Cut the fatget Lean


What Toyota has to teach veterinary hospitals.

Every year, prominent veterinary trade journals publish benchmarks and metrics of veterinary practices. What if there was a new paradigm that set the bar at a totally new level-not just another way of thinking outside of the box, but a whole new box?

What is the “new box” that could change how veterinarians and practice managers think, manage and improve their organizations? It's what's worked in some human hospitals: University of Michigan Medical Center in Ann Arbor decreased discharge time from more than three hours to 89 minutes, a reduction of 54 percent. Say hello to the Toyota Production System (TPS), or Lean, which aims to deliver exceptional customer value while eliminating “fat.”

The skinny on Lean

Fundamentally, Lean is the long-term commitment to giving customers value in a continuous flow of work, without waste. At its heart, Lean dissects processes into their separate, individual steps. All of the steps are meticulously analyzed to determine which are necessary, which add value, and which are wasteful and can be eliminated. 

In order to add value, the product or service must be something that the client wants and is willing to pay for. Each step in the process must enhance the product and must be done right the first time. Any deviation is a form of muda, the Japanese word for “waste.” 

The 8 forms of muda

1. Defects. Doing something incorrectly or spending resources to fix an error. 

2. Overproduction. Doing more than the client asked for and is willing to pay for, or doing something before it's actually required.

3. Transportation. Redundant movement of patients, resources or specimens.  

4. Waiting. Periods of non-production, due to waiting for something or someone.

5. Inventory. Inefficient or excessive inventory.

6. Motion. Unnecessary movement of staff.

7. Overprocessing. Acting at a higher level than is necessary or will be utilized.  

8. Staff talent. While this one is not part of the original seven, it involves the waste of not utilizing team members effectivel and not acknowledging their unique talents, perceptions or potential intellectual contributions.

The Lean “toolbox” contains many other items such as:

> The “5 S's” (sort, straighten, shine, systematize and standardize) to organize work areas

> “Fishbone” analysis (cause and effect analysis) to clarify the root cause of problems

> Value-stream mapping that graphically shows steps and times involved in processes

> Just-in-time systems that allow inventory to be managed more visibly.

The Toyota Production System has proven itself in virtually every type of manufacturing setting, and now it's not uncommon to visit human hospitals and see the signs of a Lean initiative in place. Physicians, medical staff members and patients all over the world are benefiting from incredible gains in profit, patient safety, timely access to life-saving treatments, resource utilization and employee engagement. It's time for veterinary medicine to get Lean. 

Dr. Ponsford was a small animal practice owner for 27 years. He is now an associate veterinarian in Dallas. Mark Graban is an author, speaker, and consultant in the field of “Lean healthcare” and has worked with healthcare organizations since 2005 after starting his career in engineering and manufacturing.