This paper describes a project team's use of A3 reports to focus their conversations and direct their decision-making process throughout the design phase of a hospital project. A3s are named after the size of the paper they are presented on (approximately 11" × 17") and provide a concise description of options and tradeoffs associated with a given problem or decision. A3s are widely used at Toyota as conversation pieces and to document steps of the Plan-Do-Check-Act (PDCA) cycle that supports their continuous improvement process. A3s combined with use of an integrated form of agreement (IFOA) promote the creation of shared understanding of various design options and associated design impacts, and thus support set-based design. This paper presents the development and use of an A3 report related to selection of a landscape architecture consultant. Research on this case study indicates A3 report detailing must advance in parallel to design development; otherwise, insufficient detail is available to facilitate 'real time' decision making.