title: Using A3 thinking to improve the STAT medication process.
abstract: BACKGROUND
  Although the term STAT conveys a sense of urgency, it is sometimes used to circumvent a system that may be too slow to accomplish tasks in a timely manner. We describe a quality-improvement project undertaken by a US Department of Veterans Affairs (VA) hospital to improve the STAT medication process.
  
  
  METHODS
  We adapted A3 Thinking, a problem-solving process common in Lean organizations, to our problem. In the discovery phase, a color-coded flow map of the existing process was constructed, and a real-time STAT order was followed in a modified "Go to the Gemba" exercise. In the envisioning phase, the team brainstormed to come up with as many improvement ideas as possible, which were then prioritized based on the anticipated effort and impact. The team then identified initial experiments to be carried out in the experimentation phase; each experiment followed a standard Plan-Do-Study-Act cycle.
  
  
  RESULTS
  On average, the number of STAT medications ordered per month decreased by 9.5%. The average time from STAT order entry to administration decreased by 21%, and time from medication delivery to administration decreased by 26%. Improvements were also made in technician awareness of STAT medications and nurse notification of STAT medication delivery.
  
  
  CONCLUSIONS
  Adapting A3 Thinking for process improvement was a low-cost/low-tech option for a VA facility. The A3 Thinking process led to a better understanding of the meaning of STAT across disciplines, and promoted a collaborative culture in which other hospital-wide problems may be addressed in the future.
authors.affiliation: Division of Nursing Business and Health Systems, University of Michigan School of Nursing, Ann Arbor, Michigan; VA Ann Arbor Hospital Outcomes Program of Excellence (HOPE) Initiative, Ann Arbor, Michigan.
authors.forename: Milisa
authors.initials: M
authors.lastname: Manojlovich
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Chase
authors.forename: Megan
authors.initials: M
authors.lastname: Mack
authors.forename: Meghan K
authors.initials: MK
authors.lastname: Conroy
authors.forename: Karen
authors.initials: K
authors.lastname: Belanger
authors.forename: Debbie
authors.initials: D
authors.lastname: Zawol
authors.forename: Karen M
authors.initials: KM
authors.lastname: Corr
authors.forename: Karen E
authors.initials: KE
authors.lastname: Fowler
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Viglianti
mesh_terms: D017598:Efficiency, Organizational; D006801:Humans; D015279:Organizational Culture; D011340:Problem Solving; D017064:Process Assessment, Health Care / Q000379:methods*; D016730:Program Development; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D014481:United States