QI Learning Center: Developing an A3: A Problem Solving Approach

By: Megan Vick, Preparedness Coordinator and Quality Improvement Coordinator, Northampton County Health Department

An A3 is a living document used in Quality Improvement as a communication and problem solving tool that includes a concise summary of the problems you are trying to resolve and the solutions you are using to do so.   This document is structured in a way that easily lays out the primary points of your project or plan: your focus, performance, activities, and timeline.  The format has five areas of focus including: Performance, gaps and targets; Reflection on last year’s activities and results; Rationale for this year’s activities; Action plan; and Unresolved Issues. This document is meant to tell a visual story in a concise and compact format.  In fact, the name “A3” refers to the specific size of paper that the content must fit within, roughly the size of two sheets of letter size paper. The left side of the page, which includes the first three sections, helps develop the story and highlight the background of the addressed issue and the right side of the document tells us how to achieve our goals. In this article, I will describe how an A3 can be used to execute a strategic plan, specifically a CQI plan.

I was fortunate enough to participate in the Quality Improvement Advisor Training offered by the Center for Public Health Quality last year.  Below is a copy of the A3 I and another coworker drafted for our agency during the Quality Improvement Advisor program to give you an example of what this “living document” looks like.

The Performance, gaps, and targets area is the place to establish a sense of where the agency is and/or has been regarding quality improvement initiatives and activities.  Last year’s results including any charts or graphs used and CQI survey results will be placed in this section. This is also the place to develop your mission and vision, and show what your target for the next three to five years will be.  Any gaps that you may have encountered or any you may foresee being a problem will be added in this section as well.

The Reflection on last year’s activities area is where the agency is asked to assess each quality improvement initiative that was addressed within the past year.  It is important in this section to report what worked well and what did not.  Any lessons learned would be helpful to include in this section as well. Also, this section should include target vs. actual, and what may be preventing us from reaching our vision and goal.

The Rationale for this year’s activities area is a good place to acknowledge how last year’s activities will benefit or change what you are planning to accomplish in the upcoming year.  It’s also important to list what activities need to occur and why.  Any benefits such as financial returns, employee morale, client satisfaction, new services being offered, etc. will also be included in this section. The section also includes any news factors to consider this year and why they are important.

Perhaps the most important part of the A3, in my opinion, is included in the Action Plan section.  This is the area in which the agency’s timeline is included and should state the activity, who is responsible for completing it, and when the target date is to be completed.   Essentially, this will be the “who, what, where, when, and how” of the strategy. This section should not have more than five main actions.  It is important to tell the story, but keep it in a concise format to help keep the reader focused.

The final section of the A3 is the area in which any follow up or unresolved issues are named.  This is a great section to add how the status of each initiative will be reported, what support is needed and from whom, and any issues that are still unresolved and what can or cannot be done about those issues.

 

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