Background: Hospitalists encounter problems daily in their clinical practice but do not routinely engage in problem solving independently. Problems are often brought to the attention of hospital medicine leadership, but this does not support hospitalist engagement in process analysis and implementation of solutions. A reason for hospitalist disengagement is a lack of a standardized and structured approach to problem solving. Using the A3 process analysis, we identified that a lack of skill set for problem solving is a limitation for hospitalist engagement. This gap can limit the hospitalist’s ability to lead successful quality improvement initiatives.
Purpose: To engage the hospitalist team in problem solving by using A3 tool
Description: Hospitalists attended a patient safety initiative that provided a broad overview of the A3 tool. In addition, the hospital medicine leadership team was coached by an internal lean improvement coach. Next, interested hospitalists were asked to address problems identified as high priority (based on a Pick chart) and coached by a member of the hospitalist leadership team using a standard coaching framework. Hospitalists were given a pre-and post-coaching survey to gauge their skills and comfort level using the A3 process. Since the launch of this initiative in May 2020, 30% of the hospital team is engaged in problem solving. 80% of the A3s initiated are project level and as a result of the longer time to reach experimentation and for completion of A3, we do not have post coaching data. For problem-based A3’s, 2 post coaching surveys were completed with 100% of participants reporting willingness to work on another health care initiative using the A3 tool.
Conclusions: The use of the A3 tool helps to provide a structured and standardized approach to problem solving which leads to hospitalist engagement in problem identification and further quality improvement initiatives. Creating a standard coaching framework further engages hospitalists to coach other members of the team. As we continue to expand this initiative, we hope to see completion of the A3s created and coaching to be performed not only by leadership, but also by members of the hospitalist team.
