A3 Thinking Overview

The A3 is a structured, one-page improvement plan, often printed on A3 or 11x17 paper.  

A3 Thinking is a term we use to describe our standardized language and approach to problem solving, which reinforces: 

"What is important is not the format, but the process and thinking in creating the A3."

  • Critical thinking, not reactivity or assumption
  • Humility and respect
  • Problems as opportunities
  • Learning through data, facts, observation
  • Process & systems thinking
  • Engagement and alignment
  • Execution by iterative improvement (PDSA)

Zuckerberg San Francisco General Hospital and the San Francisco Department of Public Health have adopted A3 Thinking as a common approach to problem solving, with the goal of supporting an organization of problem solvers aligned to True North. 

Brief Anatomy of an A3

Left Side: What problem is currently happening and where do we want to be?

Background: What problem are you talking about and why focus on it now?

Current Conditions: What is happening today and what is not working?

Problem Statement: What specific, measurable problem will serve as your baseline performance?

Targets and Goals: What specific measurable outcomes are desired and by when?

Analysis: Why does the problem exist, in terms of causes, constraints, barriers?

Right Side: How will we work together to improve?

Possible Countermeasures: What countermeasures do you propose to address your causes and why?

Plan: What, where, how will you implement, and by whom and when?

Follow-Up: How will you assure ongoing improvement through PDSA (Plan-Do-Study-Adjust)?

For further information not answered here, please contact:

William Huen MD, MS, MPH

Associate Chief Medical Officer
Medical Director, Quality Management and Kaizen Promotion Office
Associate Clinical Professor, UCSF Department of Medicine