A3 thinking Applied: a Real World Process of Implementing An Asthma Home-Based Management Project(AMP)

Background A3 Lean Methodology/Thinking is a foundational management process and methodological structure for transforming health. Along with PDSA methodology it is a vital tool in problem solving and sustainable QI initiatives/intervention. Delivery System Reform Incentive Payment (DSRIP) is a NY State program aimed at transforming health care delivery and decreasing hospitalizations while transitioning to a more socially and community based system of care. When asked to launch a pediatric asthma management program (AMP) by DSRIP the A3 Lean Methodology was used from the outset. Objectives Outline benefits of A3 Thinking and use the example of the AMP to showcase the benefits of this approach. Illustrate the importance of teamwork and enthusiasm in the group project setting. Embody best practices, standardized education for providers and families, and a process for home assessment all aimed at better symptom control and fewer ED visits and admissions. Methods An interdisciplinary asthma workgroup was created. The elements of A3 Thinking (9 Box process) was used. The preparation phase included reason for action and identification of initial and target states. (Table A) The problem solving phase used a gap analysis, solution approach and rapid experiments. The sustainment phase included a completion plan, confirmed state and insights.(Table B) Other tools used were a reverse fishbone gap analysis and SIPOC chart (Supplier, Input, Process, Output, and Customer). (Fig.1) Results A3 Thinking process allowed us to establish a functioning team, identify current and target states and to identify gaps. Using rapid experiments the team was able to reach its target state where identification of and referral of patients to an asthma educator was 100%. Two RN's were identified and trained to be these educators. 100% of pediatric staff were trained with a standardized asthma curriculum. 2300 patients with any asthma diagnosis were identified. As of Dec 2017 105 have met criteria and been referred to the AMP. An educational flyer has been created and is given via a standardized workflow to 100% patients upon referral. Allergan testing has become a best practice for persistent asthmatics. Conclusion The A3 Thinking Process was effectively used to help implement and sustain an AMP in the Pediatric Primary Care Clinic of NYC H+H/Elmhurst as part of a DSRIP initiative. The 9 Box method allowed the team to meet regularly, to assess the current state and identify the needs, p