Monday, November 16, 2015

Some Basic Concepts

As consumers, we all have had those epic experiences with call centers, auto repair shops, plumbers, etc. Why can they not see the consumer’s point of view? Yet, back in our practices, our “provider hats” go on, and we, too, fail to consider what our clients have to deal with. In Lean, the perspective of the consumer is the priority.

One of the goals of Lean is perfection. The book Lean Thinking talks about the “continuous pursuit of perfection” (and that also might remind you of a Lexus ad slogan). We know we will most likely never get to that point of absolute perfection, but we continually try, working toward an ideal state of safety, quality, waiting times, customer satisfaction, and other meaningful measures. Just as repeatedly dividing one in half will never get us to zero, it does get us darn close. If we can eliminate 50% of waste with each attempt, then after only 5 iterations, we have removed 96.875%. That’s not perfect, but really, really close (and more importantly, far better than our starting point). With just two more iterations, we get to 99.21875%. That's really, really, really close! The Lean mindset of continuous improvement drives us to solve problems that matter and to keep working at it. Think of how to do it, not why it cannot be done.

Try to keep an open mind. Lean is not particularly difficult to understand in concept, but it is different… and it can be difficult to change an organization of any size. Discard conventional thinking. It has proven itself over and over in every company and industry that has embraced it as a complete package and given it an honest trial, practicing Lean over time. We believe the same will occur in the veterinary medicine setting.

Nothing is written in stone. Lean is about experimenting in order to deeply understand and improve. But, if that doesn't happen, we can learn from it, adjust and try again. "Best medicine does not equal absolutely correct. In school, they told us that 80% of what we were learning would be proven wrong. We just didn't know which 80%. It's the same way with best management practices. Keep iterating.

Lean takes a systems approach to management. It tends to blame faulty systems rather than people. Systems are the responsibility of management, not the workers. Workers are at the mercy of systems, and systems can be very complicated with strange ramifications.

Lean is, foremost, concerned about quality. Toyota has been able to turn operational excellence into a successful business strategy. Facebook, Twitter and practice web sites have accelerated and amplified the effects of “word of mouth” advertising.  Before you promote, you better have “all of your ducks in a row” or all of your time and money may actually be counter-productive. Remember, prepare to promote and then promote!

Lean originated out of manufacturing; automobile manufacturing more specifically. And, although it has been successfully implemented in almost every industry, including human health care, it will require some adapting for use in veterinary medicine. This technology has only been experimented with very recently and only on a very small scale in veterinary medicine. This will be a new paradigm for us. We are the ones who will define Lean in our industry.

Monday, November 9, 2015

A New Paradigm For Veterinary Practice Management

There is a new paradigm, a new methodology, with proven results over many different industries including human health care. The new model is the Toyota Production System (TPS), better known in the West as Lean, for its consistent ability to deliver both quality and value without the waste and frustration that we see in so many organizations.

Over the course of 70 years, Toyota has grown from being a small, domestic, truck manufacturer in a devastated post-war Japan to being the largest auto maker in the world, for a time in 2012, even surpassing America’s industrial revolution icon, Ford Motor Company. Additionally, they have been profitable in every one of those years except three. How has Toyota been able to accomplish such milestones? By relentlessly pursuing a strategy of operational excellence, which includes a leadership style and organizational culture that is very different than most companies.

Lean is not just a set of tools. Toyota’s own website describes their production system as being a combination of:

  1. Technical tools and methods
  2.  Management methods
  3. Philosophy and mindsets 

Practiced together, this results in an organizational culture that develops people in the organization and sets up the organization for long-term success. Toyota also emphasizes that the main goals are improving flow (in the case of healthcare, providing the right care at the right place at the right time) and ensuring quality at the source. There is a foundation of safety being a top priority (for patients and employees) instead of being a separate program or initiative. 

            Toyota also described their “Toyota Way” management system as having two key pillars:

Being respectful in the workplace is not just a matter of being nice. It means challenging people in a constructive way so they can grow and perform to the best of their ability. “Respect for people” is a phrase that is also sometimes expressed as “respect for humanity.” This means not just showing respect for all stakeholders (such as customers, employees, suppliers and the partners, the community), but also respecting our human nature. For example, Lean leaders understand that we have human limitations, such as making more errors when we get distracted or are physically or mentally exhausted. This drives us to error proof systems to help prevent common human errors, rather than just asking people to be careful.

In the Lean framework, operational excellence is based concepts, such as the following:

  1. Value ( is defined from the customer’s point of view.
  2. Work relentlessly to reduce or eliminate waste (
  3. Build a culture of continuous improvement.
  4. Standardize work to improve flow.
  5. Make problems visible and react quickly.
  6. Understand problems and solve them at their root cause(s).
  7. Demonstrate deep respect for workers and all stakeholders. 

Successful practices realize that long-term success comes from satisfied clients. Clients should truly feel we have their best interests at heart. Hopefully, they would choose our practice not necessarily because we are less expensive than another practice, but that they received value for the hard-earned money they spend with us. We are responsive to their desires, and we value their time as much as we value ours. Satisfied clients help resurrect the idea of positive, direct ”word of mouth" advertising.