Shawn Cash and Ed Jurgill, cardiovascular invasive specialists, presented the team’s findings at Penn Medicine.
“Find your thorniest issue and tackle it,” said
Jim O’Connor, Senior Director Cardiovascular Services. “That’s what an A3 can help you do.”
In September, the Cardiac Catheterization Lab (Cath Lab) at Lancaster General Hospital, identified a priority issue: Zero percent of morning cases started on time. The delay in the first two cases of the day, which were scheduled to start at 8:30 a.m., created a ripple effect that caused patient delays or cancellations for the remainder of the day. The result? Lower patient satisfaction scores, physician dissatisfaction, and lower employee engagement.
“The A3 process really enabled us to slow down and look at the ‘why,’” O’Connor said. “It allowed us to bring together the entire team, from techs to physicians, and identify the root cause of why our patients were late to the procedure.”
Named for the 11-by-17 size paper that is used, an A3 is a tool that provides structure to problem solving. The tool helps leaders manage the improvement of a process, helping teams to identify and eliminate the root cause(s) of unfavorable states.
O’Connor said that through the root cause analysis, the team identified the issue causing procedures to start late: The history and physical updates (H&Ps), a necessary step before a procedure, were not being completed in the morning in a timely fashion and hence eating into the procedure time.
“We didn’t have a clear process for completing H&Ps,” he said. “But now, we do.”
In three months, the Cath Lab Team increased the number of first-of-the-day cases that start on time from zero percent to 40 percent. The effort has improved the patient experience and brought together a diverse employee group, helping to improve overall employee engagement – both system goals for LG Health.
“Sure, you have things happen that are out of your control, such as patient arrival time, but we now have a process in place that everyone agrees to – and more importantly, it is working,” O’Connor said.
Working so well, in fact, that the team was asked to present at the Penn Medicine Performance Improvement A3 Cohort – a report out from teams across the health system that have had success with Performance Improvement or Continuous Improvement, as it is known at LG Health.
During the report out, the team presented its case to Penn Medicine leaders, including Ralph Muller, President & CEO of the University of Pennsylvania Health System. The Cath Lab Team was awarded the Rapid Improvement Award for having the fastest improvement following the initiation of an A3.
What was the A3 Process Like?
“The A3 process provides your team with a structured methodology to help identify and solve an issue that may be plaguing a department,” O’Connor said, “but you’re not alone; your team has a PI coach to help guide you and keep you on track."
The entire A3 process took about four to six weeks, but O’Connor said it was worth it. So much so, that he has about three additional A3s going on within other departments.
“I would tell other leaders that it’s definitely a leap of faith at first,” he said. “We all think we are good firemen and can put out the fire, but the A3 helps you find the heat source.”