Project Title: Owner: Date:
Team Members:Problem Statement: Briefly state the problem. What, When, Where?
Scope In: Define limits on what is and what is not being included in this analysis. This could be departments, patient types, or process paths.
Background/Current Conditions:
Expand on the What, When, and Where to How, How much/many, How often, to whom, by whom, etc. What happens today? Describe the context or history of the situation. What is the result of the problem? What is being observed? Who is involved or affected (stake-holders)? What reports or measures are being used to track performance in the area? This can include a process map, pictures, or other visual representation.
Root Causes:
Using tools such as 5 Whys, Fishbone, Pareto Chart, or other graphs explore what are the root causes of the symptoms. Sometimes you will need to research data, interview staff, or do a Gemba walk.
Goals: Describe the results you would like to see addressing the major factors contributing to the current condition. What is the Target Condition?
Estimated Project Completion:
Estimate beginning/ending dates and important milestones.
A3 Plan ∙ Do ∙ Study ∙ Act (PDSA)
Countermeasures (Plan):What do you plan to do at a high level? What results do you expect to see? What could possibly go wrong?
Implementation (Do):
Describe what actions you are going to take. Identify steps including who is assigned and when it is due. Carry out the change or test.
Results/Conclusion (Study):
Collect data and begin analysis. What behaviors did you observe? What happened? What were the challenges? What did you learn? Did you meet your measurement goal listed in the countermeasures (show results)?
Follow-up Actions (Act):
Are we ready to make a system change (if so: who, what, when, where)? Do we need to make revisions and test again in next PDSA?
UMMHC CITC, A3 11X17 08/20/2013