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.
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).
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).
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.”
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:
Chip Ponsford DVM "My fear as vet med discovers Lean is that #Lean will be known for tools, not philosophy." Philosophy matters.
— Mark Graban (@MarkGraban) March 4, 2016
He also emphasized the need to learn and think… to be inspired by others, but not just copy:
— Mark Graban (@MarkGraban) March 4, 2016
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.”
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:
We've had a few articles published in an industry publication:
VETERINARY ECONOMICS – Mar 01, 2015
VETERINARY ECONOMICS – Mar 06, 2015
Dr. Chip Ponsford explores how to “tend” your veterinary practice in order to harvest an efficient, successful business.
VETERINARY ECONOMICS – May 21, 2015
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:
- NC Vet College Dives Into Lean Training
- Training: Lean – What Is It and How Can It Help Your Practice?
- ‘Lean' approach lightens staff members' workload
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?