We will look at the use of the classic LEAN A3 in a 2-year, multi-level, multi-organizational improvement situation. We will use an actual project that worked on decreasing patient harm in the nurse-sensitive indicators of CAUTI, CLABSI, CDIFF, FALLS, and HAPI. As supporting tactics, we will identify how we used cascading A3s (parent and child), and pre-developed fishbone diagrams that could be tailored to each of the 4 markets, to enhance reliability and engagement. Psychological safety is identified as the ‘secret sauce’ that made it successful.
Tool: Cascading 8-Step A3 LEAN Communication Tool
Problem: With the advent of the COVID pandemic, Kaiser Permanente needed a new and improved interdisciplinary, collaborative, root cause, and data-driven method to better partner and collaborate in communicating and supporting the work of harm reduction in nurse-sensitive measures associated with HAIs, patient falls, and pressure injuries.
Tool Selection: The LEAN A3 communication tool is a proven systematic method for improving project communication. Using cascading A3s can also align root cause analysis outcomes between organizational levels that support the principles of High Reliability
Usage: This tool was used to consult, communicate, and document the nurse-sensitive measure improvements that were occurring in the 4 hospital markets of Kaiser Permanente, respecting the principles of high reliability and providing a psychologically safe milieu in which to operate
Results: Improvement in 4 of the 5 nurse-sensitive measures were achieved, with stabilization of the 5th measure. Barriers occurred with multiple changes in sponsorship, Covid surges, and competing priorities. Focusing on psychological safety and HRO principles through the use of the A3 was key
