Redesigning Clinical Workflows to Return Joy to Patient Care
Tight-Loose-Tight Leadership and A3 Thinking

Category Archives: A3 Problem Solving

Tight-Loose-Tight Leadership and A3 Thinking

Are you a “results-oriented” leader?  I hope you are, because you need good results to be successful.  How do the people you lead feel about your focus on results? Are they empowered or feeling burned out? The “Tight-Loose-Tight” approach to leadership can ensure results while empowering your team.

The basic concept of “Tight-Loose-Tight” is for a leader to empower a person or team working on a project, while ensuring the desired outcomes. This approach fosters autonomy, which workers value, and accountability, which leaders depend upon from their teams. It fits perfectly with A3 thinking.  Let’s see how.

Tight-Loose-Tight explained

The first “Tight” has to do with clearly defining the problem or project.  If the team and the leader don’t agree on and understand the problem to be solved, it’s easy for the team to develop a great solution to the wrong problem.  This happens quite often.  The risk increases the more complex the problem and the larger the number of people on the team.a3-enhanced

The left side of the Simpler A3, boxes 1-3, when completed appropriately, do a great job of ensuring a mutual understanding of the problem. Box 1 states the problem and the reason for action.  It sets the scope of the problem, ensuring the team doesn’t miss what’s needed, and avoids “scope creep” – trying to solve for world peace.  Box 2 identifies the current state of the problem, both with objective metrics that matter, and subjective feelings or impressions that capture the essence of the issue.  Box 3 sets the targets for improvement, measured objectively by the same metrics in box 2, and assessed subjectively by how things will be different once the solution is in place.  Being diligent in completing box 1-3 ensures everyone shares a common assessment and goal.

Get Loose

The “Loose” in the middle is key to tapping into the team’s creativity in coming up with the best possible solutions.  Here it is key for the team to develop a deep understanding of causes of the problem and brainstorm creative solutions that work.

The middle column of the Simpler A3, boxes 4-6, serve this purpose well.  Box 4 analyzes the gaps between the current and target state to find the deep root causes of the problem.  Box 5 considers options for solutions – “If we take this action, then we should expect this result” – which guides the team in identifying what changes to make.  Box 6 tests the assumptions developed in box 5, by doing experiments that demonstrate what works, and more importantly, what does not work despite seeming like a great idea.

Then “Do the Tighten-Up”

The last “Tight” drives success by ensuring accountability – setting clear expectations about what is to be done and what the results should be from making those changes.

phsician-meetingThe right column of the Simpler A3, boxes 7-9, drives accountability.  Box 7 is the implementation plan, specifying what actions need to take place, when they are due, and who is responsible to do them.  If they are on track, we color them green. If they are off track, we color them red, so we know that we need to pay attention to these.  Box 8 tracks progress on the metrics from the initial state toward achieving the target state.  We use the same green-red indicator to ensure we are focusing on issues that need attention.  Box 9 provides us insights, what we learned in the process that we can use to do better the next time.  For example, if our implementation plan in box 7 is all green, and yet box 8 is red because we are not achieving our targets, we need to go back and understand the flaws in our process.

The Tight-Loose-Tight approach of A3 thinking drives accountability while reducing the drivers of burnout.  It gives workers control, builds community among the team, and aligns values.  People feel a sense of involvement and accomplishment that reduces the risk of the cynicism and inefficacy that can develop in burnout.

Have you tried this approach?  If so, how has it worked? If not, what’s holding you back?

Redesigning workflows is complex work. The teams involved in a Rapid Improvement Event often find it challenging to think “outside the box” in order to make significant changes to work flow processes. There are many reasons why: The team members have not been exposed to alternatives. Others in the gemba are deeply invested in the… Continue Reading