Methods are available for surfacing and addressing
problems that are solvable at the front line, and for developing improvement
capability.
Unit managers and frontline staff should be able to apply improvement methods and tools
such as the Lean A3 method17 or the Model for Improvement18 to address process anomalies
as they arise. Structured methods for identifying problems, diagnosing problems (e.g., flow
diagrams, root cause analysis, cause-and-effect diagrams), and testing changes (Plan-Do-
Study-Act cycles) are essential, but they must be used in a true spirit of inquiry by managers
and staff who maintain a “preoccupation with failure.”19 Frontline unit managers and staff
employ these methods and tools routinely, with QI specialists to provide support as needed.
Higher-tier managers recognize and celebrate candid problem analysis and effective
remedies.