A3 Problem Solving Report
Leslie M. Beitsch1, John W. Moran2, and Annie Vosel3
November 2016
Description:
The A3 Problem Solving Report (A3) is a problem solving and continuous improvement
approach. Its name refers to a metric paper size designation that is roughly equivalent to an 11-
inch by 17-inch sized paper, which is the largest size that will fit through a fax machine, and is
the paper size that should be used for this tool. A3 helps an improvement team concisely
describe and document its problem solving process. It is somewhat similar to Storyboard, Patient
History and Physical, or SOAP (Subjective, Objective, Assessment and Plan) methods of
thinking4 and supports the Plan-Do-Check-Act (PDCA) approach to quality improvement (QI)
by providing a documentation process. A3 can be archived electronically so team members and
others can view QI activities regarding a condition or problem under investigation. This version
of the A3 Problem Solving Report is an adaptation for public health, which was originally
developed by Toyota and adapted for use in healthcare.5
When to Use:
A3 can be used when a team needs a concise approach to problem solving and documentation for
a condition that needs improvement, such as reducing instances of foodborne illness. A3 helps
team members document what is known and then guides them through the improvement process.
Using A3 on a regular basis helps an organization have a standardized improvement process that
helps instill an organization-wide culture of quality.
1
Leslie M. Beitsch, MD, JD, is Professor of Health Policy, Director of the Center for Medicine and Public Health,
and Chair of the Department of Behavioral Sciences and Social Medicine at the Florida State University College of
Medicine. He also is the former Chair of the Public Health Accreditation Board (PHAB).
2
John W. Moran, PhD, is Senior Quality Advisor to the Public Health Foundation and Senior Fellow in the Division
of Health Policy and Management at the University of Minnesota, School of Public Health. He is a previous member
of PHAB’s Evaluation and Quality Improvement Committee and Adjunct Professor at the Arizona State University
College of Health Solutions' School for the Science of Health.
3
Annie Vosel, BSN, RN, is a consultant for the Public Health Foundation. She has over 30 years of experience
working as a nurse primarily in Maternal and Child Health programs. For the past 15 years she was Director of the
Division of Women’s and Children’s Health and the Title X Family Planning Program for the Alabama Department
of Public Health. She also developed a statewide clinical efficiency initiative for the Family Planning program.
4
Make Your Clinics Flow with Synchrony, D. Han, MD and A. Suneja, MBS, ASQ Quality Press, 2016, p. xxi.
5
A3 Problem Solving for Healthcare: A Practical Method for Eliminating Waste, C. Jimmerson, Taylor & Francis,
2007
www.phf.org/QItools
Construction Steps:
Begin A3 by filling out the top of the template with the project’s start and end dates, the name of
the team leader, and the document revision number (which should be numbered in sequence).
Then complete the following eight sections:
1. Identify the Condition/Problem: Create a title that describes the project in a few words.
2. Describe the Current State of the Condition/Problem: Provide basic information about
the background and current state of the issue.
3. Define Improvement Objectives (Goals & Targets): List key objectives to improve the
current condition or problem. Be sure to state the desired characteristics of the improved
or future state.
4. List Out Data Describing the Current Condition/Problem: Indicate data points that
are known about the issue (e.g., frequency, duration, quantity).
5. Conduct a Problem/Root Causes Analysis: Use a Cause and Effect Diagram6 to
determine what is causing the issue.
6. List Out Potential Solutions: Brainstorm7 ideas that will address the root causes of the
problem.
7. Prioritize Solutions and Decide Which Ones to Implement: Use a Prioritization
Matrix8 to determine which of the potential solution(s) are most likely to best resolve the
root causes of the problem, and will meet the objectives of the project.
8. Develop an Implementation Plan and Status: List out the activities (What) to be
accomplished, the person responsible for each activity (Who), and the timeframe for
completing each activity (Due Date). This is similar to a Gantt Chart9.
Once these steps are completed, regularly update the status and percentage complete for the
implementation activities on the A3 using the color code shown in the example on the next page
(green = activity on track, yellow = activity is experiencing problems, red = activity is late or
behind schedule). If implementation activities get behind schedule, the improvement team should
develop and implement countermeasures to get them back on track.
This tool was made possible through funding from the Centers for Disease Control and
Prevention under Cooperative Agreement NU38OT000211. The contents of this document are
solely the responsibility of the authors and do not necessarily represent the official views of the
sponsor.
6
Public Health Quality Improvement Encyclopedia, Public Health Foundation, ©2012, pp. 11-12.
7
Public Health Quality Improvement Encyclopedia, Public Health Foundation, ©2012, pp. 9-10.
8
Public Health Quality Improvement Encyclopedia, Public Health Foundation, ©2012, pp. 93-94.
9
Public Health Quality Improvement Encyclopedia, Public Health Foundation, ©2012, pp. 47-48.
www.phf.org/QItools
Example: Tri City Health Department Foodborne Illness
This example shows a completed A3. Based on the steps above, the template was filled in to show the problem solving process for a
foodborne illness outbreak.
Team Leader and Contact
A3 Report Template Start Date: March XXXX End Date: April XXXX
Information: Les, Epi Dept
Revision: 01
1. Title: Identify the Condition/Problem: Foodborne Illness Outbreak 6. List Out Potential Solutions:
2. Describe the Current State of the Condition/Problem - Background and Current State
Local Hospital ER calls the health department and asks if they have any recent cases of foodborne
Food handling training course
Illness (FBI). They have a case in the ER now from a person that has just eaten at the local county fair
Hot and cold food handling techniques training
Ordinance requiring hand washing
Mobile vendor hygine documentation
3. Define Improvement Objectives (Goals & Targets) Develop and give visual reminders for posting in mobile vending van
List key objectives to Improve the Current Condition or Problem: State improved / future state desired Better staff training for enforcement
conditions. Running hot water in all mobile vendor vans
Better public education about mobile vending - tips
1. Understand the current case in the ER Improved waste disposal where mobile vendors are located
2. Determine what caused the FBI
3. Develop and action plan for the rest of this year's county fair and next year
4. Improve mobile vending inspections and licensing process
4. List Out Data Describing the Current Condition/Problem: 7. Prioritize Solutions and Decide Which Ones To Implement:
Improve mobile vendor training on sanitation requirments and temperature control
- third case this week associated with the county fair
- twice the number of mobile vendors at the fair this year than last
8. Implementation Plan and Status: Legend: On Schedule Problems Late
- no specific pattern to trace back to one mobile vendor
% Complete Due Date - Year
- temperature control studies indicated mobile vendors needed better controls
20 40 60 80 100 Month 1 Month 2 Month 3 Month Month
- adequate water supplies for sanitation an issue with mobile vendors WHAT WHO 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
X 1. Develop course materials Vanessa x
X 2. Test materials internally Gwen x
5. Conduct a Problem/ Root Causes Analysis X 3. Develop Pre and Post Test Annie x
Social Events Food Safety Licensing X 4. Inform mobile vendors of new requirements Jack x
X 5. Schedule first course Les x
Adequate heating Unsanitary Food Handler Adequate Work
/cooling – power Conditions Training Force X 6. Course evaluation and improvements Annie x
source
Temp control
X 7. Schedule next course Jack x
Freq of
Licensin training Insp
FIFO Inventory Increase in
g FBI
Public Knowledge Weather Case Reports
Stds of
Country of origin Transport
PH/Medical Staff Regulations
Temp Controls
Mandated Reports Quality of Inv during transport
Ease of reporting
FIFO
Awareness of
Supply Transport
FBI
