Using A3 Lean Methodology to Improve the Stat Medication Process

1University of Michigan, Ann Arbor, MI
2VA Ann Arbor Healthcare System, Ann Arbor, MI
3VA Ann Arbor Healthcare, Ann Arbor, MI
4Ann Arbor VA Healthcare System, Ann Arbor, MI

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 705


The term “STAT” is meant to convey a sense of urgency, yet can be interpreted differently by inpatient care providers across disciplines. We found the current STAT order process for medications at one VA facility to be fraught with inconsistent understanding by the multiple providers involved, thus contributing to delays in the essential steps of appropriately ordering, identifying, verifying, and administering medications.


Our goal was to evaluate and improve the STAT process following a commonly used problem solving process in Lean organizations: “A3 Thinking”.


A3 thinking consists of team members working through sequential phases to cultivate a deeper appreciation and understanding of the depth of the problem. The three phases include the Discovery phase for team members to develop a shared understanding of the process; an Envisioning phase to conceptualize an ideal process experience; and finally an Experimentation phase to identify and trial possible solutions.


A multidisciplinary team was convened which consisted of hospitalists, surgeons, nurses, pharmacists, clerks, technicians and was facilitated by an industrial engineer familiar with the A3 process. We constructed a color‐coded flow map highlighting the key components of STAT order entry, verification, delivery, and administration. Team members participated in a modified “Go to the Gemba” which allowed visualization of the process from others’ perspective. We also conducted real‐time STAT order time studies and surveyed physicians, nurses, and pharmacy technicians.


The team brainstormed ways to create a better process and experiments through which these changes could be implemented. We categorized ideas by both level of effort and level of impact. High impact, low effort ideas became apparent to the group and were prioritized for initial experimentation.


Each experiment followed a standard Plan‐Do‐Study‐Act (PDSA). Three objectives were identified: (1) STAT should be consistently identified and understood; (2) STAT process should be easy and intuitive; (3) STAT process will be transparent. The average total time from STAT order entry to administration decreased by 21% and the total time from medication delivery to administration decreased by 26% after the experimentation phase. Additionally, technicians were alerted 93% of the time versus 58% about the need for STAT medication delivery, and nurses were alerted 87% of the time versus 26% that STAT medications had been delivered (Figure 1).


Adapting A3 Thinking for STAT order improvement was a low cost/low tech option for one VA facilityIt not only led to a more comprehensive view of the STAT process, but promoted a collaborative and multi‐disciplinary problem‐solving approach.

To cite this abstract:

Mack M, Viglianti E, Chase V, Manojlovich M, Conroy M, Belanger K, Zawol D, Corr K, Fowler K. Using A3 Lean Methodology to Improve the Stat Medication Process. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 705. Journal of Hospital Medicine. 2014; 9 (suppl 2). Accessed May 23, 2019.

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