3P, or “Production Preparation Process,” is a method introduced to the United States during the mid-1980s by Chihiro Nakao, a contemporary of Taiichi Ohno, and a founder of the consulting firm Shingijutsu Ltd. I recall the method was called “New Production Preparation” (NPP) early along, but apparently succumbed to a marketing intervention, hence 3P.

The basic idea of 3P is to achieve, in Nakao’s words, “breakthrough or transformational changes in production process” through rapid, integrated prototyping of both product and process.

I had a 3P experience recently that reminded me how much I learn from customers. My inspiration occurred during a “mini event” to develop a build-out addition to a surgery center. The decision to use a 3P approach to develop a better floor layout was made pretty late in the process. We had one week to investigate the current condition and understand design requirements. Then we began, a team of eight clinicians—doctors, nurses, techs, and housekeepers—to “trystorm,” a term connoting brainstorming activity combined with actual doing. The first of Nakao’s “16 Catch Phrases” advocates minimal preplanning and “lightning fast” prototyping, a criteria we closely followed: the event lasted a day and a half.

Most of the 3P team had minimal previous exposure to lean concepts. But all were very passionate about patient care and “constructively dissatisfied” (a theme I take up in GBMP’s DVD Moments of Truth) with the status quo at the surgery center: bed shortages in the recovery area, ORs waiting for available beds in recovery, surgeons waiting for ORs, and, of course, patients waiting for everything.

When I introduced the concept of “patient-centered” health care from a lean perspective, a connection between passion and principle occurred—not a perfect understanding, more a fuzzy idea that focusing on the care from the patient’s point of view might yield a breakthrough. By the end of the first day (actually half-day), there was consensus regarding the status quo and a first pass concept for improvement. We agreed to “sleep on it.” This, I have found, is a very important, if not scheduled, part of the 3P process.

On day two we jumped into trystorming with a vengeance. One participant advised that she’d awakened at 2 a.m. with a thought. “What was it?” I asked.

“That we might not come up with a better layout,” she replied. Nervous laughter. We trudged on with a concept that was based on “adjacencies,” a word that connotes relative locations of departments to facilitate workflow. I reminded the team to focus on patient flow, and placed a couple of Lego people on the prototype layout to signify the patient and his family. As we broke for lunch, there was a feeling within the team that the trystorm layout created so far would not be a breakthrough. We were facing a 4 p.m. deadline for a solution, and CHI-E was kicking in.

Lunch was over quickly—back to work. A team member blurted out as we restarted, “If we can’t fix the recovery area problem, the rest of this expansion won’t matter.”

“Go with that idea,” I suggested. A new layout idea developed quickly, working back from an “ideal patient recovery area.” The principle was right: patient-focused. Ideas were popping now: trystorming and more trystorming. Within an hour, the team was sensing a breakthrough, and anxiety turned to excitement. By four o’clock, an operationally superior plan emerged that was, in the architect’s words, “totally different from what we would have drawn.”

A follow-up email from the project leader for this 3P effort sums it up:

“I know that my staff who were able to come really gained valuable perspectives and were definitely engaged in ‘thinking outside the box.’ I must admit that I was unsure how we could begin to make change, but count me in as a true believer in the process. I have always believed that if you need change to happen, it needs to happen with the caregivers first—it needs to be their ideas, or the change never happens. I think this is only the beginning for us, and I hope to be able to use what I learned from now on every day.”

So what did I learn from this customer? That if the right people (in this case the direct patient providers) have the passion to improve, then the keystone to improvement is the right principle. The technical side of lean is important, but the people side is essential:

3P = People + Passion + Principle

Do you have a 3P experience you can share?