TRANSFORMING HEALTHCARE Using A3 Thinking to Improve the STAT Medication Process

BACKGROUND: Although the term STAT conveys a senseof urgency, it is sometimes used to circumvent a systemthat may be too slow to accomplish tasks in a timely man-ner. We describe a quality-improvement project undertakenby a US Department of Veterans Affairs (VA) hospital toimprove the STAT medication process.METHODS: We adapted A3 Thinking, a problem-solvingprocess common in Lean organizations, to our problem. Inthe discovery phase, a color-coded flow map of the existingprocess was constructed, and a real-time STAT order wasfollowed in a modified “Go to the Gemba” exercise. In theenvisioning phase, the team brainstormed to come up withas many improvement ideas as possible, which were thenprioritized based on the anticipated effort and impact. Theteam then identified initial experiments to be carried out inthe experimentation phase; each experiment followed astandard Plan-Do-Study-Act cycle.RESULTS: On average, the number of STAT medicationsordered per month decreased by 9.5%. The average timefrom STATorder entry to administration decreased by 21%,and time from medication delivery to administrationdecreased by 26%. Improvements were also made in tech-nician awareness of STAT medications and nurse notifica-tion of STAT medication delivery.CONCLUSIONS: Adapting A3 Thinking for processimprovement was a low-cost/low-tech option for a VAfacility. The A3 Thinking process led to a better under-standing of the meaning of STAT across disciplines, andpromoted a collaborative culture in which other hospital-wide problems may be addressed in the future. Journal ofHospital Medicine 2014;9:540–544. 2014 Society ofHospital Medicine