8 The Personal A3 – Becoming the Change: Leadership Behavior Strategies for Continuous Improvement in Healthcare

The Personal A3

Throughout this book, we have highlighted the power of the personal A3 to help leaders identify and focus on behavioral changes they need to make. It is the first step in a leader’s personal transformation. Figure 8.1 (see next page) is a sample (blank) A3 Personal Improvement form; this is also available as a download at catalysis.org/personal-A3.

FIGURE 8.1 A3 Personal Improvement

Before we go into detail about how to use a personal A3, however, we should clear up one misconception. The personal A3 is not a problem-solving tool like the standard A3. A leader’s behavior is not a problem to be solved.

Yet, all of us can improve. Our hypothesis is that leadership behavior is a condition in the workplace. This means that it must be considered as a factor in operations, and therefore, it is open to improvement. Because this is sensitive territory, we obviously cannot set up a team to study the issue and propose solutions.

Instead, we have leaders use the personal A3 as a method to encourage evidence-based thinking about their leadership. It is a framework for identifying goals, gaps, experiments, and plans for intentional follow-through. It has the same sections as a regular A3 and is iterative in its use.

It is designed to help leaders focus on their strengths and opportunities, to create personal responsibility, and to gauge progress toward their goals. And really, everyone in this work has the same goal: to create an organization filled with problem solvers.

Those who adopt an intentional practice with the personal A3 begin by acknowledging two facts. Leadership behavior has an outsized impact on the motivation and attitudes of people in the organization, intentionally or not. And nobody has a perfect understanding of the effect they have on others. In doing the work of a personal A3, leaders learn to see more clearly how they are facilitating change—toward becoming that organization of problem solvers—and how they are getting in the way.

We are all doing a little of both.

Developed by Margie Hagene1 and based upon John Shook’s book Managing to Learn, the personal A3’s power is in the way that it draws a clear connection from individual behavior to organizational goals, even while keeping the work of individual growth very personal. It has proven so useful over about a decade since its introduction that we begin all leadership coaching relationships with it.

Please note that we draw a clear distinction between a person’s traits and behaviors. A trait is defined as a summary of a person’s qualities. For instance, we might call a person bold. A behavior is the specific evidence of that trait, such as outspokenness for the bold. So, when we talk about behaviors, we are focused on what can be shown by the evidence. Instead of saying a leader is or is not humble, we are interested in seeing evidence of humility when working through a personal A3.

In the following pages, we will step through each section of the personal A3 as a coach would—asking questions, warning of pitfalls. While every person and situation is different, 157there are enough commonalities, we believe, for this to be useful.


The title of an A3 should not be an afterthought. You are about to devote some significant time and personal energy to this endeavor. What are you trying to accomplish? The title should tell us—and remind you—what will be the focus of your thinking.

It can be as simple as “My Improvement Plan,” or “Becoming a Better Leader for Problem Solvers.”

A title can also provide a clear indication that you are heading in the wrong direction, particularly when the title focuses more on the organization than the individual. Titles such as “Getting Physicians Engaged in Improvement” or “Creating More Productive Meetings” are clear indications that a leader is moving the focus away from the self and onto the organization.

Certainly, physician engagement and more productive meetings are worthy of an A3 in many organizations. But those are problem-solving A3s. This is a personal A3, and we need to focus here on personal gaps and strengths in order to get at the root of more subtle issues.

If you have titled your personal A3 with an organizational goal—or skipped that part—and come back to these words later, this is an opportunity to reset. Dig a little deeper. Why are you putting in the time for yourself?

This may also be time to find a coach, a person whose job it is to help you pay attention to how you approach this work. Over the past decade, we have found that nearly everyone needs a person like a coach or facilitator to bounce ideas off of and to challenge the usual ways of thinking. We need to be encouraged to push beyond our initial instincts and to stay personal, to be willing to change ourselves instead of trying to change others or our organizational structures.


Write down a fresh date every time you do another iteration of work on your personal A3. No more than one or two months should pass between sessions, particularly during your early practice with the personal A3. There will be new assessments to make, changes to be noted. If more than three months have gone by, more current evidence of what is working and what is not will be lost.


That’s you.


This is usually an outside professional or a trusted colleague with experience in the discipline of keeping the work personal, intentional, and respectful.


What is the nature of this issue?

Perhaps you have noticed that nurses do not linger when you stop to chat. You explain this away by saying that people are busy, that your leadership position makes a lot of people shy. Still, you wonder about the pattern.

Maybe you are annoyed with the way meetings go. Resolutions are elusive. Your fellow leaders continue lobbying for a particular solution or point of view long after the official meeting breaks up. The conversations seem endless, and yet the executive team is not having the kind of honest, fierce discussions that you need.

Or, maybe you haven’t seen the surface of your desk in two years and it seems like the tasks pile up much faster than anyone could handle.

These are good starting points when thinking about the background of your personal A3. Everyone has these vague, indistinct issues. Investigating these patterns is how we identify our gaps.

If we were to attack these issues with a traditional A3, we would probably end up focusing on the nurses, or on the other executives, or the way work is distributed as the source of the problem. What is wrong with them? How can we change the process that is causing this problem?

The personal A3 opens up the possibility that your behavior is helping to create these situations. For instance, maybe you tend to pontificate instead of asking questions and that makes people less inclined to open a conversation with you. Or maybe you have a tendency to impatiently cut off debate too soon in team meetings. Do you prefer to do the work yourself rather than teaching and coaching others?

Two more important questions to consider: Why is change needed? What would be the consequences or risks of not participating in the change? If you do not articulate for yourself the reasons for self-improvement and the probable repercussions of inaction, it will be too easy to remain in stasis.

The personal A3 will help you identify the root of the issues, but only if you let it. Therefore, begin broad with the nature of the possible problem. And then be clear about why you seek improvement and what the consequences might be of ignoring it. We need these personal reminders as to why the work is important.


Begin this section by listing the specific actions you have already taken to commit to this exploration and the outcomes of those actions.

Perhaps you have talked with colleagues about the impact of your behaviors, or—hopefully—you have completed a radar chart to assess your strengths and limitations. (See Chapter 9 for a deep dive into radar charts.) Review the specific evidence collected thus far.

Data collection remains an important part of the A3 work, but it looks different here. Questions and answers from personal reflection are important data points. A radar chart is also valuable data. A lunchtime conversation with a trusted insider can be a rich vein of information and insight.

An excellent source of data is to do a poll of peers, bosses, and subordinates asking that they identify your strengths and stumbles. Good questions on such a poll might be:

   What have you observed in my behavior that unleashes creativity in others?

   What specific behaviors of mine have shut the team down?

Many people will be tempted to use annual performance reviews as data inputs. This should be avoided. In most organizations, performance reviews are little more than the opinions of one person crammed into a check-the-box format. They are required pieces of paperwork and usually lacking in generous insight. The performance review does not ask how a person could improve; it asks if the person is good enough to do the job at hand. It is the wrong question.

The critical takeaway here is that you need to collect evidence of how other people view your actions and note those alongside your own thinking. Do they connect? Are you focusing on the right issues?

Remember, the work here is to identify your strengths as well as your limiting behaviors.


The opportunity statement is a product of your own deep reflection; nobody else can suggest one for you. For those of us who avoid deep reflection, this can be uncomfortable. It would be far more efficient to select one from a list of prompts, right? Pick the opportunity that sounds most achievable and move on.

But this could only offer a vague and probably meaningless direction. Nobody wants to spend months chasing a vague and meaningless direction. Only you will recognize the grains of truth in the feedback you get from colleagues.

For instance, when Al Pilong Jr. was first introduced to this work, he was prepared to undertake some real action. Al was comfortable with action. But the CEO of Munson Medical Center and COO of the newly compiled Munson Healthcare got feedback that he was already doing a lot. Too much, perhaps. His opportunity statement was a simple realization: I would rather do than coach others to do.

For Mr. Dube in South Africa, feedback from colleagues made him see that most people only saw him in firefighting mode. Deeper reflection led him to realize that he was not that comfortable being out at the front line without an immediate job. His opportunity: Go see in order to understand. (As opposed to go see in order to fix.)

Note that, in each case, the opportunity was personal. This is where it is particularly tempting to shift focus to the organization. That’s where the problem is, right?

Focus on this as an opportunity for you.


The goal is not perfection. You, a human being, are aiming for better, not perfect.

The first step toward defining this better state is personal reflection. You probably know what better would feel like. Now, you need to translate those feelings into actions—into observable, measurable behaviors.

This is often the moment where people need to go back and reassess the current state, because the goal also needs to be meaningful to the situation and to the people that will be most affected. It needs to stay personal.

For instance, Al’s target state was one in which he coached others to solve problems instead of taking tasks from others. But coaching was not the only goal. Al wanted to be an effective coach and to instill problem-solving capabilities in people throughout the organization.

So here, in his reflection on his target state, Al was also thinking about how he could measure his coaching effectiveness, such as tracking how many problems got solved before they hit his desk.

Mr. Dube’s goal was to find ways to be comfortable at gemba—observing, listening—when there were no fires to fight or tasks to accomplish. That means he needed to work through some discomfort, which was a sign he was heading in the right direction. Discomfort almost always points toward a gap to be addressed.

Like a great many CEOs, Mr. Dube was more comfortable in his office—where people came to him—than at gemba. Working in this way, the conversation about the problem was almost always being held far away from the work itself. It was not ideal.

As we dug into the reasons for his discomfort, it became clear that Mr. Dube’s gap was that he had not clearly identified his purpose at gemba. He needed to arm himself with humble questions and to reflect on what he wanted to learn from others. Soon, he was enjoying his time at gemba, where he felt more effective than he had in his office.

With these two examples, you can see how goals are tied to opportunity statements without being overly reactive. The target state does not expect organization-wide changes; it does not expect others to necessarily change their behavior.

Instead, we create personal goals that can be observed by others, intentionally monitored by us, and reflected upon in order to better understand how individual behavior effects the whole organization.


Why are you acting this way?

We do not want to go down a rabbit hole of childhood disappointments or Freudian analysis here, but this is an important moment of reflection on root cause. You need to ask why and how you began to blurt the “right” answer or try to control situations or whatever the issue is. Only when we understand why we behave in a certain way will we see how to make intentional changes in a way that make us feel comfortable and valued.

Many clinicians can trace some of their undesirable behaviors to medical school, where they were taught to make clear decisions, inform the team, and maintain control of the situation. Or maybe you came up through the leadership ranks based on your knowledge and good ideas. After years of getting good notice and promotions based on your ability to come up with solutions, it is natural to have difficulty giving up this

Understanding why you act the way you do will help illuminate your gaps and, from there, guide you to the next steps and experiments.

Al Pilong, for instance, knew that he felt good when he solved problems for others. He felt like an asset to the organization. How could he feel valued without doing that?

In his target state, Al envisioned a future where he taught others and coached them as they solved problems. This was another way to help people and be an asset to the organization, he knew. A root cause contributing to the gap was that he did not feel entirely comfortable becoming a teacher. Like many people, he had not acquired the teaching/coaching skill set.

Analysis leads to the plan.


This is a simple list of experiments to try in order to become a better coach and leader. Maybe you want to learn to ask better questions. A countermeasure might be taking a list of effective questions (see Figure 9.2 in Chapter 9) with you to gemba and check off the questions you asked. It might be taking a colleague to lunch and practicing asking those questions naturally.

This is simply a list of actions that directly relate to your opportunity statement and your gaps.


Like a problem-solving A3, this step in the process has many parts: identifying experiments, developing a plan, checking the results of those experiments, and making adjustments based on outcomes. Add to this a practice plan, which is simply a detailed plan for practicing new behaviors every day.

For a leader who needs to better understand frontline operations, or who needs to learn to observe without offering opinions, the practice plan might be a regular series of gemba visits with a coach or colleague to observe.

For someone like Al, who needed to teach and coach others, the plan would include acquiring some teaching skills and then adding regular coaching sessions into his schedule.

To stay on track with the personal nature of this work, we advise people to stick to “I” statements when describing their plans. This should be familiar territory for anyone who 169has undergone interpersonal communication training. For instance:

   “I will go to gemba and ask only open-ended questions.”

   “I will talk less and listen more.”

   “I will learn how to ask open-ended questions.”

   “I will update my radar chart monthly.”

Create a clear start date for the experiment being run and list exactly what you will do and when. Make sure it is clear how you will know that the experiment is being run.


After creating a plan and schedule, ask how you will know if you are improving.

Most people build time into their schedule for personal reflection, to ask if they are doing the work and whether they are noticing a difference. Maybe people are responding to you more openly? How do you know that? Note specific instances.

You need specific feedback from others, such as a coach or trusted colleague. Also, ask for opinions from the people in your regular huddle or committee meeting. It can be unnerving to be so vulnerable, but this is also an excellent example for others. A CEO who goes into a meeting and announces that she is working on her listening skills and asks for the group’s help by raising a hand if she interrupts or runs over someone will have a roomful of helpers. And she will be living evidence of the seriousness of behavior change and her commitment to this work.

Another type of feedback we regularly employ involves one-on-one interviews with just one or two scripted questions. In this exercise, the leader might say, “I am working on 171my own personal improvement, and I would like your help in evaluating my progress for my A3. Can you take a minute to answer two questions for me?”

Take notes either while people reply or just after this interview in order to freshly capture their words. Many of us emphasize either the positive or the negative so strongly, it can be difficult to remember nuances of what another person says.

Once the evidence begins to show that your behavior is indeed changing, it will be time to return to the section on current conditions. Has your behavior change achieved the desired effect? If it has, how will you continue this practice? If not, what are the new experiments you will try?

Do not forget self-reflection. We are our own best critics; reflection is the path to improvement.

Which is why—up next—the radar chart is so powerful.

1. A former global internal consultant for Ford Motor Co. focused on transformation and organizational effectiveness, Margie Hagene is now on faculty at Catalysis and the Lean Enterprise Institute where she coaches leaders in a variety of fields.