Early Days of Lean in Veterinary Medicine?


Last Friday morning, I partnered with Chip Ponsford, DVM, a doctor of veterinary medicine, to give an introductory Lean continuing education presentation at the annual conference of the Texas Veterinary Medical Association.

Our talk was titled: “What Veterinarians Can (and Should) Learn From Toyota.

That was Chip's suggested title – it was him talking to the vets, not me (as the engineer) telling them they should learn from an automaker.

Chip first reached out to me via email in about 2012. In 2013, he said, in our second exchange:

“I am a veterinarian in El Paso interested in introducing Lean to my profession. I have read numerous books, including both editions of your book. There was a recent article in one of the vet magazines introducing six sigma, so, now more than ever, I think the time is right for veterinarians to learn about this.”

As I got to know Chip through emails and a few phone calls, I realized he was an avid learner. He's read so many different books on Lean and the Toyota Production System (including Ohno and others), so I was impressed with his willingness to read “manufacturing books” and figure out how this applies to the vet med world.

Here is a picture of us after our session. We had 2.5 hours to try to introduce veterinarians and practice owners to Lean.

Mark Graban Chip Ponsford

He was a practice owner for a long time… so I'm pretty sure I recommended the book Follow the Learner by Sami Bahri, DDS. There are probably more parallels between Dr. Bahri's story and that of a typical veterinary medicine practice owner. The typical vet med practice seems more like primary care clinics for people… with a little bit of surgery done on site. A “human hospital” might be as foreign of a concept to learn from as a car factory would be.

It would be easy for a veterinarian to say:

  • “We're different, we're not a car factory… patients are not cars” OR
  • “We're different, we're not ThedaCare or Virginia Mason… we treat multiple species.”

No longer a practice owner, Chip is now in the Dallas / Fort Worth area, working as an employee for a clinic. That creates some different change management challenges for him, since he's not “the boss” (although neither he nor Dr. Bahri would describe themselves using that old command-and-control term).

Hear Mark read this post (as part of the “Lean Blog Audio” podcast):

I don't have much experience in vet med, but I spent a week last year at a university, a vet med teaching hospital, and their Large Animal Clinic. It wasn't good for my allergies, but it was fascinating to see the processes and environment around providing care to cows, horses, llamas, and the like. This was more like a hospital with animals often doing inpatient stays overnight or for days (in stalls and pens, instead of rooms and beds).

The types of problems and challenges that I saw there were very similar to human healthcare, including:

  • Silos and poor communication… negatively impacting patient flow
  • Errors and mistakes that could harm the animals
  • Staff who aren't engaged in Kaizen (continuous improvement)
  • Processes and SOPs that sort of just evolved and aren't managed actively
  • Managers who are spread way too thin
  • Denial about changing market conditions and the need to do things differently

Chip and I also spent a day with a small animal vet med practice near our homes and, while it was generally better managed, they still had lots of opportunities for improvement (and admitted as much, which is a good sign).

Our Presentation

Rather than presenting Lean as a fad, or a bunch of tools, or something to implement, I suggested to Chip that we start with the classic Ohno words of “Start from need.”

Screen Shot 2016-03-06 at 12.36.36 PM

Chip did a great job of articulating the patient care and business challenges that are faced in vet med, including:

  • Falling income for veterinarians
  • Pet owners relying more on Google and less on their veterinarian
  • “Sticker shock” and price pressures, amplified by the economy, and the need to either reduce costs or increase value to payers (and most vet med is paid for out of pocket, instead of by insurance)

In our discussions, I asked Chip if there is a “patient safety movement” in healthcare and he wasn't really aware of any direct parallels to the discussion and actions taken in human healthcare over the past 20 years. You can find references online to vet med mistakes being a problem, but there's less of a “movement.” I mentioned how Lean is being applied to improve quality and patient safety in human healthcare.

We covered basic Lean methods and principles, emphasizing that Lean is not just tools, it's a philosophy and a management system.

As Chip said so well:

He also emphasized the need to learn and think… to be inspired by others, but not just copy:

Chip covered basic Lean concepts, including:

  • Value and waste
  • Value streams
  • Flow and pull (reducing batch sizes)
  • 5S and visual management

I talked about aspects of Lean management, including Kaizen, mistake proofing, problem solving, and other core concepts.

One older veterinarian came and talked to Chip later in the day and said the presentation was “life changing.”

What Now?

Chip and I both hope attendees are inspired to learn more, to experiment, and put Lean practices into use. The level of awareness and limited number of publications in veterinary medicine reminds me of where human healthcare was ten or twelve years ago. I hope veterinary medicine can learn from mistakes and missteps that were made, in some cases, in human healthcare.

Chip established a “Lean Vets” blog that I'm helping him with and will be contributing to:

Screen Shot 2016-03-06 at 12.49.20 PM

We've had a few articles published in an industry publication:

Cut the fat–get Lean


Growing the Lean veterinary practice

Dr. Chip Ponsford explores how to “tend” your veterinary practice in order to harvest an efficient, successful business.

Put the Lean concept into action at your veterinary practice

Begin and maintain this system's philosophy to make your practice more productive and efficient.

Chip and I also wrote a conference proceedings paper about Lean. We're sharing most of it on the Lean Vets blog and might publish it eventually as an eBook.

We're also going to link to and write about the handful of articles that we could find so far on Lean in veterinary medicine, including:

Chip and I also plan to do a podcast soon on this topic.

Will Lean work in veterinary medicine? Of course. Will it be easy? No. Will everybody be able to lead a transformation? Probably not.

There's great potential… Lean in vet med will lead to:

  • Better patient care
  • Better client satisfaction
  • Lower costs and prices
  • Better financial performance for the practice owners

What comes next?

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. The fact that people are starting to trust Google over their local vet clinics is a problem. Their are probably tons of pets that have died or become seriously injured/ill because of this. If you have a pet, make sure you go to a vet, it’s their job to keep your pet alive and healthy for as long as they can.

    • Thanks for your comment, Sarah. It seems that the challenge for vet med is to help make it more affordable to see a veterinarian… many would probably like to see a vet, but can’t afford it or can’t get in at a convenient time, right?


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