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Table 1 Summary of adapted topics in the initial project phases

From: Improving accessibility for outpatients in specialist clinics: reducing long waiting times and waiting lists with a simple analytic approach

Topic Activity
Understanding of processes/Value stream mapping Detailed analysis of current processes and identification of topics that generated reduced utilization of resources, waste and delays for personnel and patients. Cross-professional teams.
Application of A3 as a problem-solving tool to prioritize actions and evaluate root causes. Analyses of suggestions for how to organize and design alternative work flows to improve resource utilization and reduce waste
Identify current condition and root causes of problems
Define future targets
Follow up, countermeasures and experimentation
Introduction of team work during interventions involving front line personnel Team approach to problem solving to safeguard a shared understanding of problems and their solutions, and to build a culture of continual improvement and learning. Multidisciplinary process improvement teams included staff and management representatives involved in the treatment.
Select small changes to ensure early results Identity most promising initiatives to ensure improvements as soon as possible and select uncomplicated solutions.
Establish regular meetings between the personnel groups involved Implement huddle meetings and methods that help relay information to problem solvers and create stable structures for continual improvement. Ad hoc ‘lean teams’ to address specific problems when relevant
Involvement of management Most important, but most challenging, and which did not succeed in all clinics: Engage management in continual problem solving and avoid senior management choosing quick-fixes instead of analyzing and addressing root causes.
  1. aA3 is a LEAN method that provides a simple, strict approach that systematically leads toward problem analysis and solving using a single sheet of A3 paper