3P: production preparation process

Today’s healthcare leaders are using kaizen (continuous incremental improvement) to transform their organizations and address the many process problems their teams face on a daily basis. Occasionally, those problems are so significant that they cannot be fully overcome with kaizen alone. 3P (production–preparation–process) is an additional lean approach that experienced lean leaders can use to radically redesign processes, products and facilities to better meet the demands of the healthcare marketplace.

3P is based on the Japanese concept of kaikaku (revolutionary change made over a short period) and can be used to generate “quantum leaps” in an existing process or to design processes that don’t currently exist. It can also be used to assist in the implementation of new equipment, information systems and staff workflows. The ultimate goal of all 3P projects is to enhance flow while simultaneously improving quality, affordability and time to market for new products and services.

Example: New patient registration process, remodeled PACU, redesigned staff workflows in a new inpatient facility.

Methods and Implementation Approach

3P teams spend five days developing various process/product designs and evaluating/refining them based on quality, cost and service criteria. The basic outline of a 3P event is as described here:

  • Define product or process design objectives–The team seeks to understand the core customer requirements that need to be met and the extent to which the existing processes are meeting them. These requirements are summarized in the form of “keywords.”
  • Diagramming–“Fishbone diagrams”, “string maps” and/or “process flow maps” are created to highlight the seven flows of medicine and the various inputs to the processes being studied. The project team then analyzes the diagrams and brainstorms “key words” that describe the desired attributes of the future designs.
  • Referring to nature–The team tries to find examples of each process key word in the natural world. Once the unique qualities of the natural process are dissected, team members discuss how similar processes might apply to the delivery of healthcare.
  • Brainstorming–Individual team members use “7-designs” forms to stretch their thinking and generate breakthrough ideas. Ideas are compared, consolidated and refined, based on full team input and design criteria.
  • Mock-ups and simulation–Over a series of days, the team mocks up and simulates the preliminary designs to ensure that the final design supports smooth flow and meets all critical design criteria.
  • Hold design review–Once a final design has been developed, it is presented to a larger group of stakeholders for feedback.


  • Visioning workshop:
  1. Identify project scope and important functions of future process or product.
  2. Create an A3-3P. 
  • 3P workshop:
  1. Process, product or facility redesign.
  2. Process-at-a-glance.
  3. Mock-ups.
  4. 3P action bulletin.