises please join me on Friday, March 23rd from 3:15- 4:15PM at the AHRA Spring Conference for my session, “Introduction to Robust Process Improvement Through A3 Thinking.” I look forward to seeing you there!

John J. Beall is the Deputy Commander Patient Support Services Senior Clinical NCO (Asst VP) at Madigan Army Medical Center in Tacoma, WA. He can be reached at

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