tag:blogger.com,1999:blog-59189479623219338502024-03-06T01:07:44.437-06:00LeanVetsA blog about the Toyota Production System, or Lean, for veterinarians.E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.comBlogger73125tag:blogger.com,1999:blog-5918947962321933850.post-73972937244651925382020-08-15T15:37:00.023-05:002020-08-15T15:44:32.822-05:00Lowering the River<p dir="ltr" id="docs-internal-guid-e48ed3dd-7fff-c2a3-501a-7ac4024f8589" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Certainly, there is not a lot of good that comes out of a worldwide pandemic such as Covid-19. But one bright spot of it is that it has forced every aspect of life to be rethought, reimagined and re-engineered. Many of the things we thought were so necessary to the way we work and live may, in fact, be much less important. Coronavirus has made many of us innovate, improve, become more agile. It has triggered a rapid evolution of our systems and processes, much of which will become the new normal. This highlights a major advantage that Lean organizations possess. The Lean infrastructure is designed for continuous improvement, quick response and problem solving up and down the organization. </span></p><br /><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">An example of this that I heard about on the radio recently, was the changes that college entrance committees were being required to make in their selection process of new freshman students when the last semester of high school was so disrupted and taking SATs (or other admissions tests) has been impossible for health and safety reasons. In some high schools, they went to a Pass/Fail grading system versus the usual four point system. How do these college boards deal with this? How important are college entrance tests; are they really that informative? Many universities have instituted (re-instituted) the entrance essay as a metric for admission. Will these essays become a permanent requirement for admission post Covid-19?</span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span></p><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPaa0tQHybvkMnsbWc5qMP711pYWj4VXfZpXuONLGN5OfteLxXrsmMfXVjJgFtatRTDtQKxy31kE0fFfJnKfL9cax9k7ayPBRL-m05aPyDRSbJPMkfN0FgI89tD0S7DjXF0fR4Ckgt7T0/s1575/20200815_153159.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1088" data-original-width="1575" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPaa0tQHybvkMnsbWc5qMP711pYWj4VXfZpXuONLGN5OfteLxXrsmMfXVjJgFtatRTDtQKxy31kE0fFfJnKfL9cax9k7ayPBRL-m05aPyDRSbJPMkfN0FgI89tD0S7DjXF0fR4Ckgt7T0/s640/20200815_153159.jpg" width="640" /></a></div><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span><p></p><br /><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">One of the axioms in the Lean environment is to "lower the level of water in the river." When the water level is high, systems and processes seem to sail by smoothly because rocks are covered and we go over them; flow occurs effortlessly. However, this often leads to complacency; a false sense of well being. Lean organizations will routinely introduce small changes to their </span><a href="http://www.leanvets.com/2016/02/value-stream.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">Value Stream</span></a><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> that cause a little bit of chaos. It "lowers the water" just enough to show where the rocks (waste, defects, </span><a href="http://www.leanvets.com/2016/01/in-japanese-word-for-waste-is-muda.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: Arial; font-size: 11pt; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">muda</span></a><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">) are. These rocks are problems, never before illuminated, that need to be solved in order to avoid potential, future pitfalls; to survive and to be better tomorrow than we are today. Covid-19 has "lowered the river" exposing dangerous "rocks" among many of our systems, especially healthcare. Lean teaches that systems should be in place that make problems (or potential problems) quickly identifiable and corrected quickly at the root cause level.</span></p><br /><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">For example, if one of your Value Streams (e.g. annual wellness exams) has been functioning very well with five staff members involved, then try changing it to only use four (and reallocate that fifth person to new work that can, perhaps, drive growth for the practice. What problems does removing a person introduce; what rocks pop up? How would your practice deal with that change? How might you have to evolve and improve? </span></p><br /><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Or, if your inventory is set at a certain level with a certain reorder point, what changes would be needed to avoid rocks if you decided that these levels be decreased by ten percent, saving capital and carrying costs? But be mindful that lowering the water too quickly can make us crash the boat. You might be able to start by putting 10% of inventory in a separate “emergency use only” location -- and when you can improve your processes to the point of truly not needing it, then use up that 10% without replacing it. </span></p><br /><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Or, what would your practice need to change in order to start seeing appointments every twenty minutes rather than every thirty minutes? How can we do so in a way where nobody feels rushed and so that care and service doesn’t suffer, not to mention the quality of worklife?</span></p><br /><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">By occasionally, but routinely, "lowering the level of the river", Lean organizations start seeing new "rocks" that stimulate innovation, creativity, problem solving techniques, staff engagement and place them even farther ahead of their competition; more capable of sailing in rough times.</span></p><br /><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">It will be very interesting to see what life will be like (better? or worse?) one, two or five years from now because of what Covid-19 has invoked. Though, hopefully, in the future it will not take a worldwide pandemic to teach us the necessity of "lowering the river" and continuous improvement. </span></p><br /><p dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: Arial; font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">How might this be experimented with in your practice?</span></p><br /><p><span style="font-family: Arial; font-size: 11pt; white-space: pre-wrap;">Thanks for reading.</span> </p>E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-34252654747221584232020-07-16T11:13:00.004-05:002021-12-23T18:04:59.144-06:00A Lean Reference List<div><br /></div>These are most of the books that I have read over the last seven or so years and that I found most helpful. When I first started reading and learning about the Toyota Production System (Lean), one could probably fit all the available books on one shelf. Today, it would require one (or more) bookcases! More proof that Lean is real.<div><br /></div><div><h2 style="text-align: left;">Books</h2><div> <br /><i> Lean Thinking: Banish Waste and Create Wealth in Your Corporation</i> by James Womack and Daniel Jones<br /><br /><div><i> Lean Hospitals: Improving Quality, Patient Safety and Employee Engagement, 3rd Ed</i>. by Mark Graban<br /><br /></div><div><i> Healthcare Kaizen: Engaging Front-line Staff in Sustainable Continuous Improvement</i>s by Mark Graban and Joseph Swartz <br /><br /></div><div><i> The Executive Guide to Healthcare Kaizen: Leadership for a Continuously Learning and Improving Organization</i> by Mark Graban and Joseph Swartz<br /><br /></div><div><i> Measures of Success: React Less, Lead Better, Improve More</i> by Mark Graban<br /><br /></div><div><i> The Toyota Way: 14 Management Principles from the World's Greatest Manufacturer</i> by Jeffrey Liker<br /><br /></div><div><i> Follow the Learner: The Role of a Leader in Creating a Lean Culture</i> by Dr. Sami Bahri<br /><br /></div><div><i> Lean Lexicon: A Graphical Glossary for Lean Thinkers compiled by Lean Enterprise Institute</i>, Edited by Chet Marchwinski<br /><br /></div><div><i> Understanding Variation: The Key to Managing Chaos</i> by Donald Wheeler<br /><br /></div><div><i> Toyota Production System: Beyond Large-Scale Production</i> by Taiichi Ohno<br /><br /></div><div><i> Taiichi Ohno's Workplace Management </i>by Taiichi Ohno<br /><br /></div><div><i> The Toyota Way Fieldbook</i> by Jeffrey Liker and David Meier<br /><br /></div><div><i> Learning to See: Value Stream Mapping to Add Value and Eliminate MUDA </i>by Mike Rother<br /><br /></div><div><i> Value Stream Mapping for Healthcare Made Easy</i> by Cindy Jimmerson<br /><br /></div><div><i> Lean Daily Management for Healthcare: A Strategic Guide to Implementing Lean for Hospital Leaders</i> by Brad White<br /><br /></div><div><i> Toyota Kata: Managing People for Improvement, Adaptiveness and Superior Results</i> by Mike Rother<br /><br /></div><div><i> The Toyota Kata Practice Guide </i>by Mike Rother<br /><br /></div><div><i> Training Within Industries: The Foundation of Lean </i>by Donald Dinero <br /><br /></div><div><i> Out of the Crisis </i>by W. Edwards Deming<br /><br /></div><div><i> The New Economics for Industry, Government, Education</i> by W. Edwards Deming <br /><br /></div><div><i> The Deming Management Method</i> by Mary Walton<br /><br /></div><div><i> Dr. Deming: The American Who Taught the Japanese About Quality</i> by Rafael Aguayo<br /><br /></div><div><i> The Toyota Way to Lean Leadership: Achieving and Sustaining Excellence Through Leadership Development</i> by Jeffrey Liker and Gary Convis<br /><br /></div><div> <i>Toyota Talent: Developing Your People the Toyota Way by Jeffrey Liker and David Meier<br /> Developing Leaders at all Levels: A Practical Guide </i>by Jeffrey Liker and George Trachilis<br /><br /></div><div> <i>Toyota Culture: The Heart and Soul of the Toyota Way</i> by Jeffrey Liker and Michael Hoseus<br /><br /></div><div> <i>The Toyota Way to Continuous Improvement: Linking Strategy and Operational Excellence to Achieve Superior Performance</i> by Jeffrey Liker and James Franz<br /><br /></div><div> <i>The Toyota Way for Service Excellence: Lean Transformation in Service Organizations</i> by Jeffrey Liker and Karyn Ross<br /><br /></div><div> <i>Practicing Lean: Learning How to Learn How to Get Better…Better</i> edited by Mark Graban <br /><br /></div><div><i> The Machine That Changed the World: The Story of Lean Production- Toyota’s Secret Weapon in the Global Car Wars That is Now Revolutionizing World Industry</i> by James Womack, Daniel Jones and Daniel Roos</div><div><br /></div><div><i> Lean Solutions: How Companies and Customers Can Create Value and Wealth Together</i> by James Womack and Daniel Jones <br /><br /></div><div> <i>Gemba Walks </i>by James Womack <br /><br /></div><div> <i>The Lean Turnaround: How Business Leaders Use Lean Principles to Create Value and Transform Their Company</i> by Art Byrne<br /><br /></div><div> <i>Lean for Dummies </i>by Natalie Sayers and Bruce Williams<br /><br /></div><div> <i>Creating a Lean Culture: Tools to Sustain Lean Conversions </i>by David Mann<br /><br /></div><div> <i>Managing to Learn: Using the A3 Management Process to Solve Problems, Gain Agreement, Mentor and Lead </i>by John Shook<br /><br /></div><div> <i>Beyond Heroes: A Lean Management System for Healthcare </i>by Kim Barnes with Emily Adams<br /><br /></div><div> <i>Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience</i> by Charles Kenney<br /><br /></div><div><i> The Lean Guide to Transforming Healthcare: How to Implement Lean Principles in Hospitals, Medical Offices, Clinics and Other Healthcare Organizations</i> by Thomas Zidel</div><div><br /></div><div><i> Lean Doctors: A Bold and practical Guide to Using Lean Principles to Transform Healthcare Systems, One Doctor at a Time</i> by Aneesh Suneja and Carolyn Suneja</div><div><br /></div><div><i> On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry</i> by John Toussaint<br /><br /></div><div> <i>Value Stream Mapping: How to Visualize Work and Align Leadership for Organizations</i> by Karen Martin and Mike Osterling<br /><br /></div><div> <i>Hoshin Kanri for the Lean Enterprise: Developing Competitive Capabilities and Managing Profit</i> by Thomas L. Jackson<br /><br /></div><div> <i>The Basics of Hoshin Kanri </i>by Randy Kesterson<br /><br /></div><div> <i>Gemba Kaizen: A Commonsense Approach to a Continuous Improvement Strategy, 2nd Ed. </i>by Masaaki Imai<br /><br /></div><div> <i>The Spirit of Kaizen: Creating Lasting Excellence One Small Step at a Time</i> by Robert Maurer<br /><br /></div><div> <i>A Study of the Toyota Production System: From an Industrial Engineering Viewpoint by Shigeo Shingo<br /> Patient-Centered Strategy: A Learning Strategy for Better Care</i> by Jeff Hunter<br /><br /></div><div> <i>The Lean Startup: How Today's Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses</i> by Eric Ries<br /><br /></div><div> <i>Implementing TWI: Creating and Managing a Skills Based Culture </i>by Patrick Graupp and Robert J. Wrona<br /><br /></div><div> <i>The 7 Kata: Toyota Kata, TWI, and Lean Training</i> by Conrad Soltero and Patrice Boutier<br /><br /></div><div> <i>The TWI Facilitator’s Guide: How to Use the TWI Programs Successfully </i>by Donald A. Dinero<br /><br /></div><div> <i>A Lean Guide to Transforming Healthcare: How to Implement Lean Principles in Hospitals, Medical Offices, Clinic and Other Healthcare Organizations </i>by Thomas G. Zidel<br /><br /></div><div> <i>The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the “No Wait” Department</i> by Jody Crane and Chuck Noon<br /><br /></div><div> <i>A3 Problem Solving: Applying Lean Thinking </i>by Jamie Flinchbaugh<br /><br /></div><div> <i>A Factory of One: Applying Lean Principles to Banish Waste and Improve Your Personal Performance </i>by Daniel Markovitz<br /><br /></div><div> <i>The Outstanding Organization</i> by Karen Martin<br /><br /></div><div> <i>Clarity First </i>by Karen Martin <br /><br /></div><div> <i>The Lean Strategy </i>by Michael Belle, Daniel Jones, Jacques Chaize and Otest Fiume<br /><br /></div><div> <i>Multipliers: How the Best Leaders Make Everyone Smarter</i> by Liz Wiseman<br /><br /></div><div> <i>Measure What Matters: How Google, Bono, and the Gates Foundation Rock the World with OKRs</i> by John Doerr<br /><br /></div><div> <i>The Five Dysfunctions of a Team: A Leadership Fable </i>by Patrick Lencioni<br /><br /></div><div> <i>Scrum: The Art of Doing Twice the Work in Half the Time</i> by Jeff Sutherland, JJ Sutherland<br /><br /></div><div> <i>The New Work</i> by Aaron Dignon <br /> <br /><h2 style="text-align: left;"> On The Web</h2> Lean Enterprise Institute www.lean.org</div><div><br /></div><div>Dr. Ponsford's LeanVets blog www.leanvets.com</div><div><br /></div><div>Mark Graban’s Leanblog www.leanblog.org<br /><br /></div><div> Shingo Institute www.shingoprize.org<br /><br /></div><div> The Deming Institute deming.org<br /><br /></div><div> TWI (Training Within Industry) Institute twi-institute.org<br /><br /></div><div> Catalysis (formally ThedaCare Center for Healthcare Value) createvalue.org<br /><br /></div><div> Kaizen Institute us.kaizen.com<br /><br /></div><div> Toyota TSSC tssc.com<br /><br /></div><div> Toyota's TPS Page www.toyota-global.com/company/vision_philosophy/<br /> toyota_production_system/<br /> <br /> <br /> Hope this helps. </div></div></div>E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-10082117416739374992020-03-12T10:55:00.002-05:002020-03-13T14:41:32.130-05:00Systems Thinking: Bringing It Closer To Home<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7u6N1fyxdQvyma6R3_BRgO776g2aoIvmhctVv2dMwKt4tl7HURewEoyWYmU8VdmYKReBKOKXjTrzgqlifEJ6yg73O_Qkb5ytjCyVvo9rA7XZFNeOBOfLoKwFZl4FVagEkmuVqP4D1_XY/s1600/20200309_150206.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1244" data-original-width="1443" height="547" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7u6N1fyxdQvyma6R3_BRgO776g2aoIvmhctVv2dMwKt4tl7HURewEoyWYmU8VdmYKReBKOKXjTrzgqlifEJ6yg73O_Qkb5ytjCyVvo9rA7XZFNeOBOfLoKwFZl4FVagEkmuVqP4D1_XY/s640/20200309_150206.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A mindmap illustration of a systems approach to many of the things that affect your take home (net) pay</td></tr>
</tbody></table>
<span style="font-family: "arial" , "helvetica" , sans-serif;">When</span> we think about all of things that we need to consider when negotiating compensation with a potential new owner/manager, most of us are probably only concerned about base pay, production percentages and benefits packages. If this is good, we're good. And, I used to be in this same group. But, experience can be a ruthless teacher.<br />
<br />
So, let me share some of my experiences with those of you that have not racked up forty plus years in the profession, working on both side of the "boss" desk, in private and corporate environments, in practices of two to six doctors, in low cost/high volume and high cost/low volume practices. Maybe, you won't have to reinvent the wheel. Plus, I think this is a good illustration of understanding things from a systems point of view.<br />
<br />
What is a system? Thank you for asking! A system is the "game" with all of its "rules" that affect us, the players, and determine if and how "we win or lose." It is all of the departments, policies, procedures, cultures, ways of thinking, agendas, biases and ignorance that come to bear on a particular area or person, namely us, the employee. Workers are at the mercy of the systems. They have no control over systems. Leadership is responsible for systems. However, in order to know how you will fare, you need to appreciate the intricacies of the "game." You need to think from a systems stand point.<br />
<br />
Most of us veterinarians, these days, work on a production basis, i.e. we are paid a certain percentage of what we produce in medical and surgical fees less taxes and certain deductions. Many times there is a base salary in the mix, also. So, for example, we are paid the greater of X% of our gross production or a salary, whichever is higher for the current period. And we are happy!<br />
<br />
But this is only the tip of the iceberg. Looking at the illustration above, one can see there is much more involved than one might expect.<br />
<br />
<u>U.S. Tax Code</u><br />
<ul>
<li>Obviously, you have to pay your "favorite uncle" first. And, the government is a humongous system!</li>
</ul>
<br />
<u>Employment Contract</u><br />
<ul>
<li>Percent of gross, obviously.</li>
<li>Base salary. Usually, you either get your percentage of production (POP) or the base salary, whichever is higher for the period. Ideally, this is designed to give you a minimum paycheck while you are building your production. However, I have been in "systems" where the language of the contract was that POP was not based on gross production, but on gross COLLECTED production, i.e. if the client didn't pay the bill, I didn't get any POP for that invoice. So, my paycheck is dependent on the practice's accounts receivable system; an area I, as an employee, have no input or say about.</li>
<li>Negative ProSal. This is my terminology for having to pay the practice back for any base salary paid but that your POP failed to cover. For example, in the first pay period of the month, I get $500.00 base salary. At the end of the month, I get paid another periodic base salary of $500.00. I produced $4000.00 by the end of the second pay period of which I'm entitled, by contract, to 20%, or $800.00. They already paid me $1000.00, yet my POP only amounted to $800. So, they TAKE BACK $200.00 of "overpaid wages" and my last paycheck for the period is only $300.00. It wasn't an either/or situation, at all. It amounts to straight production. The base salary language in the contract was "smoke and mirrors." </li>
<li>Play close attention to the Non-Compete clauses. It may not affect your earning potential with the present owner, but it very well could affect future earning potential with a different employer. (This also goes for relief Veterinary services. If you get asked to come to work for a practice that you worked at through a relief service, it might be a violation of the non-compete agreement you signed (Remember?) with the service.)</li>
</ul>
<div>
[A sideline note here. I contracted to work 4.5 days/ week for a set base salary. A pay period was every two weeks. So, I agreed to, and was available, to work four days every week plus every other Saturday. During the first two-week work period of my employment, my employer only scheduled me for three days each week and no Saturday. They weren't that busy. However, I only got paid for six days of base salary. This is not the definition of salary. That is per diem pay. I protested and received the other two days of salary. My point was that I was agrreable, available and willing to work the 4.5 days per week. It was their choice not to have me come in, not mine. Unless, it was my choice not to work, I was entitled to my base salary. Be careful, employers, especially of some smaller corporations (that may be under capitalized), may try to cut expenses any way they can dream up. Their "best interests" are sometimes in direct opposition to your best interests. Their systems are <b>their</b> systems!]<br />
<br /></div>
<div>
<br /></div>
<div>
<u>Policy Manual</u></div>
<div>
<ul>
<li>This is where a lot of the detail about "perks" and "comps" are listed. The point here is that the Policy Manual may take on the same power as any other contract, especially if the contract refers to items in the manual. (So, get and read the Policy Manual as if it were a contract, because it very well may be.)</li>
<li>Other items may also affect your take home pay. How much PTO do you get? How is it accumulated? How much is a "days wages" worth if you take more PTO than allowed or take it before it has accumulated? What insurance is offered? What is the employee portion? Is there any allowance for CE? Is it enough to go to a major convention in order to cover all required hours for licensing? Who pays for uniforms? What retirement programs are available? When do they take effect? Is there employer matching? How much? When are you considered vested?</li>
</ul>
<div>
<u><br /></u>
<u>Practice Demographics</u></div>
</div>
<div>
<ul>
<li>Where your practice is located may affect your potential pay. Which state? Urban, suburban, rural? High percent of nearby non-residential establishments (businesses)? Neighborhoods mostly house or apartments? Are the residents young with kids (and pets!), older and on Social Security, or single, career climbers? What socioeconomic level is the majority of the residents? What is the level of discretionary income? Unfortunately, considering these types of things is important.</li>
</ul>
<div>
<u><br /></u>
<u>Inventory</u></div>
</div>
<div>
<ul>
<li>It may not be immediately evident, but inventory is another system that can affect your paycheck. If you don't have it, you can't sell it. If you can't sell it, you can't earn your POP. And if this happens too much, frustrated clients will leave to go to practices that do have what they need, when they need it. (Diminished long-term growth; less net income in the future)</li>
<li>The inventory system is influenced by other sub-systems, policies and procedures. For example, the method of triggering reorders (tags, want lists, kanban bins, etc.) % of stock outs, availability of alternative drugs (variety), reorder point (is enough drug available to get through the next order/delivery cycle) to name a few.</li>
<li>The Lean concept of Just-In-Time thinking is the utilization of inventory (or any resource) only when it is needed, where it is needed and in the amount needed. Seems like a good rule of thumb, but, as with most things, it is relative. In reality, the time from selling out to ordering to receiving new product is not instantaneous. Therefore, some level of safety stock is necessary to keep on hand. How much depends on many of these aforementioned systems and sub-systems are at work and is the big question (Google 'Economic Reorder Point' and/or 'Economic Reorder Quantity').</li>
</ul>
<div>
<u><br /></u>
<u>Average Client Transaction (ACT)</u></div>
</div>
<div>
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<li>One of the major drivers for net income is the the ACT.</li>
<li>But, the ACT is influenced by the practice's fee structure, the portfolio of services and procedures offered and whether the there are discounts and coupons available for clients to use (and how your contract counts their value toward gross production).</li>
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<u>Appointments</u></div>
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<li>Appointments is another one of the systems that affects your net income, especially appointment density; the number of appointments available per hour or per hour per doctor. Are appointments scheduled on the hour? Half hour? Quarter hour?</li>
<li>What are the hours of operation each day? What days of the week?</li>
<li>How many surgery days per week? Who gets what days?</li>
<li>Can any Doctor see any client/patient who doesn't have a preference? Or, are all clients already assigned to other vets so that you will have to "build" your clientele from scratch with new clients to the practice? And, therefore...</li>
<li>How quickly is the practice growing and what is the practice's marketing strategy (another system)? You can't earn from clients that don't walk in the door!</li>
<li>How many other doctors are vying for clients? What is the internal competition like? (Believe me, there is ALWAYS some level of internal competition, especially as long as compensation is based on POP.)</li>
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<u>Gender Differences </u></div>
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<li>Does this occur in Veterinary Medicine?</li>
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This is probably not an exhaustive or complete list of influencers on your net income. However, I'll bet it encompasses more than you previously considered.</div>
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Glance back at all of the different systems; all of the different policies, agreements, understandings, aspects of the practice you work for and/or all of the "games." How many of them do you have ANY control or, even influences, over? Taxes? Inventory? Your practice's demographics? Accounts Receivable policies? Fee structure? Appointments? Marketing? You have partial influence in the contract. The Policy Manual?? Yet they determine your ability to survive, grow, enjoy life, contribute to your world?</div>
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This is why thinking in terms of all the system involved is so important. And understanding how changes in one area can have profound effects in another.</div>
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The last time I interviewed for a job that paid on POP, I asked to see the last several periods of ACTs, and gross income. I looked at their state of inventory and asked about how they order drugs. I asked how much a rabies and distemper vaccine, plus a fecal exam, routine deworming and flea/heartworm would cost the client. This is one of my "index" invoices that I use to evaluate fees between practices (other "index" invoices include routine canine spay + pre-anesthesia blood work + IV cath/ fluids + pain injection + pain meds to go home or a dental prophy without extractions + routine labs + IV cath/fluids. It is simular to how one might use the S&P 500 Index to evaluate other investments or how the Consumer Price Index works). I had them show me the appointments over the last few months. I drove around the practice to check out the neighborhood. I "Googled" the practice to see client reviews. I checked out if they board, do grooming or have dental xrays and ultrasound. What does the staff look like? Enough to support good client flow? Trained well enough that I only have to worry about that which I am uniquely trained and licensed for? I was interviewing the practice as much, or more, as they were interviewing me.<br />
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Just like playing Black Jack in Vegas, I know the odds are in the casino's favor (they set the rules; system) but, I want to get as much in my favor as I can. So, maybe I can choose to play at a casino where they use only three decks versus five, or one that reshuffles only after 75% of the boot is dealt, versus 50%. The more I understand the systems in use, the better my choices will be (hopefully!).</div>
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I worry about the young, naive vets coming up who haven't had the level of experiences that I have had. They are at the mercy of their employer's systems, more and more of which are large, faceless corporations (or "wannabe" corporations) with much deeper pockets and, possibly, a different perspective and agenda. Who will speak up for these neophytes? Who will watch over them? The fox that is in charge of the hen house?</div>
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Maybe, it is time for the younger generation of veterinarians, vet techs, vet assistants and receptionists to consider forming an employment union, the way workers had to during the Industrial Revolution, and for the same reasons. There is power in numbers they say! And, it is the "power" that determines the "game". The Registered Nurses had to do it.</div>
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Thanks for reading.<br />
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-2791584774759221632020-01-02T23:05:00.001-06:002020-01-02T23:05:34.868-06:00Fractals In Your Practice, Oh My!<div dir="ltr" id="docs-internal-guid-f746a5ba-7fff-038a-6609-d73eab93213c" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">As I mentioned in the last post, I have been listening to the Audible version of the book "The New Work" by Aaron Dignon. I am really enjoying it and highly recommend it. At any rate, I continue to find inspiration and new perspectives with which to understand the Lean mindset. So, with that in mind…</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Have you ever heard of 'fractals'? There are many applications of fractals, but I am most familiar with them as a kind of symmetrical art. The structure of much of nature is based on fractals. A very accurate measurement of the length of the craggy coastline of England was found using fractals. Animation software uses fractals to design mountains or forests, etc.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Wikipedia partially define fractals as:</span></div>
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<span style="font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Fractals exhibit similar patterns at increasingly small scales called self similarity, also known as expanding symmetry or unfolding symmetry; if this replication is exactly the same at every scale, as in the Menger sponge, it is called affine self-similar. Fractal geometry lies within the mathematical branch of topology.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Got that!?</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Anyway, it might be easier to show you a sample of fractal art.</span></div>
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<span style="border: none; clear: left; display: inline-block; float: left; height: 397px; margin-bottom: 1em; margin-right: 1em; overflow: hidden; width: 214px;"><img height="397" src="https://lh4.googleusercontent.com/bCAKkHBAFulKGSI1l3_c9Jvm3Z9gFRqWfMP8EDA7nShFyZOt4-oPvMXjTr5-A8ATO4wzzTnGxFL9Z2YRUXU3emA8fOvkyBI4uvmvy3MshT30tnlodcrRSVwOWvW79Vvq5yeG2Z6y" style="margin-left: 0px; margin-top: 0px;" width="214" /></span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">In this graphic, the branches and sub-branches are similar to the main tree trunk, but at decreasing scale. We could go on to draw successive smaller, similar branches on the sub-branches, theoretically </span><span style="font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">ad infinitum.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Also, what is represented here as a complete tree very well could actually be a branch on a successively larger tree, </span><span style="font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">ad infinitum. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Any who...It reminded me of the process of <a href="https://www.leanvets.com/2018/11/lean-veterinary-strategy-deployment.html" target="_blank">strategy deployment (</a></span><span style="font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.leanvets.com/2018/11/lean-veterinary-strategy-deployment.html" target="_blank">Hoshin Kanri</a></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.leanvets.com/2018/11/lean-veterinary-strategy-deployment.html" target="_blank">)</a> in our organizations. Recall that strategy deployment is the introduction, integration and alignment of our <a href="https://www.leanvets.com/2016/12/true-north.html" target="_blank">True North</a> statement and focus areas down through the organization to the rest of the team.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Just like our fractal tree, each level of the practice should mirror the True North vision and focus area concepts, yet on a successively smaller, more discrete scope. In other words, the lead managers' level should reflect and further define the upper concepts as it affects them at their level and in their practice area. The lead reception's metrics would be similar in concept, but different in the data monitored than the lead surgery tech's metrics. Yet, both of them would be following and supporting Leadership's values.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">The same is true for the frontline staff level as compared to the leadership level and manager level. They would monitor even more detailed metrics from their practice area's point view at their level. The frontline metrics support and give detail to the managers' metrics which, in turn, support and and give detail to the leadership level and the True North statement. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Therefore, if we look at the entire practice, we can see that in each area, and at each level, the top most values are mirrored. Everyone is aligned and working towards the True North concepts from their perspective. Front line staff are monitoring those metrics that drive the manager metrics, and managers are monitoring those metrics that drive the Leadership (True North) metrics. The front line's "tree" is the same as the manager's "tree" which is the same as leadership's tree, but each appropriate for their particular level and function.Thus, Fractal Organization!</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Thanks for reading. Let me know what you think about all of this.</span><br />
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<a href="https://www.amazon.com/dp/B07XK71812/ref=cm_sw_r_em_apa_i_Ogs9Db1HQ37V0" target="_blank"><img border="0" data-original-height="698" data-original-width="1098" height="203" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgv1XxSoomSpIynHKYNKQLBdkb3Wnaae-aPJ1zI-tt0oSlCeJnsUEj3q22SpI514iLdKBBSqxCQgslbdAcdMQ9vSRAmFZnM4i2n3GsFX9rCKIcEjP2LnGUM3jaunYoALIiUeUEuqP4HXo/s320/20191214_120714.jpg" width="320" /></a></div>
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<a href="https://www.amazon.com/dp/B07XK71812/ref=cm_sw_r_em_apa_i_Ogs9Db1HQ37V0" target="_blank">Click here to buy!</a></div>
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-90838478455180198182019-12-02T16:17:00.000-06:002019-12-02T16:30:54.853-06:00Status Quo Begets Status Quo <span style="font-family: "arial" , "helvetica" , sans-serif;">I have been listening to the book <u>Brave New Work</u> by Aaron Dignon. Have you read it? I find it very interesting. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">When talk we (I) think about <span style="color: #cc0000;"><a href="https://www.leanvets.com/2018/04/process-behavior-charts-better-way-to.html" target="_blank">Process Behavior Charts</a> </span>(PBCs), it is usually in order to filter out the “noise” and highlight any “signals" in our metrics; to determine if we are still within the Natural Process Limits (NPLs). A PBC that stays within the NPLs indicates the system which the metric is monitoring is working as it was designed. Any data outside of the NPLs is one (of three) of the signals that indicates something has changed in the system, necessitating the need for closer scrutiny. A PBC is referred to as the “Voice of the System” (VOS).</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">But the corollary to this is: </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>If you are not happy with where the metric is charting, then in order to improve the chart, it means changing (improving) the system; the thinking and approach. </b></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">As Dignon points out, if we want a 10-fold increase in production, we pretty much intuit that that will require major changes in our thinking and approach; the system. But, if we are only looking for a 10% improvement, somehow, we think that that can be achieved by "status quo " thinking. He calls this the "status quo bias." Any change in the metric requires a change in the system; the thinking and approach.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Even the modest 10% change will require different thinking and approach. Status quo thinking will only lead to status quo results. So, when the Practice Manager or area director (or even the C-suite) issues a new goal or benchmark for the new year or next operating period, then our response should be, "Great!! What are <u>you all</u> going to change within <u>your</u> thinking and approach (<u>the</u> system) to result in any chance of hitting that new goal?” Because, without that change first, the new goal 'just ain't going to happen!' Commanding it to happen or incentivizing it to happen or threatening if it doesn't happen will not make so.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Status quo begets status quo!</b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Remember, operational systems are created by and are the responsibility of Management. Workers are at the mercy of systems! </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Come join Mark Graban and I at the 2020 AVMA Veterinary Leadership Conference in Chicago as we facilitate the audience participation workshop of W. Edward’s Deming’s “Red Bead Experiment” which was designed to illuminate these concepts and more. </span><br />
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<a href="https://www.amazon.com/Lean-Veterinary-Practice-Management-Utilization-ebook/dp/B07XK71812" target="_blank"><img border="0" data-original-height="539" data-original-width="914" height="188" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMDtFujEHgQtHZtAcSwTtbAm9ZvBh3MN6oSOO_LXdbK-bbZ1ULspZuEHq2JHwCwcd-FF2KDxk7SeKFDifPwFytkIEV4wP98mkvA3qtqxcso9emsCXvBBjD5dOnUsngkfo-ukaiCMfU2GE/s320/20190910_123017.jpg" width="320" /></a></div>
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-76291136254810220272019-09-18T10:10:00.002-05:002019-10-15T15:35:29.593-05:00Why Lean Is Important: From An Informed Client's Perspective<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Today's post comes from Gerald Cronin of the Vivarium Operational Excellence (VOE) Network.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The VOE Network is a worldwide group of Lab Animal and Biomedical veterinarians and experts that have discovered and been successfully utilizing the Toyota Production System, or Lean, to reduce valuable research costs while at the same time improve research quality and animal quality of life. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">From thier own website:</span><br />
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">"Every modern industry and organization has been influenced by the operational advances of the Toyota Production System, the thinking that made Toyota the #1 auto manufacturer in the world. Decades of research has proven that Toyota's systematic approach to improving operations has tangible long-term benefits to customer service, quality, productivity, adaptability and ultimately to reduce costs."</span><br />
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">"The Biomedical Research community recognized these advances over a decade ago and thus began the adaptation of systematic continuous improvement techniques to the Lab Animal Industry. Consistent with Toyota's philosophy of "sharing what they have learned from over 50 years of experimentation with the world", the Biomedical Research community understood that together, we could improve operations better, faster, cheaper if we shared our knowledge with each other." </span><br />
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">"With over a decade of experience, the VOE-Network was born to help the entire animal care community improve operations through members' experimentation, learning and sharing."</span><br />
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">"The Vivarium Operational Excellence Network is a consortium of animal care institutions and companies committed to quality clinical and veterinary research driven by operational excellence. We are a members-run organization that responds to the evolving learning needs of its members. Learning spans the organizational spectrum from front-line technicians through Webinars, videos and Lean Belt certification to leadership skills gained from our Leadership Academy events and offerings. We also look to industry for insights into the best ways to improve operations as well as ways to build a problem-solving culture."</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Today's post:</span></div>
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<span style="font-family: "times" , "times new roman" , serif;">I took my dog to a large Veterinary practice about a year ago and needed to use the restroom. The restroom was tucked inside the clinical staff area, so I needed to navigate through some hallways to get to where I needed to be. Along the way, I was able to see “behind the curtain” of this operation. I was disturbed to see rooms full of medical supplies in random areas, cardboard boxes both opened and unopened piled on top of each other, medical devices stacked on top of unfolded towels and on top of unopened boxes, there was almost zero floorspace for staff to move around. Random bottles that looked to contain some sort of medication were in random locations. Then there was the office with piles of paperwork, computer terminals were poking through the mess, almost as if they were struggling for air.</span><br />
<span style="font-family: "times" , "times new roman" , serif;">The staff was walking from room to room and asking each other “have you seen the (X clinical item)?” “Did you call Mrs McGillicuddy or was I supposed to”? “Sorry for the wait, Mr. Cronin, we’re really busy today” and “We will need to schedule your next appointment, we were hoping the machine would be ready today, but it’s in need of maintenance”.</span><br />
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<span style="font-family: "times" , "times new roman" , serif;">I made it to the restroom and got to see more of the same on the way back. The trip made me pause, as I now questioned the quality of care my dog was about to receive. I’m also thinking about what I was going to get billed for and why I need to come back. Piles of inventory and random clutter, medications that didn’t seem to belong there, medical devices mixed with cardboard boxes filled with supplies 3-boxes deep. Machines that should be operational but are not. The red flags were popping up everywhere. What am I paying for? Can I trust this clinic? Who can I trust here? Do they know what they are doing?</span><br />
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<span style="font-family: "times" , "times new roman" , serif;">You can tell a lot from what you see in a clinic. Maybe some of the judgements are assumptions, but often they are pretty accurate. The telltale signs of disorganization, the questions staff ask each other, the delays, the missed information, the clusters of inventory that often contains expired materials; all give me the chills, no matter if I’m going for my annual physical or if I’m taking my dog to the Vet. To me, the paying customer, they all tell a story of wasteful processes that I know are built into my bill.</span><br />
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<span style="font-family: "times" , "times new roman" , serif;">I’ve been a Lean practitioner in healthcare for a few years, watching and helping clinical teams improve their care to the patient in the bed. If they can do more for the patient in a better, easier way, they are all over it. I now work in the Veterinary world, and I have seen amazing transformations of quality of animal care and improvements to the Veterinary staff quality-of-life by focusing on improving small (sometimes tiny) process that support their daily work. It’s so exciting to see folks enjoy the teeny challenges of improving their own work. Lousy processes are like “pebbles in your shoe”; workers agonize through the customs and clutter; given the chance, they would stop and remove the pebble to make life better. Lean thinking does just that for workers, and the animals and their owners benefit exponentially. </span><br />
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<span style="font-family: "times" , "times new roman" , serif;">If you ever feel frustrated, rushed, frazzled, buried by complaints, or workers constantly asking questions looking for “common sense’ answers, the prescription may not be buried in a store room or office, but right here, sitting out in the open at no charge to you. The world of Lean thinking is liberating, and Lean thinkers are eager to share their learnings and experiences with you. We are here to help you; we’ve all been through the same frustrations and we found the prescription. Take one small dose daily; you will be amazed at how your quality of life will improve. (My dog is OK by the way).</span><br />
<span style="font-family: "times" , "times new roman" , serif;"><br /></span>
<span style="font-family: "times" , "times new roman" , serif;">Gerry Cronin</span><br />
<span style="font-family: "times" , "times new roman" , serif;">gmcronin@mgh.harvard.edu</span><br />
<span style="font-family: "times" , "times new roman" , serif;">Vivarium Operational Excellence Network</span><br />
<span style="font-family: "times" , "times new roman" , serif;">www.voenetwork.com</span><br />
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<a href="https://www.amazon.com/Lean-Veterinary-Practice-Management-Utilization-ebook/dp/B07XK71812/ref=sr_1_1?keywords=Lean+veterinary+practice+Management&qid=1568819147&sr=8-1" target="_blank"><img border="0" data-original-height="1377" data-original-width="1074" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjE3m18LnHKVbMod4jFADaDqqHvY2mS4eo68RRjc-xfwlpYs3nG_UHuFRiuCdtpvq7pMokOuvVBj7TQNIjTt2DB7yV2_3wJHbHJH_rJZkmWWsgSUNn7zr7IcmFJ6y0iqxLwUu7_XzNMzn8/s640/20190910_173038.jpg" width="497" /></a></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Thank you so much, Gerry. If any of my readers would like to contribute to this blog, please contact me through leanvets@aol.com. </span><br />
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-66791013558653180062019-09-10T12:51:00.000-05:002019-09-10T12:52:10.986-05:00Prepare To Promote, THEN Promote<br />
<span style="font-family: "times" , "times new roman" , serif;">It seems to me that, on balance, there is an inordinate amount of attention and money spent on advertising, optimizing social media presence and attracting new clients without much thought being given to our practice systems and foundations. Of course, marketing is necessary and important, especially in this day and age. But beware of "putting the cart before the horse."</span><br />
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Make sure you are as close as you can be to your <a href="http://www.leanvets.com/2016/12/true-north.html">True North</a>; that you have done everything you can to reduce wastes, improve quality and flow, utilize resources effectively and maximize value to your clients from <b>their </b>perspective before you embark on PR projects. Marketing poor systems and value streams is not the kind of PR you want.<br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: x-large;">My new book is now available through Kindle!</span></td></tr>
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Thanks for stopping by.E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com2tag:blogger.com,1999:blog-5918947962321933850.post-17242864010111560932019-07-24T17:18:00.000-05:002019-07-24T17:18:17.972-05:00Top 10 All-time Most Viewed Posts<span style="font-family: arial, helvetica, sans-serif;">I was looking back over the post since it inception, approximately 3 years ago, and thought it would be interesting to see what were the most viewed. The following list is what I discovered and its rank (Click on the title to go to that post):</span><br />
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<span style="font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.blogger.com/blogger.g?blogID=5918947962321933850#editor/target=post;postID=3320757919140299220;onPublishedMenu=template;onClosedMenu=template;postNum=18;src=postname"><span id="goog_1233478914"></span>Error Proofing vs Fool Proofing</a></span></div>
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<span style="font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.blogger.com/blogger.g?blogID=5918947962321933850#editor/target=post;postID=1941933098266880583;onPublishedMenu=template;onClosedMenu=template;postNum=51;src=postname">Root Cause Problem Solving and The 5 Whys</a></span></div>
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<span style="font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.blogger.com/blogger.g?blogID=5918947962321933850#editor/target=post;postID=9072091409216680590;onPublishedMenu=template;onClosedMenu=template;postNum=46;src=postname">Introducing Lean to the Texas Veterinary Medical Association Conference 2016</a></span></div>
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<span style="font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.blogger.com/blogger.g?blogID=5918947962321933850#editor/target=post;postID=3298794365180570031;onPublishedMenu=template;onClosedMenu=template;postNum=44;src=postname">Ohno's Circle and Gemba Walks</a></span></div>
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<span style="font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.blogger.com/blogger.g?blogID=5918947962321933850#editor/target=post;postID=3143028631099567705;onPublishedMenu=template;onClosedMenu=template;postNum=26;src=postname">Sayings of the Lean Fathers</a></span></div>
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<span style="font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.blogger.com/blogger.g?blogID=5918947962321933850#editor/target=post;postID=2802808352887456338;onPublishedMenu=template;onClosedMenu=template;postNum=50;src=postname">PDCA (PDSA) Cycle</a></span></div>
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<span style="font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.blogger.com/blogger.g?blogID=5918947962321933850#editor/target=post;postID=330044218587375164;onPublishedMenu=template;onClosedMenu=template;postNum=47;src=postname">Kaizen</a></span></div>
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<span style="font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.blogger.com/blogger.g?blogID=5918947962321933850#editor/target=post;postID=1244755687840154012;onPublishedMenu=template;onClosedMenu=template;postNum=42;src=postname">What Is This Takt Time You Speak About? </a></span></div>
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<span style="font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.blogger.com/blogger.g?blogID=5918947962321933850#editor/target=post;postID=3160011224139969169;onPublishedMenu=template;onClosedMenu=template;postNum=31;src=postname">10 Lean Alternatives to Blanket Fee Increases</a></span></div>
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<span style="font-size: 11pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.blogger.com/blogger.g?blogID=5918947962321933850#editor/target=post;postID=8818019700354682712;onPublishedMenu=template;onClosedMenu=template;postNum=27;src=postname">Lean and Veterinary Medicine: Like a Glove</a></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Here are a couple of my favorite post:</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="https://www.blogger.com/"><span id="goog_43839472"></span>The Origins of Lean are Not All Japanese</a></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="https://www.blogger.com/"><span id="goog_348800918"></span>Training Within Industry: A Closer Look At the Job Instruction Course<span id="goog_348800919"></span></a></span><br />
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<a href="https://www.blogger.com/"><span id="goog_801124223"></span>Process Behavior Charts: A Better Way to Evaluate Your KPIs<span id="goog_801124224"></span></a><br />
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Thanks for stopping by. Please tell your friends about the blog.<br />
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<br />E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com1tag:blogger.com,1999:blog-5918947962321933850.post-13611868442427236852019-04-29T11:58:00.000-05:002019-05-16T08:36:10.934-05:00R-E-S-P-E-C-T <div dir="ltr" id="docs-internal-guid-fb571d9e-7fff-0d41-2c8f-4927f61386fa" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">“</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Respect for people” is a fundamental principle of Lean and a major difference between Lean and the Western, more </span><a href="https://en.wikipedia.org/wiki/Frederick_Winslow_Taylor" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Taylor</span></a><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">-esque, concept of management. The Western tradition, which is still a part of educating MBAs, is that management knows best and makes all decisions. Workers are to do as they are told. </span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">There is a quotation by Henry Ford to the effect that the problem with workers is that, not only do they come with two hands, but also, unfortunately, a brain. Workers are not hired to think! Lean is much less of a top-down style of management, and much more of a bottom-up, inclusive, transparent style. This is not to say, however, that the asylum is completely handed over to the patients. </span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">This core belief influences the relationship Toyota managers and supervisors have with their workers. For Toyota, management’s primary function is more of teacher and less of an organizational police officer. We now understand, more than before, that the focus for Toyota is not just on building quality automobiles, it is primarily focused on the building of problem solving, innovative, respected employees who, then, build quality, innovative automobiles.</span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"><img height="338" src="https://lh6.googleusercontent.com/eOJxaZJ25S8tVcYexBCMu8-nct0YjO54MS6mX9syrxJSMtBjiUDYJ8EeP5CILCvxBR5tb11WjdlFx4iAYp2oFyuqz-WGN3e-ooGXvLyiMlinlOIfCIMouY_Ix_0LeRAnqovdWY84" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="329" /></span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Dealing with people from a basis of respect permeates every aspect of Lean. </span></div>
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<span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Systems thinking:</span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Have you ever had the feeling that, at some point at work, you were damned if you do and damned if you don't? Or, that you are in the the middle of a Catch-22 situation? If so, you have probably been the victim of poor systems or systems colliding with each other. That feeling of not being in control or at the mercy of things bigger than you. </span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Thinking in terms of systems means understanding that the systems at work within an organization are management and leadership designed. Systems are the responsibility of management. Workers have no authority to control or overhaul systems. They are at the mercy of the systems. Yet, many times, staff are blamed for what is, in actuality, a system design problem.</span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">For example, if a job is not being performed well, systems thinking would first consider such things as does the worker know that job is their responsibility, has the worker been trained adequately, does the worker have the necessary tools, and does the worker have timely and correct information?</span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Systems thinking is more respectful. It recognizes that systems should be investigated when problems occur before blaming people. </span></div>
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<span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.leanvets.com/2016/02/value.html" target="_blank">Value</a>:</span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">The Lean definition of value is that which the client wants and is willing to pay for, and that improves the health status of the pet, without defects and waste along the way. Our clients get exactly what they want, when want it and in the amount wanted. They pay for only value adding services. The concept of defining value </span><span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">from the client’s point of view</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"> shows respect for them. </span></div>
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<span style="font-family: "arial"; font-style: italic; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Variance and overburdening:</span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Lean understands that large variances in workload can be the source of difficulties and overburden our staff. Lean suggests work loads try to be leveled as much as possible. Being watchful for the overburdening of staff comes from respect. </span></div>
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<span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.leanvets.com/2016/02/just-in-time-jit.html" target="_blank">Just-In-Time</a> </span></div>
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<span style="background-color: white; font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">The Just-In-Time (JIT) concept is the procurement and delivery of resources, (whether that be drugs, supplies, access to diagnostic equipment and information, or patients, doctors and staff) just exactly where it is needed, just exactly when it is needed, and just exactly in the amount needed. Nothing more and nothing less. </span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">With respect to staff and personnel, the Just-In-Time idea is based, in part, on recognizing and respecting the unique value of everyone's time and skills; to only use them when, where and in the amount needed.</span></span></div>
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<a href="https://www.leanvets.com/2016/02/standardized-work.html" target="_blank"><span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Standardized work</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"> </span></a></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Standardized work is the </span><span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">mutually</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"> agreed upon method to do or handle a certain process or situation that helps insure quality, timeliness and safety, and gets everyone on the same page working in the same direction. It shows respect by involving staff in its definition and formal writing, and by eliminating ambiguity and the anxiety it causes to workers that come from policy and process chaos. </span></div>
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<span style="font-family: "arial"; font-style: italic; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.leanvets.com/2016/02/kaizen.html" target="_blank">Kaizen</a></span></div>
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<span style="font-family: "arial"; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kaizen</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"> is a Japanese word that can be translated to mean “good change,” “change for the better,” or “continuous improvement.”</span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">While improvements can be large, time consuming and expensive major changes, the most common are the small, daily, quick, inexpensive ideas submitted by staff that improve quality, flow, safety, value to the client and make work life just a little easier. Staff are on the frontline of our practices every minute of every day. They know, better than anyone, where and what the problems are. And, they probably know better how to remedy them than we owners and managers do.</span></div>
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<span style="font-family: "arial"; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kaizen</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"> shows respect by recognizing what an asset our staff is, and allowing them to partner with us in improving the practice; to be engaged and be part of the solutions, rather than always being blamed for the problems.</span></div>
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<span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.leanvets.com/2016/02/standardized-work.html" target="_blank">5S</a></span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">5S projects are the physical cleaning and reorganization of a particular room or area of the practice. It helps the staff to work with less clutter, frustration and confusion on a daily basis. It creates better flow within the hospital which increase value to clients; all ways of showing respect.</span></div>
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<span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Go to </span><span style="font-family: "arial"; font-style: italic; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.leanvets.com/2015/12/gemba.html" target="_blank">gemba</a> </span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">"Genchi Genbutsu" (go and see) means that whenever there is a problem found, all relevant stakeholders (management </span><span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">and </span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">staff) should go to where the problem occurs (the “</span><span style="font-family: "arial"; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">gemba”</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">) and solve it </span><span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">together</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">. It shows respect by recognizing that staff have valuable input to the situation. </span></div>
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<span style="font-family: "arial"; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><a href="https://www.leanvets.com/2018/05/andon-cords-and-practice.html" target="_blank">The Andon cord</a></span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">On the Toyota production line, workers are provided with a mechanism to sound an alarm and ask for help anytime they find it necessary. The line stops if the problem is not quickly resolved. Toyota trains and trusts its employees to use the Andon cord when an issue of quality or safety is in question. It shows respect by creating a culture of safety and trust for anyone to speak up, even if they think there might possibly be an inkling of a concern.</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"><br /></span><br />
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">It is my humble opinion that if veterinary staffs knew about and understood the Lean mindset and its worker-centric (and client-centric) philosophy, there would be such a grassroots revolution within the profession that owners, managers and corporation leadership would have no choice but to start thinking Lean within their practices. Maybe, we could start now and circumvent all of the "</span><span style="font-family: "arial"; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">bloodshed</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">."</span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Thanks for stopping by. Please share this blog with your contacts! And, let me know if you have any questions, comments or post ideas.<br /><span style="font-size: 11pt;"><br /></span></span></div>
E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-92186583374730079882019-04-19T13:57:00.001-05:002019-04-21T18:56:28.932-05:00Toyota Kata<div dir="ltr" id="docs-internal-guid-1a93c447-7fff-ffd4-c74c-ff2083fee896" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">This is a continuation of the last <span style="color: cyan;"><a href="https://www.leanvets.com/2019/03/training-within-industry-closer-look-at.html" target="_blank">post</a></span> dealing with the training methods taught to Japan by the U.S.'s Training Within Industry after WWII. As explained in that post, the three TWI J-courses had a major influence on several of key concepts of the Toyota Production System, namely Standardized work, respect for workers and continuous improvement. But, true to Toyota’s character, they took that information, put their own “flavoring" on it, and developed what Mike Rother calls Toyota </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> comes from the world of oriental, martial arts. It means “form.” There are two primary </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">; Improvement </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> and Coaching </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Toyota Improvement </span><span style="font-family: "federo"; font-size: 18pt; font-style: italic; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Kata</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline;">When we think about the distance between where we are currently and our True North (or any other challenge), it can seem immeasurable. Or, the idea of a Lean transition and all that that entails can seem overwhelming. But, handling these emotions comes down to the metaphorical concept of how to eat an elephant; one bite at a time. Improvement </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline;">kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline;"> is the standardized work for taking each bite. </span></span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><img height="514" src="https://lh6.googleusercontent.com/aONcsaf8xx0M4C2WOEWMl7sRgjuePKJKQGK27TYyfYaOIPRsXf8D1XZo1TOsKdsl6HPe0G6HIx4AUVtECxEbagkXySN8OPJ9UDul4GflFJtYui0Wvljj_TYM4YF0P9QLZFcrdO38" style="border: none; transform: rotate(0rad);" width="499" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">The first step is to have a good understanding of where you are going; your direction, your True North or the challenge before you. In the figure above, “CC" stands for our current condition and “TC" is the target condition. The target condition is what we feel is the next logical step on our journey to True North or our goal. Part of the journey to our next TC is clearly visible and we have a very good idea how to get that far. But, after that, there is the part that is less knowable. It is more obscure, intimidating and without a clear plan. So, how do we get through this part of the quest? We <a href="https://www.leanvets.com/2016/02/pdca-pdsa-cycle.html" target="_blank">PDSA</a> our way through it. </span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">We make a plan, experiment and see if we get closer to out target condition. The path that this takes us on is not necessarily straight. There will probably be some “zigging" this way and “zagging" that way, but through the use of A3 thinking, we will reach our TC. One bite gone! Eventually, by continuing to identify each next successive “bite" (target condition) and repeating the process, we get closer and closer to our goal. This is the essence of the Improvement </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Toyota Coaching Kata</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">As the name implies, the Coaching </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> is the standardized work for managers to mentor and monitor individuals and groups involved in improvement </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">. It consists of five questions:</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><img height="133" src="https://lh3.googleusercontent.com/cfTKM7PCNkTL8_eZC_4GGaVrpWStH2hvUI_UBZRqWBHbGbAH4ypeGEPwXrkAUrM5mP3Hp3bz_Pdzn3x18n0z0OGq4LBqw6PaL6-dhXpafiGGj-z-H0xCL0tW6l3Ye55dlOuKHcF1" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="557" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">As you probably can tell, these questions are simply asking the group to visualize and verbalize the PDSA cycle.</span><br />
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Where are you trying to get to? </span><span style="font-family: "arial"; font-size: 12pt; white-space: pre-wrap;">What is your direction or challenge and what is your next target?</span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><span style="font-family: "arial"; font-size: 12pt; white-space: pre-wrap;">What is your current condition? Where are you now?</span></li>
<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><span style="font-size: 12pt; white-space: pre-wrap;">What is one thing that is keeping you from reaching the target? What are the problems? If there are more than one, then deal with this one now, and come back to the others later.</span></li>
<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><span style="font-size: 12pt;">What countermeasures are you going to try and, if successful, what will that future state look like?</span></li>
<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><span style="font-size: 12pt;">When can we study and evaluate that experiment?</span></li>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">You may have several groups, each trying to reach the next target condition of their improvement project, but for you, as the coach/mentor, the questions remain basically the same. Rather than solving the problems for them, you are asking questions that will lead them, through A3 thinking, to solve their own problems, learn, and deeply understand the process. Coaching is a scheduled, periodic endeavor, much like <a href="https://www.leanvets.com/2019/02/a-different-kind-of-rounds-lean-daily.html" target="_blank">Lean Daily Management</a>, but less frequent. We are monitoring that the project is on task and progressing appropriately.</span><br />
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">Thanks for reading. Your comments, suggestions, ideas and questions are always appreciated. </span><br />
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-33225588699051101662019-03-25T18:19:00.000-05:002019-07-24T16:56:00.552-05:00Training Within Industry: A Closer Look At the Job Instruction Course<div dir="ltr" id="docs-internal-guid-b320d825-7fff-8e85-3e7d-c2957cff2b2d" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">With this post, I take a closer look at the Training Within Industry's Job Instruction course that I introduced in the post <a href="https://www.leanvets.com/2019/02/the-origins-of-lean-are-not-all-japanese.html" target="_blank">"The Origins of Lean Are Not All Japanese."</a> One of the reasons, from a systems viewpoint, staff may not be performing well is inadequate training. </span><br />
<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Job Instruction (JI) course</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">This course was designed to teach supervisors how to teach new workers. These people knew their jobs well and had a lot of experience, but many didn't understand how to teach someone else. This course showed them how to dissect the job into its individual steps and provided them with a standard way of instructing on a step-by-step basis. This was the nidus for Lean standardized work.</span></div>
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<span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">HOW TO GET READY</span><span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">TO INSTRUCT</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Have a Time Table--</span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> how much skill you expect him to have, by what date.</span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Break down the job—</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> list important steps.</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> pick out the key points. (Safety is always a key point.)</span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Have everything ready—</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> the right equipment, materials and supplies. </span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Have the workplace properly arranged—</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> just as the worker will be expected to keep it.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">HOW TO INSTRUCT</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Step 1—Prepare the worker</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Put him at ease.</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> State the job and find out what he already knows about it. </span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Get him interested in learning job.</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Place in correct position. </span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Step 2—Present the operation</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Tell, show and demonstrate one IMPORTANT STEP at a time.</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Stress each KEY POINT. </span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Instruct clearly, completely and patiently, but no more than he can master.</span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Step 3—Try out performance</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Have him do the job—correct errors. </span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Have him explain each KEY POINT to you as he does the job again. </span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Make sure he understands.</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Continue until YOU know HE knows.</span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Step 4—Follow up</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Put him on his own.</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Designate to whom he goes for help.</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Encourage questions. </span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> Taper off extra coaching and close follow-up.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">________________________________</span><span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">If the Worker Hasn't Learned,</span><span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "federo"; font-size: 18pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">The Instructor Hasn't Taught.</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="font-family: "arial"; font-size: 12pt; white-space: pre-wrap;">Below is an example of the Job Instruction method of teaching a new student how to clean an endotracheal tube after it has been used following our standardized work for the activity.</span><br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><img height="784" src="https://lh5.googleusercontent.com/aFeoBVdVOVYtdBrO6RKZ0vOIaALK8shlS6KubTDWKuaoj0XuAW3OeC151Z-89GhznLkQrgcOXm5QfPJ-pZ984BMrwHCduw7XfxpPhsWifkcZVBUjqZUBgTm-VVA1Zwg2fo0Ks2Rk" style="border: none; transform: rotate(0rad);" width="624" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><img height="838" src="https://lh5.googleusercontent.com/6UOlqVA1Xz-Tym2FcSbcHEZPNlydWBGAe1GnsYioI5WYGbFAhtZSrOqy-23GSomo01NOfuO15LTgQ9_wzaPj9sHct2FD4oregO2mxWAwrngR06yc8i5c0OLjEfMCtIZmld1l31bU" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="610" /></span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"><img height="890" src="https://lh3.googleusercontent.com/aw93OfJqMBlGWd7owePKVgvmfLZfcXiDjqBUn_iSnKG2nSlRKc2mKm5YAybcAwNogkGHfbVVjCuFZ-p9BpzaWqX7PGh8m676lzWhkXcfLmSP6kiv9kx5GjUrPDMg48kxYbvQHUWI" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="583" /></span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">At this point, you can have the student go through the process another time or, if you feel confident of his ability, allow him to work independently. Be sure to praise him for his attentiveness, and give him permission to reconnect with you at any time for any additional assistance he may need.</span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">As explained in the earlier post referenced above, the three TWI J-courses had a major influence on several of key concepts of the Toyota Production System, namely Standardized Work, respect for workers and continuous Improvement. But, true to Toyota’s character, they took that information, put their own “flavoring" on it, and developed what Mike Rother calls Toyota </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> comes from the world of oriental, martial arts. It means “form.” There are two primary </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">; Improvement </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> and Coaching </span><span style="font-family: "arial"; font-size: 12pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kata</span><span style="font-family: "arial"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">. I will look at Toyota <i>Kata</i> in the next post.</span></div>
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<span style="white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Thanks for stoping by. If you enjoy and learn from this blog, please tell a friend or colleague. And, as always, comments always appreciated. </span></span></div>
E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-38362446960944245742019-03-19T11:42:00.000-05:002019-03-19T18:09:34.893-05:00Great Scores For Kaizen At 2019 AVMA Veterinary Leadership Conference <span style="font-family: "arial" , "helvetica" , sans-serif;">This past January, Mark Graban and I had the honor and pleasure of speaking at the 2019 American Veterinary Medical Association's Veterinary Leadership Conference in Chicago. The title of the 90-minute lecture was <b>The Lean Concept of Kaizen: Taking Your Practice To the Next Level...And the Next!</b><span style="color: magenta;"> </span><span style="color: #444444;">The attendance was good.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #444444;"><br /></span></span> <span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #444444;">I started the session with a brief introduction to the history of Lean, starting with Lean manufacturing through Lean management and Lean healthcare to, now, Lean veterinary medicine. Mark, then, took over in his usual dynamic and enthusiastic style. He explained the literal and common definition of <i>kaizen, </i>why it is a better system than suggestion boxes, the PDSA cycle, and ending with a description of a simple <i>kaizen </i>system using Idea cards, Summary cards and a conspicuous Idea board. Along the way, he gave numerous examples from both human and multi-species (veterinary) healthcare.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #444444;"><br /></span></span> <span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #444444;">Just a few days earlier I presented a one hour webinar entitled <b>The Lean Methodology: Evolution of Veterinary Practice Management </b>for the AVMA's Lead and Learn webinar series. For this webinar, I took the approach that the Lean mindset is very much akin to the scientific method of diagnosing and treating disease, which we as veterinarians are extremely familiar with. I tried to demonstrate that in both cases we have an ideal vision (Health and True North), we perform a physical exam (in Lean it is "go to <i>gemba" </i>and create a current Value Stream Map), we define our current state and, then, list the gaps between the two conditions (master problems list). At this point, both methodologies analyze the list for root causes (tentative diagnoses) and perform an experiment (treatment) with their respective tools and processes. At the end of the experiment, we assess our success, or lack thereof, and either sustain the new condition or experiment again with a different set of countermeasures. </span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #444444;">I haven't received any follow-up from the webinar, but attendee scores for the lecture were very satisfying.</span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #444444;">As the results show, 91.2 percent either agreed or strongly agreed that the information presented was useful. In addition, 87.9 percent either agreed or strongly agreed that the material was presented effectively.</span></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #444444;">Lean is starting to make its way into veterinary practice management. Something that Mark and I have been advocating for the past three years. But, even more exciting is that others within our profession see it as valuable. That has always been the benchmark.</span></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #444444;">Lean is not a complete abandonment of all the concepts of traditional management; it is not a dogma. However, many of the older, traditional management concepts are challenged by this different mindset. Just as a computer language does not dictate what program or application is produced; it only supplies the means. Lean is, also, an infrastructure...for adaption and continuous improvement in practice management.</span></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #444444;">The AVMA Lead and Learn webinars (including mine) are available for viewing free of charge to members <a href="https://www.avma.org/Events/CE/Pages/default.aspx" target="_blank">here</a>.</span></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #444444;">Thanks for stopping by. Dialogue is always welcome.</span></span></div>
E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-69726662162993467692019-02-26T14:05:00.001-06:002019-02-26T14:05:39.240-06:00A Different Kind Of Rounds: Lean Daily Management <div dir="ltr" id="docs-internal-guid-1bea1182-7fff-e3de-b52d-b12202831f15" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">As doctors and veterinary staff, we are well acquainted with the daily ritual of morning or change of shift medical rounds. This is the gathering of hospital staff and doctors to be updated on the current status of all of the patients in the hospital for treatment, and for the dissemination of new treatment orders by the doctors in charge. This is a form of </span><a href="https://www.leanvets.com/2016/02/standardized-work.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">standardized work</span></a><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">. It gets everyone on the same page in a routine and timely manner.</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Lean Daily Management (LDM) serves the same purpose, but for the operations and management side of the practice.</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><img height="525" src="https://lh3.googleusercontent.com/RSS-SXl3H8Nd22CXE2tn0ZZFOE3jiYxSi_UAXVmeT9EKI-J1qFdjvjIf_-Jr7CaHyMoetgYZ7cXarzjy7nuywGp9lWpg-8kWUuLEyPV1nyC3qV7We-RdInyB8t0IiitUxtpFjJ6g" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="598" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Each morning, leadership and management go to the </span><a href="https://www.leanvets.com/2015/12/gemba.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">gemba</span></a><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> to meet with staff of a particular area of the practice to go over that area's board. What numbers are up (and why?) and what numbers are down (and why?). Or, better yet, do the </span><a href="https://www.leanvets.com/2018/04/process-behavior-charts-better-way-to.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Process Behavior Charts</span></a><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> (PBC) of the data show any "signals" or is it all just "noise?" (see also Mark Graban's book "</span><a href="http://www.measuresofsuccessbook.com/" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Measures of Success</span></a><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">") What countermeasures should be tried? Any new kaizen ideas? What, if anything, can management do to support the staff? Any evidence that standardized work is not being followed?</span><br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><b>Sidebar</b>: One of the two Process Behavior Charts above is showing two signals. Can you identify which chart it is and what the signals are? </span><br />
<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">LDM helps support our progress through that big </span><a href="https://www.leanvets.com/2016/02/pdca-pdsa-cycle.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">PDSA cycle</span></a><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> called </span><a href="https://www.leanvets.com/2018/11/lean-veterinary-strategy-deployment.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">hoshin kanri</span><span style="color: #1155cc; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> or strategy deployment</span></a><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">. Remember, part of the Act (/Adjust) phase of a successful PDSA cycle is to sustain the results (for now), write new standardized work, scale up if appropriate, and start teaching to the new standard. This brings a new current state, and the next target condition is identified, initiating a new PDSA cycle of improvement. </span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><img height="380" src="https://lh6.googleusercontent.com/AKQxINf62jZk68tuvFC5BWxwU6wVh3GOVSxI2PUbSmFiMYxn47Y_YUH0ap5G9jqppKNv0j_zYI7yYaQ0PpanDnyIwBqA1GTQH2Gbnc7bIj9h0rSFP30dRbodtOlS2S8uFgFIYrus" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="524" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">In the figure above, the wheel has been moved up the ramp (improvement) through A3 thinking and </span><a href="https://www.leanvets.com/2016/02/kaizen.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">kaizen</span></a><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">. But, there are forces in any system that want to undo that which has been accomplished. Some call it entropy; I think of it as organizational gravity. The function of standardized work is to counter those evil forces by stabilizing and sustaining the new current state. </span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">The role of LDM is to sustain and stabilize ("nail down") standardized work as it is currently written. LDM functions as a "checks and balance" for standardized work, which acts as a wedge to help prevent organizational backsliding. LDM is the setting aside of time on a daily basis to monitor for this potential. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">So, to recap, standardized work sustains the current state, and LDM sustains the current standardized work. </span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Lean Daily Management meetings should take 10 to 20 minutes per day. They are typically done in the mornings, however, they need to be a scheduled, daily priority for all involved. Choose the time that’s best for your practice and team.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">All extraneous interruptions should be put on hold for the entirety of the time. During the meeting, a staff member from the department or area of the practice, such as the Hospital Care team, quickly reviews the metrics, status of any countermeasures, new problems that have come up, any cross training efforts, new and ongoing </span><span style="font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">kaizen</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">, etc. with management. The staff member that leads the meeting should rotate from amongst the entire team, so that everyone gets the opportunity to lead the conversation and learn. </span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">As is the Lean perspective, management takes on a teaching and mentoring capacity; asking questions to stimulate A3 thinking, encouraging all efforts and practicing servant leadership.</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">So, Lean Daily Management accomplishes several things:</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 1. Gets management to the places where work occurs (go to </span><span style="font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">gemba)</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 2. Facilitates conversation and consensus building with staff</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 3. Demonstrates management's commitment to the staff</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 4. Monitors the metrics that support the True North statement and KPIs</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 5. Allows time to encourage and appreciate </span><span style="font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">kaizen</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> efforts</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 6. Sustains and audits standardized work</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 7. Creates increased engagement of the workers</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> 8. Show respect for workers</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><a href="http://www.leanpub.com/leanvets" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><img height="269" src="https://lh3.googleusercontent.com/wbUGftwS8X1AXtTSaRnbAH0j0bNahwa5TnWVYxw2cOPLyYAxPA6wWGaQHKXd-Bg4H81KQe63_zSf7N2g6QcNVIYpQuIli5WPWv5HqD-EgogwMKSuoI3Ov8GK9AScvO-3L4b6xBB4" style="border: none; transform: rotate(0rad);" width="492" /></span><span style="color: black; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span></a><a href="http://www.measuresofsuccessbook.com/" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><img height="275" src="https://lh3.googleusercontent.com/DVYe6EMLPWzEFW4W7pK1zLa49Ml2BmZPEt0SPHjZSN3ptpo11oMIDb1l_-g9xDU8RPUFRivc7KS_0jpHlJO5L3QC1uhiGWn4fyBv8FjSd2FZfGok-wKq550UlgV2SziTbE_Wb6gM" style="border: none; transform: rotate(0rad);" width="489" /></span><span style="color: black; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="color: black; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="color: black; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span></a><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Thanks for stopping by. Comments, questions, and suggestions always welcome.</span><br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Also, to answer the sidebar questions, the bottom PBC is showing a signal that needs to be investigated. The first signal is the data point above the upper process limit.The second signal is three or four of the last four data being closer to one of the process limit lines than the average. In the case above, the last <b>five</b> data points are closer to the lower process limit line than the average. In fact, it appears that we may be trending around an entirely new, lower average, which indicates that the whole system has changed somehow. Both of these conditions should have been recognized earlier than now, if they weren't. The next step is root cause analysis and formation of countermeasures, i.e. PDSA problem solving.</span><br />
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-12458641577677184782019-02-03T17:13:00.001-06:002019-02-06T05:56:54.886-06:00The Origins of Lean are Not All Japanese <span style="font-family: "arial" , "helvetica" , sans-serif;">Over the past few years, while discussing what Lean is with people, I have had one or two of them make comments to the effect that they weren’t interested in learning about anything coming from Japan (or any other foreign country!).</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Now, while it is true that Lean did come from Toyota via the T</span><span style="font-family: "arial" , "helvetica" , sans-serif;">oyota Production System (TPS)</span><span style="font-family: "arial" , "helvetica" , sans-serif;"> and Toyota developed this in</span><span style="font-family: "arial" , "helvetica" , sans-serif;"> Japan, much of what originally went into it came from the good ole' U.S. of A.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">There were four primary entities from the United States that had an influence on and are responsible for a very large part of what came to be TPS. They are:</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">1.<span style="white-space: pre;"> </span>Henry Ford and Ford Motor Company</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">2.<span style="white-space: pre;"> </span>W. Edwards Deming </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">3.<span style="white-space: pre;"> </span>Training Within Industry (TWI)</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">4.<span style="white-space: pre;"> </span>1950s U.S. grocery stores</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><b><u>Henry Ford</u></b></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><b><u><br /></u></b></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">The first influence came from Henry Ford's idea of the assembly line and mass production, allowing the increased manufacturing of identical products by several orders of magnitude. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">These concepts included highly standardized parts, which also allowed for the quick replacement of defective parts with identical replacements, which saved time. But, the mindset was still based on inspecting and repairing defects after the fact instead of preventing defects, as Toyota had already been focusing on. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Not to mention that most of these defects weren't caught until the whole auto had been built, so sometimes it was just as easy to scrap the car altogether. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">But, what the heck! America was victorious after the war and had plenty of returning workers and plentiful resources. What’s a few thousand defective products and the time and labor to fix the situation? Japan was a defeated country with a scarcity of resources, which required them to be more creative.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Toyota, as well as the rest of the world learned from Ford as he started the mass production assembly line. However, they would tweak it quite a bit in the years to come. And, others would learn that Lean applies in environments that are not moving assembly lines.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u><span style="font-size: large;">W. Edwards Deming</span></u></b> </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">In recent years, a Toyota executive said:</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">"</span><span style="font-family: "arial" , "helvetica" , sans-serif;">There is not a day I don’t think about what Dr. Deming meant to us. Deming is the core of our management.”</span></blockquote>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">W. Edwards Deming was an engineer, mathematical physicist, and statistician during the twentieth century, becoming one of the greatest quality gurus of all time. In 1947, Dr. Deming was asked by the United States to go to Japan to help with the census during the post war restoration efforts. While he was there in that capacity, he gave a series of lectures on quality and process control to the Japanese Union of Scientists and Engineers. They eagerly incorporated his material into their thinking. The Deming Prize is still given out in Japan for examples of the highest quality organizations.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUT33owKsum5Q84df7mxmI8B4jSgeq50cU8w951-cddjnkG59nbBC5-3NQcAO4pbzDUUuhPxh8XpRXR6fJqx1-4qBYRt9n47YeU1Yll4I9luY8gTgADhcDSiGjDjvwfJe7RlgRTKXIH6g/s1600/20181101_165251.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="819" data-original-width="835" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUT33owKsum5Q84df7mxmI8B4jSgeq50cU8w951-cddjnkG59nbBC5-3NQcAO4pbzDUUuhPxh8XpRXR6fJqx1-4qBYRt9n47YeU1Yll4I9luY8gTgADhcDSiGjDjvwfJe7RlgRTKXIH6g/s200/20181101_165251.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The PDSA (or PDCA) cycle is also known as the Shewhart cycle (or the Deming cycle)</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">From Dr. Deming, Japan and Toyota learned about building quality into the product at the gemba, the PDCA cycle and systems thinking.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><b><u>Training Within Industries (TWI)</u></b></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><b><u><br /></u></b></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">When the United States decided to enter World War II, most all able bodied men were ushered into military service. This left a large deficit in the workforce population, especially at a time when the military industrial complex was gearing up. In order to replace this workforce, women were recruited to fill these positions. Think of “Rosie the Riveter.”</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgptQxkUZbZq3mVCjYCcc9bcioIChsUSGClX-YD-0G7QXG9_FKKgyIvRFcYzPcMxCbFvTJ5rly597fLJ_EAkQVDkF1Ep7BHRe5QOyFnh3TcjGwBeoTRRhtDKZcNZeIJKN4WqHZ5ITrwKMM/s1600/20181126_162824.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1259" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgptQxkUZbZq3mVCjYCcc9bcioIChsUSGClX-YD-0G7QXG9_FKKgyIvRFcYzPcMxCbFvTJ5rly597fLJ_EAkQVDkF1Ep7BHRe5QOyFnh3TcjGwBeoTRRhtDKZcNZeIJKN4WqHZ5ITrwKMM/s200/20181126_162824.jpg" width="156" /></a></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">The problem, of course, was that these new hires had little to no training in industry. Because the need was so immediate, the war department started the Training Within Industry (TWI) program.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Training Within Industry was a predominately volunteer program to help get new workers up to speed as quickly as possible. Many of the TWI trainers were loaned to the project by manufacturers, which continued to pay their salaries.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">No manufacturing company was forced to utilize the TWI program. They had to request TWI help, and many did. There were also cases where TWI was used in healthcare.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">There were four training programs offered at different times called the Jobs programs. These included the Jobs Instruction (JI) course, the Jobs Methods (JM) course, the Jobs Relations (JR) and, later, the Jobs Safety (JS) course. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">The program was very successful and contributed greatly to the United States being among the victors. When the war was over and the United States was helping to rebuild Japan, the TWI programs were exported. Manufacturers, including Toyota, enthusiastically incorporated the concepts into their own cultures. There is still a copy of an original TWI manual in the Toyota company museum. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Once the war was over, the War Department ended the TWI program, the men returned to their jobs, the industrial revolution was on its way, resources were plentiful, manufacturers didn't see the need of TWI in their companies and interest in TWI dwindled to almost nothing. In recent years, however, there has been a renewed excitement in the old programs and methods.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>The TWI Job Instruction (JI) course</b></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">This course was designed to teach supervisors how to teach new workers. These people knew their jobs well and had a lot of experience, but many didn't understand how to teach someone else. This course showed them how to dissect the job into its individual steps and provided them with a standard way of instructing on a step-by-step basis. This was the nidus for TPS's standardized work.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7MspvlJ8GNztI47snmRYoJHz-TC7WZzzwrRvZ9PD525QXLX26jzYO4nH51Q1SscFMEz2fqcgFEU42SjCENQCdKsnY6gJAVr9pN6jsckns8L9RJNy2wB7l0EKYN6YDYlI268deFbnB-xk/s1600/20181127_121951.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1268" data-original-width="1466" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7MspvlJ8GNztI47snmRYoJHz-TC7WZzzwrRvZ9PD525QXLX26jzYO4nH51Q1SscFMEz2fqcgFEU42SjCENQCdKsnY6gJAVr9pN6jsckns8L9RJNy2wB7l0EKYN6YDYlI268deFbnB-xk/s320/20181127_121951.jpg" width="320" /></a></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Training cards (as shown above and below) for each of the “J" courses were given to students to constantly refer to when dealing with their workers at their jobsite. This was necessary to protect the uniformity and integrity of the material throughout the project.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>The TWI Job Methods (JM) course </b></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHtnXpNhDWcS2ssA6Q90LtPwIl81ElLvSwPhywzSYAwUyIrU9zSA7KwIflJrJgEdESCuFcJgLUyLsqT3alB2e4U_wftPy3nU1f7IYtn11AmASPwplvxgtoPS_QrNqvsfGzBo7QbBcuZLM/s1600/20181127_121811.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1198" data-original-width="1572" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHtnXpNhDWcS2ssA6Q90LtPwIl81ElLvSwPhywzSYAwUyIrU9zSA7KwIflJrJgEdESCuFcJgLUyLsqT3alB2e4U_wftPy3nU1f7IYtn11AmASPwplvxgtoPS_QrNqvsfGzBo7QbBcuZLM/s320/20181127_121811.jpg" width="320" /></a></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Job Methods taught how to improve the work being done. It was the impetus for kaizen or continuous improvement.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>The TWI Job Relations (JR) course</b></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8cp5OnV_DCjekMbAmodJc2vb1fOG3_VxRvegeYTBmzoUo17z5GrW5s5ThYufZXU0WT1n46FUKu_D1vW-w0uqzVsFixLrHu3ncTaDZLCeJKLggqSS86L0lf6_67n-qZmeVa-erqzgCDQw/s1600/20181127_121241.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="897" data-original-width="1221" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8cp5OnV_DCjekMbAmodJc2vb1fOG3_VxRvegeYTBmzoUo17z5GrW5s5ThYufZXU0WT1n46FUKu_D1vW-w0uqzVsFixLrHu3ncTaDZLCeJKLggqSS86L0lf6_67n-qZmeVa-erqzgCDQw/s320/20181127_121241.jpg" width="320" /></a></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><br /></b></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">The Job Relations course instructed supervisors how the deal with interpersonal relationships and conflicts. Toyota's commitment to the respect of workers and people came from this information.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAH4-SIUhtU0yALq3HuUkwQw9en8iswSh9lVZzwOGiFM7ubX54DfCz8-gw0qCET70Ylc17MnxvcIr7l30rR3wp3_goHwZczAsSCPSPV38L5fRzsOrCEWl4ABpnKWDKTv6Uda9o3t0NV-4/s1600/20181207_144347.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1503" data-original-width="1392" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAH4-SIUhtU0yALq3HuUkwQw9en8iswSh9lVZzwOGiFM7ubX54DfCz8-gw0qCET70Ylc17MnxvcIr7l30rR3wp3_goHwZczAsSCPSPV38L5fRzsOrCEWl4ABpnKWDKTv6Uda9o3t0NV-4/s320/20181207_144347.jpg" width="296" /></a></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">These early concepts eventually evolved into Toyota's Improvement Kata and the Coaching Kata. These are the standardized work of how managers and supervisors teach and mentor their direct reports.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><u><b>1950s United States Grocery Stores </b></u></span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Toyota executives who had come to the United States to observe and learn were intrigued by the way our grocery stores replenished their shelves at night with only those items that had sold that day. By the next morning, when the store reopened, the shelves were full for customers to purchase and the cycle repeated. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Very little inventory was kept in the back of the store which cut down on costs to warehouse a large inventory and the capital tied up in that merchandise. All of this appealed to a small company in a small, recovering country. Just-In-Time thinking was born from this U.S. grocery store concept</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4_839xh2rNZgG1H5kZcodyU3rhM7bkbCW-_xzJP2CO7xM0npNIOZpQs7ZlIYmYRfIYgIiseik5lSZRsRl6gHd2ab4Nq5TO7BnJ76IlA-0lPcS31PEyMEg_8V_FxI8jqLOqEhO9SL85lQ/s1600/20181212_142838.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1562" data-original-width="1241" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4_839xh2rNZgG1H5kZcodyU3rhM7bkbCW-_xzJP2CO7xM0npNIOZpQs7ZlIYmYRfIYgIiseik5lSZRsRl6gHd2ab4Nq5TO7BnJ76IlA-0lPcS31PEyMEg_8V_FxI8jqLOqEhO9SL85lQ/s400/20181212_142838.jpg" width="317" /></a></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">While there is definitely an Eastern philosophical hue to the Toyota Production System, the roots of much of the mindset, especially what we would consider the major concepts, originated from the United States. But, keep in mind that Toyota is not the same as every Japanese company. They've worked hard to create a special culture -- they've been willing to learn from other countries. How about you?</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Thank you for stopping by. Comments always welcome.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-58188541738585497082018-12-03T18:09:00.002-06:002018-12-04T14:03:54.576-06:00Acknowledgements For My In-Progress Book "Lean Veterinary Practice Management" <div style="text-align: center;">
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<span style="font-family: "arial" , "helvetica" , sans-serif;">I know it is not typical to publish acknowledgments separately, outside of the book and in a public forum. But, it is important <i>for me</i> to do so.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Below, are the acknowledgments for my in-progress book <a href="http://www.leanpub.com/leanvets"><i>Lean Veterinary Practice Management: Higher Quality, Less Waste, Greater Staff Engagement and Continuous Improvemen</i>t. </a></span></div>
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<b><span style="font-family: "arial" , "helvetica" , sans-serif;">Acknowledgements </span></b></h3>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">I have been so fortunate, in my life and career, to have been part of a profession that has been both rewarding (and frustrating!) and self satisfying (and humbling!). A veterinarian is all I ever wanted to be. I never had a backup plan, so it is good that it all worked out!</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">In the book <i><b>Honey From the Rock</b></i>, Lawrence Kushner, writes about <i>Malachim Elyon</i>, ordinary people who, knowingly or unknowingly, act as a messenger from God to intervene in the lives of other ordinary people in their times of need. We all are called for these “errands”, whether we know it or not. I have come to recognize, at least, some of these angel messengers.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">I grew up in El Paso, Texas. It was there that I became interested in Veterinary Medicine. My second home, during my high school years, was Northeast Veterinary Clinic, and one of my second “Dads” was Dr. Robert Morrison, of blessed memory. He, more than anyone, helped to solidify my determination to pursue my “calling” of Veterinary Medicine and exemplified, for me, what it truly meant to be a healer for “creatures great and small.” Thank you, Doc.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">The veterinarians of El Paso, Texas, are a unique group of individuals. Maybe, because they were all trying do the same, often difficult and thankless, job in a place that is somewhat isolated in many ways; but mostly because they were just good people! While we were friendly competitors, we all knew we were colleagues first and foremost, working toward the same honorable goals; we always had each other's “backs.” Of special importance to me were Dr. Bernie Page, Dr. Guy Johnsen, Dr. Robert Rohrbaugh, Dr. Robert Garrick and Dr. Ed Silverman. You all have been very special and very needed in my life.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">My dad was a mechanical engineer with an incredible life story. He built a power plant in El Paso, TX, a dam on the Roanoke River in North Carolina, the first radio telescope at Green Bank, West Virginia, and a radiation fishery in Gloucester, Massachusetts, that preserved fish fresh off the boats for more than a year without refrigeration. We owned a toy store later in my youth (not as cool as one might think) and I learned the fundamentals of entrepreneurship and the discipline it takes to be self employed. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">He was my first teacher of the scientific method, of understanding flow, of the Plan-Do-Study-Act cycle (though it wasn't formally taught as such), continual improvement, deep understanding, self reliance, the importance of education, honoring yourself and your family, and of respecting everyone. He was “Lean” before anyone knew that term. Dad, I am so happy that my soul chose our family to be born into. I miss you everyday!</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Several years ago, after discovering the Toyota Production System, or Lean, I reached out to <a href="https://markgraban.com/" target="_blank">Mark Graban</a>. Mark had already firmly established himself as a world-renowned expert in Lean Healthcare. He has authored or co-authored three books: <i><a href="https://leanhospitalsbook.com/" target="_blank">Lean Hospitals</a>, <a href="https://www.hckaizen.com/healthcare-kaizen/" target="_blank">Healthcare Kaizen</a> and <a href="https://www.hckaizen.com/executive-guide-to-healthcare-kaizen/" target="_blank">The Executive Guide to Healthcare Kaizen</a></i>, two of which have been awarded the prestigious Shingo Research Award. He acted as Editor for a fourth anthology book, <i><a href="http://practicinglean.com/" target="_blank">Practicing Lean</a></i>, which contains practical Lean experiences with contributions from many of his colleagues. He has also published a fifth book dedicated to Process Behavior Charts, a book titled <i><a href="http://measuresofsuccessbook.com/" target="_blank">Measures of Success</a></i>. Mark writes a post almost every day for his blog <a href="http://leanblog.org/">leanblog.org</a>. He lectures across the globe, holds popular Lean workshops, hosts webinars, is part of the leadership of <a href="http://www.kainexus.com/" target="_blank">KaiNexus</a>, a software company, is an advocate for patient safety and has a Lean consulting business. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">As if that weren't enough, he took on a “geeky” veterinarian who knew just enough about Lean to be dangerous, and has been such a friend and mentor to me since that fateful day. He has been my co-author for several articles about Lean in veterinary journals, co-presenter for a lecture on Lean in Veterinary Medicine at a Texas state veterinary conference and continues to edit (i.e. make intelligible) my blog posts at leanvets.com. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">In the ancient and honorable Japanese tradition, Mark is truly a sensei; a master and a teacher. <i>Arigato</i>, Mark.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">People often say that they married their soul mates. But, with somewhere around fifty percent of marriages ending in divorce, finding your “true soul mate” evidently takes, at least, two tries. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">That wasn't the case with me. Chris recognized me as soon as she met me! Fortunately, I was aware enough to see the same in her. She was a client of my veterinary practice (imagine that!). Since then she has been my best friend, my wife, my teacher, my guiding light, my sun and my moon. She knows me better than I know myself. Just ask her!</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">But, it is true. She has an old and gentle soul. I often think of her as the Merlin to my Arthur; my guide in the physical and metaphysical worlds. If there was ever a “messenger of God” sent to someone in need, Chris has been that for me. God has indeed blessed me! I love you more!</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">In addition, Chris has given me three of the most wonderful children, Paul, Caitlin and Corinne. They have arrived at adulthood with intelligence, common sense, good hearts and the same gentle soul as their mother. Being a father to this group has, almost, been too easy…almost!</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">For the past seven years my family has indulged my constant obsession with the Toyota Production System and Lean. They have been my de facto sounding boards, proofreaders, editors, “critiquers”, champions and cheer squad. They have learned more about Lean than they ever really wanted to. For this, for their unwavering love and for their perpetual respect, I am truly humbled and so deeply appreciative. Thank you. I love you all.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Chip Ponsford</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Dallas, Texas</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">May 2018</span><br />
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-45971978367354473252018-11-07T15:10:00.001-06:002018-11-11T16:39:23.065-06:00Lean Veterinary Strategy Deployment (Hoshin kanri)<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><i><b>Hoshin kanri</b></i> is a Japanese word for <b>strategy deployment</b>. It literally translates to mean “compass management.” It is the process of introducing and aligning the organization’s <a href="http://www.leanvets.com/2016/12/true-north.html">True North</a> vision down through managers to the frontline staff. It consists of a series of <a href="http://www.leanvets.com/2016/02/pdca-pdsa-cycle.html">PDSA cycles</a> complete with <a href="https://www.leanvets.com/2017/02/preparing-soil.html">consensus building</a> <i>(nemawashi)</i> and playing “catchball” along the way.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">The first PDSA cycle is undertaken among leadership. It is here that the concept of True North is defined along with the four to six (typically) high-level focus areas and their <a href="https://www.leanvets.com/2018/04/process-behavior-charts-better-way-to.html">metrics</a>. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">When looked at as a whole, these few focus areas should completely define your practice. In other words, monitoring the metrics of the focus areas should give you a high-level indication of how the practice is functioning. If these metrics are improving, then the practice should be improving, also. The lower level metrics will compliment these metrics by highlighting the more detailed processes.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">This a true PDSA cycle in that all of the stages (Plan, Do, Study, Adjust) are completed and what is eventually chosen is not written in stone. It is an attempt at alignment; high-level standardized work. It is an experiment. If the True North statement turns out to be inadequate in some respect, then leadership simply adjusts and starts a new cycle. <a href="https://www.leanvets.com/2016/02/a3-reports.html">A3 reports</a> can follow the process in order to keep stakeholders up to speed.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">The second cycle is between leadership (Owners, C-suite, etc.) and supervisors (lead receptionist, lead surgery techs, lead hospital tech, lead groomer, lead boarding tech, etc.). Again, consensus building is of prime interest. This is not the typical management philosophy of “command and control.” It is a typical Lean “bottom-up” endeavor with "catchball" input from leaders. Leadership introduces True North focus areas to the supervisors and, then, mentors and coaches them in order to help them to decide what True North would look like at their level.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">and what processes they'll need to monitor in order to help ensure the top focus are metrics are positive. Again, this may be subject to adjustment after a period of experimentation. A3 reports are kept current.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The third cycle is between the lead staff and the frontline workers. It proceeds similarly to the cycle just described.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">So, what we now have is is an overall alignment of the practice from leadership through lead techs down to frontline staff. How that looks and what metrics are monitored will vary based on the the different areas of the practice. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">For example, we might have a True North focus area of "Processes Improvement." This applies to everyone. However, at the lead and frontline level, the metrics are different between, for instance, receptionists or exam techs or surgery techs, etc. Their metrics will be determined by what that focus area means to them from their perspectives. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">If all of this is successful, then everyone, from leadership to frontline staff, should have a hold on the same rope, on the same end, pulling in the same direction and at the same time...and winning!</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>Mark Graban's 4 Hypotheses of Strategy Deployment</u></b></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Mark has described strategy deployment as a series of four hypotheses in a series of two blog posts - <a href="https://www.leanblog.org/2015/01/strategy-deployment-as-a-series-of-hypotheses-or-predictions-part-1/" target="_blank">here</a> and <a href="https://www.leanblog.org/2016/06/strategy-deployment-as-a-series-of-hypotheses-or-predictions-part-2/" target="_blank">here</a>:</span><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre;"> </span><br />
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<b> </b>1. <b>If we focus our improvement efforts and close performance gaps in our four or five True North areas, we will therefore perform well as an organization, this year and into the future.</b><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">For example, if we choose Client education, Staff development, Community involvement, Fiscal responsibility and Hospital improvement as our five True North focus areas, then we posit that if we are successful in these areas, the practice as a whole will be successful. In other words, these five areas are the best five areas to monitor in order for the overall practice to be successful. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Remember, this is <b><i>your</i></b> True North statement with <b><i>your</i></b> focus areas for <b><i>your</i></b> practice with <b><i>your</i></b> staff and clients.</span> </blockquote>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Is this the right True North? We don't know. But, we will start with these and experiment. If it is determined these are not the best five, we can adjust them and try again. Just like treating our patients. If one diagnosis or treatment is not working, then we “back up" and try again</span></blockquote>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">What are the four or five focus areas that make up your True North and that, if successful, will results in a high probability that the hospital/clinic will be successful overall.</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></blockquote>
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2. <b>If we can improve and close our performance gaps in these key performance indicators, we will satisfy our need for improvement in our key focus areas, and therefore will be successful as an organization, overall.</b></blockquote>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">What are the metrics (two or three per focus area) that will show that our focus areas are heading in the right direction (which, in turn, indicates that the whole practice is headed in the right direction).</span></blockquote>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Are these the right metrics? We don't know, but we'll try them for a while and then evaluate our decision. </span><span style="font-family: "arial" , "helvetica" , sans-serif;">If they are the right metrics, why? If they aren’t, why not? It is important to deeply understand both of these scenarios in order to learn.</span></blockquote>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Are these metrics still relevant to your organization and staff?</span></blockquote>
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<span style="font-family: "times" , "times new roman" , serif;">3.<span style="white-space: pre;"> </span><b>If we actually execute and complete these top X initiatives, projects, events and A3s, then we will make the greatest strides toward closing the key focus areas (Hypothesis 2) and therefore we'll be more successful in our strategy.</b></span></blockquote>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Not everything can be a high priority. It is easy to get sidetracked and pulled off task. You have already prioritized in the last hypothesis. Stay focused. Close the performance gaps in these focus areas in order to get the greatest gains, then you can start over with other focus areas. Err on the side of too few initiatives (so you can actually get something accomplished), rather than too many (and none of them get done or done right). With experience and reflection, you will get more accurate in choosing the number of areas you can tackle without the whole team becoming overburdened. </span></blockquote>
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<span style="font-family: "times" , "times new roman" , serif;">4.<span style="white-space: pre;"> </span><b>We actually have the organizational capacity to complete these top X priorities in a year or a given timeframe (and with the right quality).</b></span></blockquote>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Do we have the capacity in terms of personnel, resources and capital to actually accomplish these priorities in a timely fashion? If not, then either we obtain them or deselect this priority in favor of another one that can be accomplished at this time.</span></blockquote>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Thanks for stopping by. Please mention us to your like-minded friends and colleagues. </span>E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-37132227650413044512018-10-15T11:03:00.000-05:002018-10-25T14:40:59.541-05:00You're invited! ... to help me write the first Lean book devoted to veterinary practice <span style="font-family: "arial" , "helvetica" , sans-serif;">I am ready to start the process of publishing my book on the Toyota Production System, or Lean, for veterinarians and veterinary staff. This process will use Lean methodology, so I invite everyone who is interested to participate by leaving comments and questions as I go forward. This will be the first book about Lean devoted to the veterinary profession.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">I have decided to utilize <a href="http://www.leanpub.com/">leanpub.com</a> for this book. The book will initially be published in multiple e-book formats with, hopefully, a paper version later. Lean.pub uses the Lean mindset of starting small, then iterating quickly and updating frequently based on reader feedback. </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">So, I will start uploading a new chapter every couple of days to a week. At the same time I will update previous chapters and republish them. I will keep everyone updated through LinkedIn and my blog, <a href="http://www.leanvets.com/">www.leanvets.com</a>.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">With leanpub.com, a minimum price and a suggested price are listed. You can get the current version of the book, and all future updates, for either of these prices (or more if you would like for me to get paid more). You decide. At the beginning, the minimum price will be free and suggested price will be $4.99. As more chapters and updates are published, both prices to purchase the book will go up slightly. I anticipate the final suggested price to be around $16.00.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">My plan is to use the majority of any proceeds to go towards the continued teaching of Lean principles through lecturing at professional veterinary conventions and the development of staff workshops. Maybe, one day in the future, we can all come together for an annual Lean Veterinary Summit. </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The book covers the majority of the Lean methodology that I have learned over the years of study and presents it from a diagnosis and treatment perspective that veterinarians and their staff are familiar with. Just as our patients are composed of different systems, have a defined state of health and can develope problems which require an objective methodology of diagnosis and treatment, so, in actuality, do our practices. The chapters are designed to follow the same path we traveled as students in veterinary school and our daily diagnostic methods. With your help, as knowledgable and respected stakeholders in our profession, we will be successful with this new beginning; a new paradigm of veterinary practice management. </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Here is the working Table Of Contents:</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Preface</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Acknowledgements</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Introduction</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Physiology: Some basics</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Systems</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Value</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Customer</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Flow</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Value Stream</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Just In Time</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Push vs Pull</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Health: True North</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Pathology: The 3 “M’s”</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Waste </span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Overburden </span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Variance </span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Physical Exam: Establishing the Current State</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Gemba</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Value Stream Maps</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">The Working Diagnosis: Gaps and Root Cause Analysis </span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Gaps = Problems</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">5 Why Root Cause Analysis </span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Treatment: The Lean “Medical Bag”</span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Eliminate Wastes </span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Standardized Work</span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Kanban</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">5S</span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Visual Management</span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Poka yoke</span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Andon Cord</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Records: A3 Reports</span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Scientific Method</span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">SOAP</span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Deming’s PDCA Cycle</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">A3 Reports</span></div>
</li>
<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Nemawashi</span><span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">: The Importance of Consensus Building</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-style: italic; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Kaizen</span><span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">: The Environment of Continuous Improvement</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Process Behavior Charts: The Voice of the System</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Where To Start</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Continuing Education </span></div>
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<li dir="ltr" style="font-family: Arial; font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; vertical-align: baseline; white-space: pre;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Further Reading</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">On the Web</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">About the Authors </span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">E. E. “Chip” Ponsford, III, DVM</span></div>
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<span style="font-size: 12pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Mark Graban MS, MBA</span><span style="font-size: 12pt; white-space: pre-wrap;"> </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">So, the first step is choosing a title and sub-title so I can get a couple of book covers designed to choose from.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The current leanpub title is</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><span style="font-size: large;"><span style="color: red;">Lean Veterinary Practice Management</span> <a href="http://www.leanpub.com/leanveterinarypracticemanagement">(Click here)</a></span></b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Here are my ideas. Notice I have placed a number in front of each title and a letter in front of each sub-title. I have paired a title with a sub-title, but you are welcome to suggest a different combination in the format #/A to make it easy, or an entirely new idea. </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">(1) <b>A Strategy of Excellence </b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">(A) A Lean Guide For Veterinarians </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">(2) <b>The Lean Veterinary Practice </b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">(B)Higher Quality, Lower Costs, Less Waste, Better Resource Utilization and Greater Staff Engagement </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">(3) <b>Towards <u>Your</u> Ideal Practice </b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">(C) Making <u>Your</u> Veterinary Practice the Best <u>Your </u>Practice </span><span style="font-family: "arial" , "helvetica" , sans-serif;">It Can Be</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">(4) <b>Lean Veterinarians </b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">(D) The New<b> Science</b> of Veterinary Practice Management </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">You can vote by leaving a comment on this post or email me at <a href="mailto:leanvets@aol.com">leanvets@aol.com</a></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Please participate. I value your input, suggestions and questions!</span></div>
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-78853050174626683712018-10-13T14:38:00.000-05:002018-10-15T10:11:23.616-05:00Lean Veterinary Scoreboards <span style="font-family: "arial" , "helvetica" , sans-serif;">In my </span><a href="https://www.leanvets.com/2018/08/management-by-means.html" style="font-family: arial, helvetica, sans-serif;" target="_blank">last post</a><span style="font-family: "arial" , "helvetica" , sans-serif;">, I discussed the difference between Management By Means (MBM) versus Management by Results (MBR). MBR means only focusing on the end result of the metric or KPI (and hoping the means of getting there are efficient and value-adding processes) or focusing on the processes that lead to that result, understanding that if all of the processes are behaving as designed and under control, the end result is a reasonable assumption. Too often with MBR, dollars is the only metric.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">So, I wondered, could it be possible (theoretically speaking only!) to successfully manage a practice without actually measuring any money related metrics? And, what would that look like?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">In other words, without tracking gross income, average client invoice, payroll expense as a percent of gross; any money metric?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;">What non-financial Key Performance Indicators (KPIs) could be used to assure the monetary goals are met? The trick is to be able to identify all (or many) of the processes that are components of the money goals and to assign a metric to adequately monitor those processes.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;">For example, Average Client Transaction is composed of gross income divided by the number of client visits. However, these two components are the result of other systems, such as fees, reminder efficacy, ease of appointments, number of incoming calls that result in a busy signal, hours of operation, client satisfaction, medical record audits (% of services performed that get invoiced) , etc.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Here is a list of some of the non-monetary metrics I came up with in order to manage a veterinary practice:</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Quality </b></span><br />
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<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Door to Doc time</span> </li>
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<li><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;"><span style="white-space: pre-wrap;">T</span>he time from the moment the client enters the practice to the time they see the doctor; a measure of flow and, therefore, value to the client.</span></li>
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<li><span style="font-family: "arial"; white-space: pre-wrap;">Number of unscheduled follow-ups</span><span style="font-family: "arial"; font-size: 11pt; white-space: pre-wrap;"> </span></li>
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<li><span style="font-family: "arial"; font-size: 11pt; white-space: pre-wrap;">The number patients needed to be seen a second ( or more) time in order to get resolution of the pet's condition. Notice this is not scheduled follow-ups for additional treatment, tests or monitoring.</span></li>
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<li><span style="font-family: "arial" , "helvetica" , sans-serif;">% visits scheduled for recall</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">% recalls made</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">Response to 1st reminder</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">Response to 2nd reminder </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">Response to 3rd reminder </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">% pets current on RV (rabies vacs)</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># client surveys returned</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># of client referrals</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">% staff completely cross trained</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">% dogs current on HW (heartworm) prevention</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">% pets current on flea prevention </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">% blood sample hemolysed</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># of blood samples requiring redrawing</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">% of medical rounds performed on time</span></li>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="white-space: pre-wrap;"><b>Morale</b></span></span></div>
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<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># idea (<i><a href="http://www.leanvets.com/2016/02/kaizen.html" target="_blank">kaizen</a></i>) cards submitted</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># idea (<i>kaizen</i>) cards/ staff</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># idea (<i>kaizen) </i>cards completed</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">% idea (kaizen) cards completed</span></li>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="white-space: pre-wrap;"><b>Safety</b></span></span></div>
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<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># staff injuries / time period</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># pet injuries / time period</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># of adverse anesthesia events</span></li>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="white-space: pre-wrap;"><b>Costs</b></span></span></div>
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<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># of drugs or supplies found to be out of stock</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">% blood sample hemolysed</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;"># of blood samples requiring redrawing</span></li>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="white-space: pre-wrap;">Some of these probably have sub-systems or sub-processes that might require monitoring and, thus, metrics of their own.</span></span></div>
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<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"><b>I am not proposing that no financial KPIs be watched.</b> Veterinary practice is a business, after all. Some financial metrics are important and necessary. (However, they shouldn't all be financially focused, either.) Maybe we have not thought about the role that systems, processes, quality, waste, and flow plays in the money numbers; the Lean mindset. Maybe we should not worry as much about the end results and concentrate more on how we get there.</span><br />
<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"><br /></span> <span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">What metrics you decide to monitor is up to you and your staff. Remember, Lean is about making your practice the best "your" practice it can be, not a carbon copy of the practice down the road or on the other side of the country or, even, what a management guru says it should be in order to conform to some cookie cutter model. <u>Your</u> True North and <u>your</u> team (and some experimentation) will decide what metrics are important.</span><br />
<span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"><br /></span> <span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">There would be high level, focus area metrics for leadership to monitor, sub-system metrics that managers would monitor and, still another layer (sub-sub-system) that frontline staff would create. These metrics are all aligned and make up your management scoreboards</span><span style="font-family: "arial"; white-space: pre-wrap;">. Incidentally, this is an example of visual management.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtzP4oylQ2XLXOIhyC4CQ9ZJJWY_BZBtQb_wlXm5wEXAd4aEbWLhAAUPb2_IX_j3rfwRQeIG2jKLOyQYNfjkXq6X794F0DuQnHzVoZPkA8FywyuWP9HqcU3FOwC3lWx_RNgdJH7bVElm0/s1600/Screenshot_20180822-181449_Autodesk+SketchBook.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1580" data-original-width="1207" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtzP4oylQ2XLXOIhyC4CQ9ZJJWY_BZBtQb_wlXm5wEXAd4aEbWLhAAUPb2_IX_j3rfwRQeIG2jKLOyQYNfjkXq6X794F0DuQnHzVoZPkA8FywyuWP9HqcU3FOwC3lWx_RNgdJH7bVElm0/s640/Screenshot_20180822-181449_Autodesk+SketchBook.jpg" width="488" /></a></td></tr>
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<span style="font-family: "arial"; white-space: pre-wrap;">Note that these layers generally flow down from our <a href="https://www.leanvets.com/2016/12/true-north.html" target="_blank">True North</a> statement (they're top down, but there's input from lower levels along the way). Leadership metrics arise from our practice's focus areas. They check the destiny or course of the ship. Are we heading in the right direction?</span><br />
<span style="font-family: "arial"; white-space: pre-wrap;"><br /></span> <span style="font-family: "arial"; white-space: pre-wrap;">The middle and lower level metrics, created by the people responsible for that work (with some input from their leaders), check the systems and processes that make up the focus area (leadership) metrics. Are we getting to our destination with quality, safety, effectiveness and without waste? </span><br />
<span style="font-family: "arial"; white-space: pre-wrap;"><br /></span> <span style="font-family: "arial"; white-space: pre-wrap;">This flow is, in essence, what Lean strategy deployment <i>(hoshin kanri</i>) is all about; getting the ideals of the practice down to the floor (<i>gemba</i>) and aligned throughout the practice. It is everyone pulling the same rope, from the same end, in the same direction and at the same time.</span><br />
<span style="font-family: "arial"; white-space: pre-wrap;"><br /></span> <span style="font-family: "arial"; white-space: pre-wrap;">The routine of management and frontline staff huddling together in a safe, honest and trusting environment every morning to discuss the scoreboards is Lean Daily Management; a topic of later posting.</span><br />
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<span style="font-family: "arial"; font-size: 11pt; white-space: pre-wrap;"> <b>To Order, <a href="https://www.measuresofsuccessbook.com/" target="_blank">Click Here</a></b></span>
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<span style="font-family: "arial"; font-size: 11pt; white-space: pre-wrap;"><br /></span> <span style="font-family: "arial"; white-space: pre-wrap;">Thanks for reading. Comments always welcome. Please, let your friends and colleagues know about the blog.</span><br />
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-88354653335211052982018-08-29T12:34:00.001-05:002018-11-11T16:43:33.707-06:00Management By Means<br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">There are several reasons why some organizations have had difficulty obtaining the kind of results with Lean that Toyota has. One of the main reasons could be that they confuse the use of Lean "tools" with the incorporation of the complete Lean philosophy and mindset deep into their DNA.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Take, for example, the difference between Management By Means (MBM) and Management By Results (MBR), also known as Management By Objective (MBO).</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">With MBR/MBO, management sets the goals (usually financial) for the metrics. The objective of the organization is to reach the goal, without much attention to the processes or methods involved. Leaders might say things like, "I don't care how you get the results, just get it done, no matter what." Pay incentives or threats of dismissal often can, at different times, be part of the conversations and scenarios. </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Look at the <a href="https://www.leanvets.com/2018/04/process-behavior-charts-better-way-to.html" target="_blank">Process Behavior Chart </a> below, which shows only the last data point (for a metric where higher is better). </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">This is typical top-down management, which is common in the West. Workers do whatever they feel necessary in order to arrive at the goal by the deadline set by the forces that be. The method or means of getting there is a distant second concern. The focus is the end result.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">One of the problems with this approach, as seen below, is that the systems and processes, if they were exposed, may be riddled with errors, defects and/or fraud (ala <a href="https://www.leanblog.org/2016/09/some-reading-on-the-wells-fargo-scandal-and-mismanagement/" target="_blank">Wells Fargo</a>). There is a lot of variation which implies the systems and processes are not as tight as they could be. In addition, notice there is a recurring pattern to the data-- three weeks of down data followed a an up data. This very well could indicate that, for three week every month, the employees not hitting there number until the week before monthly reports come out. If the reports only show the ending point for the current month, leadership is happy (and leaves the staff alone!) </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><i>MBR is similar to trying drive by looking in the rearview mirror. </i></b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Workers have no control over systems. They are at the mercy of systems, good or bad. It is management or leadership that is responsible for the system in place. As such, if results are not predicted to be good, then the only pragmatic way they can affect the result, and not be disciplined, is to "fudge" the system somehow. </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">In a bad system, no amount of motivational rhetoric, monetary prizes or threats is going to change the system. The system gets changed by the "uppity ups" changing the system. An object in motion tends to stay in motion in the same direction unless some external force is applied to the system. That isn't part of the job description (or domain) of workers.</span></div>
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<span style="font-size: large;"><b>MBR is managing the results</b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">By contrast, MBM is focused on the processes and systems ("the means") that lead to the results ("the ends"). The metrics of MBM monitor the systems involved. The idea is that if all of the processes are stable and positive, then the results are a foregone conclusion. It is much more of a bottom-up </span><span style="font-family: "arial" , "helvetica" , sans-serif;">style of management since the staff is much more involved in choosing the metrics and monitoring the day to day functioning of the organization. The journey is as important as the destination.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">In the graphic above, we really don't need to see the final result (below) to have a reliable expectation that it will be where it needs to be. In addition, we know that our systems and processes are probably functioning properly and free of waste. While there is some variation, they appear to be under control. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">(Notice that three out of the last four data points are closer to the upper limit, which indicates that the system has changed for the better; improved. If we do know why this has occurred, we need to investigate in order to understand how to continue this trend.)</span><br />
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<span style="font-size: large;"><b>MBM is managing the processes; the operations</b></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">This is the management style of Toyota and promoted by Lean. People often say, "The right process brings the right results." We care about results... but you manage a process, not the results.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Lean is all about objective systems thinking!</b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">I will continue with the next idea in this theme in my next blog "The Practice Scoreboard."</span><br />
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-16339483816391224252018-06-23T20:08:00.000-05:002018-06-23T20:10:43.011-05:00A "Supersize" Father's Day<div dir="ltr" id="docs-internal-guid-db1c6fc4-2f4b-169f-5d8d-d939d975207e" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">I’m taking a little break from my usual Lean topics this time around for a little pet fun.</span></span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Let me introduce you to “Supersize”. “Supersize” is a nine or ten year old, steel blue, neutered male, short haired cat. We obtained him from my mother-in-law when he was just a kitten. Ever since he has been my “best cat buddy” and has trained me well. Every night, around 8:30, “Supersize” starts meowing at me to let me know he is ready for bed and that I need to lay down so he can crawl next to me and go to sleep. Typical cat; always thinking they are in charge (which they are!) and bossing everyone around.</span></span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Several years back, I was trying sleep in late one Sunday morning, when I heard a lot of commotion out in the kitchen and could smell the pleasing aroma of fresh coffee brewing. I looked to the other side of the bed to see if my wife had woken up early. She had not. There she laid, sound asleep. So, who could be up at this time of morning making coffee? I went to investigate and this is what I found…</span></span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">It was “Supersize” relaxing in the recliner with some fresh ‘joe’ in his favorite cup.</span></span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">But, I was even more surprised this past Father’s Day, when I found the gift below packaged in an appropriate gift bag.</span></span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">And, he even signed It.</span></span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">What is really impressive, however, is that he ordered it himself on the internet.</span></span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">I didn’t even know he had a credit card!!</span></span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Thanks for reading.</span></span></div>
E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-57986507821716218472018-06-03T11:17:00.000-05:002018-06-03T15:36:37.740-05:00The Law of Interconnected Waste<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">I have been reading (re-reading) <a href="https://www.amazon.com/Lean-Daily-Management-Healthcare-Implementing/dp/1498758983" target="_blank">Lean Daily Management for Healthcare</a> by Brad White. I was very impressed by the book the first time through, and am learning even more this time. This excerpt from the book concerns the relationships between waste, value, your staff and financial rewards. Thank you Brad for permission to post this material.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">This law states that all the process waste of an organization manifests itself in three ways: </span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">1. Reduced value to the customer </span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">2. Reduced satisfaction to the employee </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">3. Reduced profit to the company </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">This law offers some very powerful results from attacking waste. First, one of the best ways to increase value and quality is not to spend more money but rather to eliminate the waste and friction in your processes that sap value during production. Second, eliminating process waste will increase profits by reducing expenses. (</span><span style="font-family: "arial" , "helvetica" , sans-serif;">There may very well be an increase in demand and quality. That, though, is more of a marketing issue. The key observation here is that it costs money to produce waste. Any reduction in that waste results in less money that is spent on producing it.) </span><span style="font-family: "arial" , "helvetica" , sans-serif;">Third, reducing process waste will increase the happiness of employees. This final point is vitally important to the success of a Lean management system.</span></span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><b>The Law of Interconnected Waste</b></span></td></tr>
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<span style="font-size: large;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Taken together, these three points reveal that there is natural alignment among employees, patients, and finances. We can leverage this natural alignment by tapping in to the current frustrations that our people have regarding the workplace. Thus, one of the best places to start when seeking to eliminate waste is to simply ask your staff. </span></span><br />
<span style="font-size: large;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><i style="font-family: Arial, Helvetica, sans-serif;">What frustrates you about your job? </i></span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Any frustration they have about the daily operation of their job will invariably lead back to a process waste that impacts patients and drains resources. The management system you build will be able to take these raw frustrations, convert them into hard metrics, and then use the scientific PDSA problemsolving to drill down to the root cause. </span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">This is the secret to gaining employee buy-in. By tapping in to the simple fact that people prefer to do the job that they were hired to do, and that, all else being equal, they prefer to do it well as opposed to poorly, you can leverage their expertise to sniff out waste from the bottom up. Also, because your staff are constantly connected to the customers, they will naturally steer the organization back toward a customer-centric model because, like a horse that naturally follows the path since walking is easier, they prefer to be highly productive with lots of patient contact because that is why they entered the field in the first place.</span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>FYI: I am writing a book!</b></span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">I am writing a book explaining the Lean mindset and processes from a veterinary perspective (the first of its kind!). In it, I will be emphasizing the similarities between the scientific methods of diagnosising a pet with a disease and scientific methods of using Lean to fix veterinary practice dis-ease. I am very excited to share this information, especially with my colleagues and profession. Stay tuned for updates .</span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Thank you for stopping by. Please tell your friends about this blog. Remember, comments are always welcome.</span></span>E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-40853231908056060752018-05-04T14:05:00.000-05:002018-05-04T14:05:30.674-05:00Andon Cords and Practice Environmentalism <div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">One of the innovations that Toyota put in place on their assembly lines is the "Andon Cord." </span><br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">As the picture below illustrates, it is an actual cord (or button) that any worker can pull, which then sounds an alarm and even stops the production line if the problem cannot be resolved quickly. The alarm (blinking lights and chimes) immediately brings (to the gemba) the team leader (supervisor) to address the problem and mutually decide how to fix the issue in real time. If there are recurring problems, the team leader would then help with root cause analysis. This is important so that the same "fires" aren't being put out over and over. </span></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">This demonstrates several basic precepts of the Lean philosophy. One, quality is built into the processes. Two, quality (and safety) is part of everyone’s job description. Three, problems are handled where and when they occur. And, four, creating and maintaining an environment of respect and mutual trust between the workers and the leaders.</span><br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Now, I am not suggesting that physical ropes be hung throughout the practice, or that alarm buttons be placed in every room. Although, a practice I worked for used a software management program that dedicated one the Function keys so, if pushed, it would alert all of the other computer stations that help was needed in the room where the key was activated. </span><br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">What I am suggesting, however, is more metaphorical. Our practices need to be a place where anyone feels comfortable speaking up and symbolically "pulling the Andon cord!"</span><br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Lean, as much as anything else, is a culture. It is a culture that allows for mistakes and defects to be brought to management and other staff without fear of embarrassment or retaliation. And, to be handled by everyone with a stake in the process. Nothing else about Lean will ever have a chance without this concept being firmly in place and fiercely protected. </span><br />
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">I know of a case where a young veterinarian mistakenly amputated the healthy leg of a dog, despite being informed by the surgery techs prior to surgery that this was about to happen. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">This veterinarian, however, had very little respect for the staff and had created an environment around her of intimidation and fear. The staff did not feel comfortable in stopping the surgery (pulling the proverbial andon cord) when the patient was prepped incorrectly and placed on the surgery table with the improper limb draped in order to verify if it was the correct leg to remove and everyone was on the same page.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Leadership and management are the practice “environmentalists”; protecting the practice environment from all “trash and pollution", such as egos, jealousy, fear, detrimental internal competition, etc.</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br class="kix-line-break" /></span><br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Thanks for participating. Please follow us. Comments and questions always welcome.</span></div>
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<span style="font-family: "syncopate"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Hear ye! Hear ye!</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> </span><br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Please mark your calendars for Monday, May 7th at 1:00pm ET when I will be giving a webinar for KaiNexus with host Mark Graban. The title of the webinar is:</span></div>
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<span style="font-family: "arial"; font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">From Pets to Vets: Applying Lean In Unexpected Places</span></div>
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<span style="font-family: "arial"; font-size: 10pt; vertical-align: baseline; white-space: pre-wrap;">Please join us! You can register <a href="https://info.kainexus.com/improvement-disciplines/lean/lean-in-unexpected-places/webinar/signup" target="_blank">here</a></span><span style="font-family: "arial"; font-size: 10pt; vertical-align: baseline; white-space: pre-wrap;">. </span><br />
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<span style="font-family: "arial"; font-size: 10pt; vertical-align: baseline; white-space: pre-wrap;">and you check out a <a href="https://www.leanblog.org/2018/05/from-pets-to-vets-applying-lean-in-unexpected-places-webinar-preview/" target="_blank">preview of the webinar here</a>. </span></div>
E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-78188206571857552402018-04-30T20:38:00.001-05:002018-05-03T05:24:56.650-05:00Podcast Preview of the Upcoming Webinar on "Pets and Vets"<br />
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Hi, Mark Graban here... I'm happy that Chip is going to be doing a webinar on Monday, May 7 that's hosted by me and KaiNexus.<br />
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You can register here:<br />
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<a href="https://info.kainexus.com/improvement-disciplines/lean/lean-in-unexpected-places/webinar/signup" target="_blank"><b>Pets and Vets: Applying Lean in Unexpected Places</b></a><br />
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If you can't attend live, at 1 pm ET that day, register anyway and you'll be sent a recording and the slides.<br />
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Monday, I interviewed Chip in a preview of the webinar... you can listen below:<br />
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<iframe allowfullscreen="" frameborder="0" height="100" src="//www.hipcast.com/podcast/Hhdd7ccP?embed=1" width="100%"></iframe><br />
<a href="https://www.kainexus.com/continuous-improvement/resources-for-continuous-improvement/continuous-improvement-podcast" target="_blank"><br /></a> <a href="https://www.kainexus.com/continuous-improvement/resources-for-continuous-improvement/continuous-improvement-podcast" target="_blank">Click here to learn more about the podcast series and for more info about how to subscribe</a>.<br />
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You can also <a href="https://www.leanblog.org/2018/05/from-pets-to-vets-applying-lean-in-unexpected-places-webinar-preview/" target="_blank">read a transcript of the conversation on my blog, LeanBlog.org</a>.<br />
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We hope you enjoy the podcast and the webinar.Mark Grabanhttp://www.blogger.com/profile/07953086531083611251noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-33207579191402992202018-04-23T22:10:00.000-05:002018-04-23T22:10:22.449-05:00Error Proofing vs Fool Proofing<span style="font-family: "arial" , "helvetica" , sans-serif;">This blog post is about a Lean concept that I have wanted to share with you for awhile. It concerns the idea of error proofing or mistake proofing (<a href="https://en.wikipedia.org/wiki/Poka-yoke" target="_blank">poka-yoke</a>). </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">There is another similar term, baka-yoke, which translates as "fool proofing." </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Toyota prefers the former term because it is less derogatory and more respectful of the worker. It shows a systems mindset. It reflects Lean’s focus on “how” and “why” an error or defect occurred rather than “who is to blame.”</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">When I first graduated vet school in 1980, I purchased a personal computer (anyone remember Radio Shack’s TRS-80?) and started to learn programming. I was interested in writing small programs that would make my work easier. Eventually, I wrote a management program for my practice.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">As part of the programming, it was necessary to identify proper data input by the user, so that the software would run as designed and not “crash.” If input errors were found, the user would be notified of the problem and asked to re-enter in the proper format.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">For example, if the user was asked to enter a telephone number using the format <b>(###) ###-####</b>, I would have to write a section of code to check for proper input.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">1.<span style="white-space: pre;"> </span>Are all the characters entered either a number, a “(“, a “)” or a “-“?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">2.<span style="white-space: pre;"> </span>Were a total of 14 characters entered, including parentheses, spaces and dashes?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">3.<span style="white-space: pre;"> </span>Was the first character entered a “(“?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">4.<span style="white-space: pre;"> </span>Was the fifth character entered a “)”?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">5.<span style="white-space: pre;"> </span>Was the sixth character entered a space?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">6.<span style="white-space: pre;"> </span>Was the tenth character entered a “-“?</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">A similar set of programming code was required each and every time input was requested from the user-- very time consuming and added tremendously to the length of the program. But, GIGO (Garbage In, Garbage Out), and nobody wants that!</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">We can see this same idea in use all around us-- from simple warning signs to designs that make errors difficult or impossible. A three-pronged plug can only be plugged into a wall socket one way.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">In general, there are five levels of error proofing, as explained by <a href="http://www.markgraban.com/" target="_blank">Mark Graban</a> when he teaches Lean.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLWH8UMez0GbErWD3uLGkN7Bu0rx_ZVruHQS5osLp1x2EMbzlgDaGpwXrrcuxHkVOsrYhKtEuh1BX_v3304Q0TsewE0Ws7gPuJ9Uuvdpdm2aYEz56uQKVg1Hnt6CTxJWex5BEz8WMJ-Fc/s1600/20180423_121047.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="847" data-original-width="1144" height="295" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLWH8UMez0GbErWD3uLGkN7Bu0rx_ZVruHQS5osLp1x2EMbzlgDaGpwXrrcuxHkVOsrYhKtEuh1BX_v3304Q0TsewE0Ws7gPuJ9Uuvdpdm2aYEz56uQKVg1Hnt6CTxJWex5BEz8WMJ-Fc/s400/20180423_121047.png" width="400" /></a></div>
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<span style="font-size: xx-small;">Graphic courtesy of Mark Graban</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">As the graphic indicates, simply posting a sign admonishing workers to “Be careful” is the least effective. Making it impossible to make an error in the first place is the most effective means.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifgaRaaRYvUl2AlIPFcJiDJLtKnu7lGBvvqsK2uOE9_H43vBdZ7xjSnixDPOe65UN2bvHqIjfqmm9s72p0yWG8lse_argjop7ik1KXkLnMBOGffZ3lBwitfXSOSOlFsCWr6kNtzAi7pts/s1600/20180423_165959.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="769" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifgaRaaRYvUl2AlIPFcJiDJLtKnu7lGBvvqsK2uOE9_H43vBdZ7xjSnixDPOe65UN2bvHqIjfqmm9s72p0yWG8lse_argjop7ik1KXkLnMBOGffZ3lBwitfXSOSOlFsCWr6kNtzAi7pts/s320/20180423_165959.png" width="230" /></a></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">In the above pictures, the hospital gas panel has two ways of error proofing. First, the different hookups are color coded as a visual measure to indicate which gas hose goes to which port. Secondly, the pins of the hookup will only connect and lock with the appropriate gas port. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Idexx has error proofed their VetTest blood test slides by designing them with strategically placed notches on the edges. With this design, the slides can only be placed in the analyzer in the proper orientation.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">The file folder color coded end tabs do not prevent misfiled folders, but it illustrates the error proofing concept of making the error easier to detect.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDOkVN1s0VEOU43Fu7GTEfx_M5AmzLpOKP3wO4uLqiuuVazdQ02J-GZDsSmKh1uGXybM7PDeBYXB4m6CflhDMNKWFWG2Hqqa7xn9lxRTB0ap8v2Jxm-sgk2KWMyqeXX6q8doXb6uWq4t0/s1600/20170309_073854%25281%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1600" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDOkVN1s0VEOU43Fu7GTEfx_M5AmzLpOKP3wO4uLqiuuVazdQ02J-GZDsSmKh1uGXybM7PDeBYXB4m6CflhDMNKWFWG2Hqqa7xn9lxRTB0ap8v2Jxm-sgk2KWMyqeXX6q8doXb6uWq4t0/s320/20170309_073854%25281%2529.jpg" width="320" /></a></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">This is an illustration of just how ineffective warning signs are. If management really wanted to control the light in the closet, maybe a motion sensing light fixture would be a better option. The light would come on when someone walked in, but would then automatically turn off shortly after the individual left. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">This next photo is something that a client of Mark Graban's shared with him years ago. Mark's not sure of the origins, but the tracks in the snow show how easy it was for somebody to just drive around the gate in the road. This wasn't error proofed (and maybe the gate was broken or not needed anyway).</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiOKkY-Oe2tRIJtfHTTAJlthWGYgjwmxgVLbffrELryk-7XBLzKduIGS0BlMtv4XBB4FmVRNNz0OaXQ48tlA3NUJH4tSxSvqCIZFmSL7N4dVb8lOU-HAXP8jMAbOsxQGF-J0d3VaG-fgw/s1600/20180423_174501.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1073" data-original-width="982" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiOKkY-Oe2tRIJtfHTTAJlthWGYgjwmxgVLbffrELryk-7XBLzKduIGS0BlMtv4XBB4FmVRNNz0OaXQ48tlA3NUJH4tSxSvqCIZFmSL7N4dVb8lOU-HAXP8jMAbOsxQGF-J0d3VaG-fgw/s320/20180423_174501.png" width="291" /></a></div>
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<span style="font-size: xx-small;">Photo courtesy of Mark Graban</span></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Of course, sometimes…where there is a will, there is a way! What are you going to do?!?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;">Thanks for participating in this blog. Please follow us and tell your friends about this site.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span> <span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="background-color: white; color: #666666; font-family: inherit; font-size: 13.2px;"><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><b>Heads up!</b> I will be the guest presenter on a webinar series hosted by Mark Graban and KaiNexus on May 7th at 12:00 noon Central time. We will be discussing the new emergence of Lean management in veterinary medicine. Use this </span><a href="https://hubs.ly/H0bvsK20" style="color: #888888; text-decoration-line: none;"><span style="color: #1155cc; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">link</span></a><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">. Hope you will join us!</span></span><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 13.2px;" /><span style="background-color: white; color: #666666; font-family: inherit; font-size: 13.2px;"><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span></span></span><br />
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E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0tag:blogger.com,1999:blog-5918947962321933850.post-27806110470290051002018-04-01T21:36:00.002-05:002019-07-24T17:15:29.206-05:00Process Behavior Charts: A Better Way to Evaluate Your KPIs<div dir="ltr" id="docs-internal-guid-5e9d86c8-8212-af84-e729-05e7eb4f3fd0" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Have you ever learned something new and thought, ”Gosh! If I had had only known this years ago, my life would have been so much easier!”? We all have, I suspect. What I'm writing about in this post falls into that category.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">I remember owning my practice. I dutifully kept stats on everything I could think of:</span><br />
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<li><span style="font-family: inherit;">Gross income, </span></li>
<li><span style="font-family: inherit;">number of new clients, </span></li>
<li><span style="font-family: inherit;">average invoice total, </span></li>
<li><span style="font-family: inherit;">number of dentals or spays or neuters, etc. </span></li>
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<span style="font-family: inherit;"><span style="font-size: 11pt; white-space: pre-wrap;">I would even plot them on charts and tape them to wall of my office like a war room, constantly watching the numbers and </span>bouncing<span style="font-size: 11pt; white-space: pre-wrap;"> emotionally between feelings of “we made it through another period in good shape” and “oh sh*t, we’re down, and this must be the beginning of the end.”</span></span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">The same sort of thing happened when I worked for a corporate practice. Every week, the practice manager (PM) and I were on a conference call with our area managers to discuss “the numbers” -- our KPIs (key performance indicators) -- whether we were achieving our benchmarks, by comparing them to last month, last quarter or last year, and why or, more importantly, why not. Same emotional rollercoaster. </span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Now, for the stuff I wish I’d known back then. I recently read a book called <a href="https://amzn.to/2H48Ho7" target="_blank"><i>Understanding Variation: The Key to Managing Chaos 2nd Ed</i>.</a>, by Donald J. Wheeler, at the recommendation of my co-blogger <a href="http://www.markgraban.com/" target="_blank">Mark Graban</a>. It is a fun little book about some statistics (there is that ‘S’ word) and creating Process Behavior Charts (PBC).</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">You know that in any process or system there is going to be some amount of variation from period to period. When this is plotted on a chart, it shows up as “ups” and “downs.” Most of this is normal, it is just “noise.” But, sometimes it can mean something significant -- a “signal.” So, how do you tell the difference? By turning your data into PBCs. This way of plotting your data will “filter” out the noise and highlight any “signals.”</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">I encourage you to <a href="https://amzn.to/2H48Ho7" target="_blank">read the book</a> as there is more than I can briefly blog about, but, having said that, let me share some points before we get into the charts.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Tables with lists of numbers are difficult to understand. There is no context, and the data is difficult to visualize in this format.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Line graphs, over a longer period of time, are easier to understand and put the data in some form of continuity and context with prior periods.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Comparing two data points, such as the current period data with the same data last month or last year, doesn't offer any context. Who says the data from last period was normal? Maybe, it was a really bad period due to extraneous influences, e.g. inflation or a natural disaster that occurred at that time.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Averages tend to be pretty much in the middle of a range of data. Comparing to averages tends to create “binary output.” You are either above average (“good”), or you are below average (“bad”).</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">The setting of arbitrary goals, such as a 10% increase over last period, becomes more objective and rational. It is well and good to set the goal, but if the system cannot produce to that degree, it is simply a futile “wish.” No manner of cajoling, incentivizing or threatening employees is going to help. If the goal is outside the limits, then the system is going to have to be changed from what it is right now, and employees have no control over the systems under which they operate. That is management’s domain.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">PBCs are the voice of the system. They show how the system is functioning, and the extents to which the system can function, as it is now designed and operating. One can also assume that, without any change, the system will continue into the future as it is currently; it is predictable. If it is not where it should be, then the system has to be changed somehow. It also shows when a data is outside the limits of the system and, therefore, is a signal that something unusual has happened, and it needs to be investigated.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">The following data represents the number of new clients seen per month over the last 18 months.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">18, 16, 14, 19, 15, 17, 16, 18, 15, 14, 19, 18, 15, 18, 18, 17, 19, 11</span><br />
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Total = 297 Average = 16.5</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">When just looking at a list of numbers, it is difficult to really appreciate what is going on with the data. In this form, one might easily miss the value of the last data point.</span><br />
<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<span style="font-family: inherit;">Converting the raw data into a graph is more visually helpful.</span><br />
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<span style="font-family: inherit; font-size: 11pt; margin-left: 1em; margin-right: 1em; vertical-align: baseline; white-space: pre-wrap;"><img height="223" src="https://lh4.googleusercontent.com/vgcLPe0LIFtnlIQfkRqhR0zTxaUN3r2sdgbb2w32pTXiqddVwGqjED_BdLakT9BSomx4VdiswBpxqPN2_RbZjNRayDzb655--xD911c4fsbgRLlAyB36h0UkTiQZszn3b1zK6Ntb" style="border: none; transform: rotate(0rad);" width="449" /></span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">You can see that this running graph (or X-chart) is easier to understand and gives better context to the table of numbers.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">This appears to be a rather stable system (or process) until, possibly we get to the 18th and last data point. Is this part of the normal “noise” or do we need to investigatte? It is lower than any prior period we have recorded. I can tell you that, for me, this would have been good for at least a week of sleepless nights and two stupid, stress related arguments with my wife!</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Continuing with the chart methodology, we next determine the Moving Range (mR), between each two successive data points. This distance is always a positive number, regardless of whether the first number is larger or smaller than the first. For example, the distance between -3 and 2 is 5, or the distance between 8 and 4 (or 4 and 8) is 4.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">By comparing the first data to the second, the second data to the third, the third data to fourth, etc., we get the following table:</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">2, 2, 5, 4, 2, 1, 2, 3,1, 5, 1, 3, 3, 0, 1, 2, 8</span><br />
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Total = 45 Average MR = 2.53</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Graphically:</span></div>
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<span style="font-family: inherit; font-size: 11pt; margin-left: 1em; margin-right: 1em; vertical-align: baseline; white-space: pre-wrap;"><img height="177" src="https://lh4.googleusercontent.com/uxxewHvDLcYXvj_TS2p4m1mlbMFArWNjeoz0RkHiaPXtVmEB3J9mQBKVJGr0hNGmWUmxkgmH8boC37q2TlukmEbUj3WxuXkyDIqAL2C8gsrEBvj3SePI-c8OVyrN3ll6C-mRIAKs" style="border: none; transform: rotate(0rad);" width="400" /></span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">To see if the variation in the X chart is all routine or if there's something exceptional going on in that last data, we then complete the X-chart by calculating and drawing the average, an Upper Control Limit (UCL) and a Lower Control Limit(LCL). These are calculated as follows:</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="font-family: inherit;"><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Avg</span><span style="font-size: 8pt; vertical-align: baseline; white-space: pre-wrap;">x</span><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">= Total</span><span style="font-size: 8pt; vertical-align: baseline; white-space: pre-wrap;">x</span><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">/#</span><span style="font-size: 8pt; vertical-align: baseline; white-space: pre-wrap;">x</span></span></div>
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<span style="font-family: inherit;"><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">UCL= Avg</span><span style="font-size: 8pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">x</span><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">+(2.66×Avg</span><span style="font-size: 8pt; vertical-align: baseline; white-space: pre-wrap;">mR</span><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">) </span><span style="font-size: 10pt; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">= 16.5+(2.66×2.53) = 23.54</span></span></div>
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<span style="font-family: inherit;"><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"> LCL= Avg</span><span style="font-size: 8pt; vertical-align: baseline; white-space: pre-wrap;">x</span><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">-(2.66×Avg</span><span style="font-size: 8pt; vertical-align: baseline; white-space: pre-wrap;">mR</span><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">) </span><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">= 16.5-(2.66×2.53) = 9.46</span></span></div>
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<span style="font-family: inherit; font-size: 10pt; vertical-align: baseline; white-space: pre-wrap;">Note: The 2.66 is a conversion factor that approximates three standard deviations (but we don't calculate a standard deviation in this methodology).</span></div>
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<span style="font-family: inherit;"><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Updating</span><span style="font-size: 10pt; vertical-align: baseline; white-space: pre-wrap;"> the X-chart:</span></span><br />
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<span style="font-family: inherit; font-size: 10pt; margin-left: 1em; margin-right: 1em; vertical-align: baseline; white-space: pre-wrap;"><img height="266" src="https://lh4.googleusercontent.com/kjxQ3dbCsAZGU8G7E_bOb8Tv0iG9A70tOoJ0lhcc1CQelqqb35FLcZfaciay86RoPEfWlNLy0vPYfasIZBtlLKQxg9OGIqX7T9DloxA9UU5404uaqNx2_4-MBK7gli7WBJ81vxr2" style="border: none; transform: rotate(0rad);" width="608" /></span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">To complete the mR chart we need to calculate the Upper Range Limit, as follows:</span></div>
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<span style="font-family: inherit;"><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Upper Range Limit = Avg</span><span style="font-size: 8pt; vertical-align: baseline; white-space: pre-wrap;">mR</span><span style="font-size: 14pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">×3.27 </span><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"> = 2.53×3.27 = 8.66</span></span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Note: The Lower Range Limit is always zero, since the variances can never be a negative number.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Updating the mR chart: </span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><img height="292" src="https://lh6.googleusercontent.com/wVcps6MI2bUTu4INeFCzAvivmFxwfpsRs3IDgdRn-LnooG_O0_29brgfUqz-5rtPJeq0FPa82NrfhvdjIcB5rz3hrURtRQSN0tiUYc-s9y-Ebu3VpFV3BprtQdX2fXXiEdWt4EKm" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="599" /></span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Together, these two graphs make up an XmR chart or Process Behavior Chart.</span></div>
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Looking at the XmR charts, we can see that the last data point is still within our calculated limits. This indicates that the data is just “noise.” It is just part of the normal variation for this system or process, as it is currently designed. </span><br />
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<span style="font-family: inherit; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">That said, if we're uphappy with the average level of performance, we could try to improve the system in a systematic way. </span><span style="font-family: inherit; font-size: 11pt; white-space: pre-wrap;">There's nothing worth investigating in terms of a reactive question like "what went wrong that month?"</span><br />
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<span style="font-size: 14.6667px; white-space: pre-wrap;">The first hint of a "signal" would be any single data point above the upper limit or below the lower limit.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6cxdvw8GX5vERNuECGUWJOIcvsIIjKjgiNsPv_dwd57jgwoYrMvsGS65JbpdDQ08fLxp4ILIdTeDK2oXs7KwZZ6GmdW6jeklGKg6K_fbxAr4MTvDYC4rtW2EfDOki_7hlUB6XJ4_e2z0/s1600/Screenshot_20180401-164251.png" imageanchor="1" style="clear: right; display: inline !important; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><span style="font-family: inherit;"><img border="0" data-original-height="378" data-original-width="973" height="77" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6cxdvw8GX5vERNuECGUWJOIcvsIIjKjgiNsPv_dwd57jgwoYrMvsGS65JbpdDQ08fLxp4ILIdTeDK2oXs7KwZZ6GmdW6jeklGKg6K_fbxAr4MTvDYC4rtW2EfDOki_7hlUB6XJ4_e2z0/s200/Screenshot_20180401-164251.png" width="200" /></span></a><span style="font-family: inherit;"><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Wheeler’s book gives much more information about the meaning of the charts and some other types of “signals” to be aware of such as:</span><span style="font-size: 11pt; white-space: pre-wrap;"> 3 out of 3 or 3 out of 4 data points being closer to one of the limits, </span></span><br />
<span style="font-family: inherit;"><span style="font-size: 11pt; white-space: pre-wrap;"><br /></span> <span style="font-size: 11pt; white-space: pre-wrap;">or </span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhY1yhwFFEnMpmf5DTB6uCAsmkNN6Cv-wfMh-0uUv1XDoWOpUFuTFqLnSRateoudA26wasRC8sA9qj8JsPhfYsRBdfag-JvO5E5j0tCGKcE59twd2Jv6rCIHese7M2hM8QeZOonQ_tfj_s/s1600/Screenshot_20180401-164530.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: inherit;"><img border="0" data-original-height="386" data-original-width="1002" height="76" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhY1yhwFFEnMpmf5DTB6uCAsmkNN6Cv-wfMh-0uUv1XDoWOpUFuTFqLnSRateoudA26wasRC8sA9qj8JsPhfYsRBdfag-JvO5E5j0tCGKcE59twd2Jv6rCIHese7M2hM8QeZOonQ_tfj_s/s200/Screenshot_20180401-164530.png" width="200" /></span></a></div>
<span style="font-family: inherit;"><span style="font-size: 11pt; white-space: pre-wrap;"><br /></span> <span style="font-size: 11pt; white-space: pre-wrap;">a run of eight or more consecutive data points being on one side or the other of the central line </span><span style="font-size: 11pt; white-space: pre-wrap;">are interpreted as being a “signal.” </span></span></div>
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<span style="font-family: inherit;"><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span> <span style="font-size: 11pt; white-space: pre-wrap;">Mark Graban is currently writing a </span><a href="https://www.markgraban.com/measures-of-success/" style="font-size: 11pt; white-space: pre-wrap;" target="_blank">book</a><span style="font-size: 11pt; white-space: pre-wrap;"> on this material. It should be completed by June, but you can buy the first three chapters now through his use of the "Lean Publishing" approach. All of Mark’s books are “Top Class.”</span></span></div>
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<span style="font-family: inherit;"><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><b>Heads up!</b> I will be the guest on a webinar hosted by Mark Graban and KaiNexus on May 7th at 12:00 noon Central time. We will be discussing the new emergence of Lean management in veterinary medicine. Use this </span><a href="https://hubs.ly/H0bvsK20" style="text-decoration-line: none;"><span style="color: #1155cc; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">link</span></a><span style="font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">. Hope you will join us!</span></span><br />
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<span style="font-size: 14.6667px; white-space: pre-wrap;"><b>Update 4/4/18</b>: Watch Mark Graban talk about this material <a href="https://youtu.be/wh1WhHcsNz8" target="_blank">here</a>.</span><br />
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<span style="font-family: inherit; font-size: 11pt; white-space: pre-wrap;">Thanks for reading. Tell your friends and colleagues and, as always, comments welcomed.</span></div>
E. E. (Chip) Ponsford, III, DVMhttp://www.blogger.com/profile/03141046736662233236noreply@blogger.com0