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Make referrals ready

A3 thinking + administrative gemba. Follow the visual, practise a decision, then check your thinking.

Fictional teaching examples and AI-generated illustrations. Proposed changes and goals are not achieved results. Use the written instructions and check local conditions before applying a method.

Teaching view 1 of 2

Tell one connected problem-solving story

An A3 story links the referral route and readiness gap to analysis, a proposed trial and follow-up.
AI-generated teaching illustration. Follow the steps below, then try the practice question. View full size ↗

An A3 explains how the evidence leads to a proposed countermeasure. The current example has 62 of 100 referral packets ready first time, with a 90% goal. Its 4.8-business-day median and proposed 2-day goal are a second measure. Link missing-information observations to a testable change at intake; do not jump from a low score to a preferred solution. The owner uses the story to invite challenge and align the people who perform the work.

Follow the method

  1. Purpose + current condition
  2. Target + gap
  3. Analysis + unknowns
  4. Countermeasure + trial
  5. Follow-up + learning

Read the example carefully

The illustrative administrative route is Receive → Review → Route → Confirm. The A3 owner links the observed gap, target, analysis, countermeasure and follow-up.

62 of 100 packets are ready first time; 38 need rework. The 90% readiness goal and 2-business-day goal are proposed, not achieved.

Try it before revealing the answer

Which A3 link is missing if the team proposes a new intake form without observing rework?

Reveal the answer and reasoning

The evidence connecting the current condition and its causes to the countermeasure.

Teaching view 2 of 2

Observe readiness, then test one channel

An administrative handoff route connects observed rework, a readiness check and a one-channel experiment.
AI-generated teaching illustration. Follow the steps below, then try the practice question. View full size ↗

Agree what a ready packet contains and where its route begins and ends. Observe the handoffs without collecting personal patient data. Test the proposed readiness check in one channel, then compare readiness and elapsed business time under comparable conditions. Track reopened cases against the existing 8% ceiling so fewer incomplete packets do not conceal more downstream rework. This teaches administration, not clinical decisions.

Follow the method

  1. Define ready
  2. Observe one packet route
  3. Record missing information
  4. Trial one channel
  5. Review delay + reopening

Read the example carefully

Rework categories in the 38 packets: missing document 21; duplicate clarification 11; routing mismatch 6.

Agree readiness, observation boundary and comparable conditions. Record future results rather than filling them from the proposed design.

The existing reopened-case ceiling is 8%. It is a balancing measure alongside readiness and elapsed business time.

Try it before revealing the answer

Why keep the reopened-case measure beside the readiness goal?

Reveal the answer and reasoning

A local improvement can transfer work or errors downstream; the balancing measure helps expose that.

Build on reliable methods

Sources and further reading

  • Lean Enterprise Institute — A3 Report ↗

    A3 combines an accountable problem-solving owner, factual analysis, countermeasures, responsibilities and outcome evidence with coaching and alignment dialogue.

    Completing a template alone does not establish the quality of the thinking or evidence.
  • Lean Enterprise Institute — Gemba ↗

    Direct observation and inquiry where value-producing work occurs establish current conditions before action; following a process across departments can reveal its end-to-end operation.

    Gemba applies to service and office work as well as manufacturing.
  • Institute for Healthcare Improvement — Model for Improvement ↗

    Successive small tests under differing operating conditions develop confidence before a change is implemented permanently or spread.

    A successful initial trial is distinct from implementation and sustained improvement.
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