R-E-S-P-E-C-T

“Respect for people” is a fundamental principle of Lean and a major difference between Lean and the Western, more Taylor-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.

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.

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.

Dealing with people from a basis of respect permeates every aspect of Lean.

Systems thinking:

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.

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.

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?

Systems thinking is more respectful. It recognizes that systems should be investigated when problems occur before blaming people.

Value:

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 from the client’s point of view shows respect for them.

Variance and overburdening:

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.

Just-In-Time

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.

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.

Standardized work

Standardized work is the mutually 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.

Kaizen

Kaizen is a Japanese word that can be translated to mean “good change,” “change for the better,” or “continuous improvement.”

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.

Kaizen 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.

5S

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.

Go to gemba

"Genchi Genbutsu" (go and see) means that whenever there is a problem found, all relevant stakeholders (management and staff) should go to where the problem occurs (the “gemba”) and solve it together. It shows respect by recognizing that staff have valuable input to the situation.  

The Andon cord

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.

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 "bloodshed."

Thanks for stopping by. Please share this blog with your contacts! And, let me know if you have any questions, comments or post ideas.

Training Within Industry: A Closer Look At the Job Instruction Course

With this post, I take a closer look at the Training Within Industry's Job Instruction course that I introduced in the post "The Origins of Lean Are Not All Japanese." One of the reasons, from a systems viewpoint, staff may not be performing well is inadequate training.

Job Instruction (JI) course

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.

HOW TO GET READY
TO INSTRUCT

Have a Time Table--

   how much skill you expect him to have, by what date.

Break down the job—
   list important steps.
   pick out the key points. (Safety is always a key point.)

Have everything ready—
   the right equipment, materials and supplies.

Have the workplace properly arranged—
   just as the worker will be expected to keep it.

HOW TO INSTRUCT

Step  1—Prepare the worker
   Put him at ease.
   State the job and find out what he already knows about it.
   Get him interested in learning job.
   Place in correct position.

Step 2—Present the operation
   Tell, show and demonstrate one IMPORTANT STEP at a time.
   Stress each KEY POINT.
   Instruct clearly, completely and patiently, but no more than he can master.

Step 3—Try out performance
   Have him do the job—correct errors.
   Have him explain each KEY POINT to you as he does the job again.
   Make sure he understands.
   Continue until YOU know HE knows.

Step 4—Follow up
   Put him on his own.
   Designate to whom he goes for help.
   Encourage questions.
   Taper off extra coaching and close follow-up.

________________________________
If the Worker Hasn't Learned,
The Instructor Hasn't Taught.

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.

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.

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 Kata.

Kata comes from  the world of oriental, martial arts. It means “form.” There are two primary kata; Improvement Kata and Coaching Kata. I will look at Toyota Kata in the next post.

Thanks for stoping by. If you enjoy and learn from this blog, please tell a friend or colleague. And, as always, comments always appreciated.

Great Scores For Kaizen At 2019 AVMA Veterinary Leadership Conference

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 The Lean Concept of Kaizen: Taking Your Practice To the Next Level...And the Next! The attendance was good.

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 kaizen, why it is a better system than suggestion boxes, the PDSA cycle, and ending with a description of a simple kaizen 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.

Just a few days earlier I presented a one hour webinar entitled The Lean Methodology: Evolution of Veterinary Practice Management 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 gemba" 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. 

I haven't received any follow-up from the webinar, but attendee scores for the lecture were very satisfying.

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.

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.

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.

The AVMA Lead and Learn webinars (including mine) are available for viewing free of charge to members here.

Thanks for stopping by. Dialogue is always welcome.

A Different Kind Of Rounds: Lean Daily Management

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 standardized work. It gets everyone on the same page in a routine and timely manner.

Lean Daily Management (LDM) serves the same purpose, but for the operations and management side of the practice.



Each morning, leadership and management go to the gemba 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 Process Behavior Charts (PBC) of the data show any "signals" or is it all just "noise?" (see also Mark Graban's book "Measures of Success") 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?

Sidebar: One of the two Process Behavior Charts above is showing two signals. Can you identify which chart it is and what the signals are?

LDM helps support our progress through that big PDSA cycle called hoshin kanri or strategy deployment. 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.

In the figure above, the wheel has been moved up the ramp (improvement) through A3 thinking and kaizen. 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.

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.

So, to recap, standardized work sustains the current state, and LDM sustains the current standardized work.

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.

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 kaizen, 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.

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.

So, Lean Daily Management accomplishes several things:

1. Gets management to the places where work occurs (go to gemba)
2.  Facilitates conversation and consensus building with staff

3.  Demonstrates management's commitment to the staff

4.  Monitors the metrics that support the True North statement and KPIs

5.  Allows time to encourage and appreciate kaizen efforts

6.  Sustains and audits standardized work
7.  Creates increased engagement of the workers

8.  Show respect for workers

Thanks for stopping by. Comments, questions, and suggestions always welcome.

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 five 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.

The Origins of Lean are Not All Japanese

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!).

Now, while it is true that Lean did come from Toyota via the Toyota Production System (TPS) and Toyota developed this in Japan, much of what originally went into it came from the good ole' U.S. of A.

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:

1. Henry Ford and Ford Motor Company
2. W. Edwards Deming 
3. Training Within Industry (TWI)
4. 1950s U.S. grocery stores

Henry Ford

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. 

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. 

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. 

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.

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.

W. Edwards Deming 

In recent years, a Toyota executive said:

"There is not a day I don’t think about what Dr. Deming meant to us. Deming is the core of our management.”

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.

The PDSA (or PDCA) cycle is also known as the Shewhart cycle (or the Deming cycle)

From Dr. Deming, Japan and Toyota learned about building quality into the product at the gemba, the PDCA cycle and systems thinking.

Training Within Industries (TWI)

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.”

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.

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.

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.

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. 

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. 

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.

The TWI Job Instruction (JI) course
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.

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.

The TWI Job Methods (JM) course 

Job Methods taught how to improve the work being done. It was the impetus for kaizen or continuous improvement.

The TWI Job Relations (JR) course

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.

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.

1950s United States Grocery Stores 

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. 

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

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?

leanpub.com/leanvets

https://www.measuresofsuccessbook.com

Thank you for stopping by. Comments always welcome.

A Response To a Comment About My Post "Lean Self"

Last month, shortly after my blog on the “Lean Self”, my friend and mentor Mark Graban posted a comment to that blog. This was unusual.  Usually, Mark emails his questions and points of concern to me after receiving my final draft of the blog post, but before I publish the final, final draft. His questions sometimes come from sheer confusion about what it is ‘that I am really trying to say’, but many times it is his way of teaching in the Socratic (and Toyota) method. That is, rather than lecturing, asking the student a series of questions that lead the student to discovering the answer or reflecting deeper on the subject. Occasionally, I am not sure which it is.

I have decided to answer in another blog post, rather than a reply to the comment that may go unnoticed.

Mark comments:

Thanks for sharing this, Chip.

I agree that having a personal “true north” and understanding your own “current state” can be beneficial.  I don't quite see how to apply the idea of a “value stream” though. What is “value?” How does it flow? How do you see that connection in one’s personal life?

Mark

Here is my response.

Mark, thank you for your comments. Please forgive my tardiness in replying. I have been recovering from a little bit of surgery.

Your questions have caused me to re-evaluate my premise as regards extrapolating the Lean mindset to the “self.” As they should.

What is ‘value’ in this context?

Another way to arrive at an answer to this question is to ask, “What is really important to you in healthcare?” Or, “What is really important to you in a car?” For the “self” it would be, “What is really important to you in your life?” I think (hope!?) for most people it would be “contentment.” To be contented financially. To be content at work. To be content in our relationships.  To be content with ourselves. The Hebrew word “shalom” is generally translated as meaning “peace.” And it does, but it is the peace that comes from being “whole” (content spiritually, physically, emotionally, psychologically); not having excess or being destitute, but from having enough or being grateful with what you do have.

Part of the Lean definition of “value” is that the customer be willing to pay for it. If you are not willing to put a price on what you want, it doesn’t really hold any value. This holds true for the “self”, also. But, it doesn’t necessarily mean money. It means doing the hard work of honest self reflection, letting go of false assumptions, admitting mistakes, mending relationships, simplifying, budgeting, pushing back the ego, stepping out of the forest and,then, prioritizing and starting, somewhere, on a lifelong journey of improvement.

What is the “value stream’?

The Lean concept of the “value stream” requires, amongst other things, a provider, a customer and a “gemba” (the place where the work actually occurs). Unlike other applications of Lean where the provider and customer are separate entities, for the “self” they are the same, us. And the “gemba” is our hearts and minds.

The steps we go through in our hearts, minds and lives to get whatever value we get is the “value stream”. Whether that process results in contentment or “dis-ease” in a particular area of our life depends on how much muda (waste, i.e. faulty thinking, biases, rewritten history, skewed priorities, energy vampires, B**l S**t, etc.) is embedded. Graphically representing this thought process produces a “value stream map”

For example: I must be perfect →  I burned the turkey → I’m a bad cook → I’m a lousy wife → I’m a bad person.  Not good “flow.” Lots of bad processes and “trash.” What’s the value here?

Note that using 5 Why might take you back through this process. For example:

     Why are you a bad person?  Because, I am a lousy wife.

     Why are you a lousy wife? Because, I am a bad cook.

     Why are you a bad cook? Because, I burned the turkey AND I must be perfect!

BINGO!! A possible root cause. The false belief that “I must be perfect!”!

Now, to be able to map this current state value stream may not be easy and it may require the help of “stakeholders” (others who have our best interest at heart). And, just as in any other Lean application, finding the “waste” in order to produce a better future value stream will work best if our “stakeholders” are given access to our gemba and are present; if we are open, honest and communicative about what is going on inside of us and in our lives.

Thus, I think the Lean concepts of value, true North, gemba, current value stream, future value stream, A3 thinking, 5S, 5 Why and kaizen are just as valid working on improving ourselves as it is in improving manufacturing, service industries, healthcare, etc. for the customer- us!

Lean Self

One of the aspects of the Lean methodology that I appreciate most of all is the breadth of its  application. Lean is applicable to manufacturing, retail, service businesses, professional associations (Nudge, nudge AVMA!), human healthcare, dental practice and veterinary practice. It can even be extrapolated to one’s own life.

One of my extended family members is going through a rough time, as we all do on occasion. She came to us for some help. Since I naturally think and problem solve with a Lean mindset, I took this approach. Via guided questioning, we went through considering her problems, as I would with a practice problem.

True North

As with any Lean application, the first step is to define the ideal state: our ‘True North. If you were perfect, what would that look like? What areas of your life would you choose to define that perfection? What would be the focus areas? These might include such areas as spiritual ideals, physical ideals, financial ideals, relationship ideals, career ideals, etc. Pick four to six to work on at this time (or even just one!); choosing too many will be overwhelming and spread your work too thin. Create a True North statement in writing. Refer to this document often.

The Current State

Now that you have some conception of where you want to go, you need to honestly define your current state. Where are you right now in each of your focus areas? In an organization, this would be facilitated by going to the gemba with all of the stakeholders (line workers, supervisors, managers, etc) present, in order to observe what is really occurring in the Value Stream and, perhaps, drawing a Value Stream Map. Your gemba is deep inside you. It is your true self, warts and all. No preconceived ideas, no masks, no ego. What is the reality on your “shop floor?” Who are your stakeholders? Consider spouses, good friends, clergy, close colleagues, doctors, advisors. Write down your current situations.

Identify the Gaps.

At this point, you know where you want to be, and where you are in your focus areas. What are the differences or gaps? For example, you know you would like to be at some ideal state financially, and you know where you’re at currently. What is the difference between these two states? These are the problems you need to solve now. Write these down for each of the focus areas.

Root Cause Analysis (5 Whys)

Take some time to think about this step. Why are these gaps present? How did they come about? Why did this reason occur, and why did it happen? How did it happen? Ask enough times that you feel you have identified a root cause. This is important because, until the root cause is found and dealt with successfully, it will continue to be a problem. Notice I didn’t ask who was to blame. Try to concentrate on the systems, biases, prejudices, emotional needs, habits and the like. The idea is to deeply understand how this issue came about. It’s not because you are a bad person. We all are damaged in some way and have shortcomings,but how did these root causes contribute to your current state? Talking with your stakeholders may help.

Design Countermeasures

Now it is time to actively try to remedy the gaps: the problems. In each of your focus areas, what can you do to get even a little bit closer to your ideal state? Remember, though, your ideal state is perfection, and that is not realistic. There are always going to be gaps (problems), but with patience and persistence, you can get very close, greatly reduce your stress and frustration, and greatly increase your happiness, confidence and self-actualization.

Pick the low hanging fruit. Start with the easy stuff. Rack up some small successes that will then lead to greater momentum to tackle the bigger stuff. Focus on baby steps.

These countermeasures are experiments. After the trial period, evaluate the results. If they didn’t work out as planned, reflect on why and how, then tweak the experiment and try again. Try not to get disheartened. Lean is a journey. There will always be experiments to try.

If they do produce gains, then reflect on this, also. Why did this experiment work? What did you learn about the situation, about yourself. Can this same idea or principle be utilized in another aspect of yourself? Sustain this new you and rewrite your new current state. Congratulations!

5S

5S is one of the “tools” in the Lean system. It stands for Sort, Straighten, Shine, Systematize, and Sustain. It typically is used to reorganize a physical space, such as a surgery room, exam room drawer, office. It is used to decrease confusion, wasted time hunting down instruments or tools, and increase visual management.

Are there aspects of your life that could benefit from eliminating “garbage,” reorganizing, and/or prioritizing? What about faulty thought processes, biases, relationships, habits, wasted resources, beliefs?

Kaizen

Kaizen means continuous improvement. There is no set amount that is required, only that we try to be better tomorrow than we were today. There is no punishment if we are not successful on every attempt. We just try again. Again, baby steps. As stated above, Lean is a journey, it is a philosophy, it is a mindset. It is lifelong. The process of defining our current state, identifying gaps and experimenting will never end. But, success will come, if only one millimeter at a time.  “Patience, Grasshopper”!

Final Note

I am not speaking from any ivory tower. I struggle with all of this from time to time and have for most of my life. I, too, am on a journey; a work in progress. Veterinary medicine is not easy.  Veterinary practice management is even harder. I have started a practice and been a solo practitioner for over 30 years (for two of those years I owned and operated two practices), merged practices, worked for a corporation and three other employers. I have stayed awake many a night worrying about my business, my family, my health and my faith. I have experienced complete ‘burn out’ and come out the other end. My goal is to attempt to be better tomorrow than today. None of us are responsible for saving the world, but we are required to participate. Success, in my humble opinion, is to leave this world a little better for having lived here. A Lean mindset supports this effort.

Thanks for stopping by. Comments always welcome.