“Lean” Into Toyota’s Management Strategies to Improve Your Veterinary Clinic’s Performance

How many stories have you heard about young veterinarians who come into the profession filled with passion and desire to help animals, but find themselves burned out and leave the field sooner than they would have liked?

Unfortunately, this was a common scenario in the past and most of the frustration came from poor management.

Luckily, times have changed, along with approaches to management. As always, something new and unfamiliar can be unsettling at first, but today’s management methods, such as Lean, have proven their effectiveness and caused positive changes in various fields, including animal health care.

The first company to ever implement what is now known as Lean, was Toyota. The company made the first car in 1937, and never looked back. Toyota is known for its innovative approach to management and efficient operations. Toyota’s strategy has been adapted to numerous business areas, and it is now time to apply these practical principles to the veterinary world. Find answers to the most frequently asked questions about Lean methodology and understand how to implement its principles in your practice.

Lean is a Westernized term, and can be loosely defined as the ability to trim all the waste out of a process, procedure, or system. The methodology can be applied effectively to any business field, including animal health care. The main functions of  Lean include increasing the client’s value from the client’s perspective, reducing costs, increasing quality, utilizing resources for efficiency, engaging staff, and continuously improving.

Lean employs staff-  and “staff as a customer-” oriented approaches as it sees the team as the most valuable asset that an organization has. Such an approach means that questions in the workplace shift from “Who did it?” to “Why did it happen?” to get to the root of the problem and effectively solve it. It is crucial to consider that Lean methodology is not just a set of tools; it combines technical tools and methods, management strategies, and a specific philosophy and mindset. This combination results in the establishment of an organizational culture that drives success.

Lean comes from  Toyota’s production model. Toyota is one of the most successful companies worldwide, and it has repeatedly outperformed its competitors in quality, reliability, productivity, cost reduction, sales, and market share growth. By the end of last year, it was the third-largest car company in North America in terms of not only sales but production. — In terms of global market share, Toyota recently became the world’s second-largest carmaker. What made the company so successful and how was it able to maintain its high-level performance? It was built on the unique principles that no other company had implemented before.

The Toyota Way is built on two pillars: The first is continuous improvement, which takes in the concepts of challenge, and Kaizen, and the second is respect for people, which embraces respect and teamwork.

Since its inception, Lean has found its way into many other industries which adapted it to fit their needs. One of the most vital principles that Lean focuses on is mutual respect. Lean considers staff as an essential asset and management can use the staff’s intelligence, experience, and expertise to solve issues that present in the workflow.  This has not always been the case in the veterinary world; where management has the reputation for its absence of a staff-oriented approach. In the traditional authoritarian management structure, the ones running the show were typically profit-driven and had no real knowledge of or experience in running a veterinary practice. Thus, this top-down approach took enthusiastic and energetic staff members and pushed them to the breaking point where they became burned out and no longer wanted to be in veterinary medicine.

Fundamental to Lean methodology is to change this approach and make the staff truly a part of the process. As staff makes decisions and shares opinions, they become partners and implement improvements that lead to increased clinic performance. What is even more critical is that the clients receive better service, patients get better care, and staff is more satisfied — which helps prevent burnout.

From a Lean perspective, we need to distinguish two types of customers to map out the value stream.

• External customer. This is a person (and animal) who receives value from the service. In veterinary medicine, the client and the patient are external customers. They are the determinants of the value and ultimately, the reason why the veterinary business exists.
• Internal customer. This person is a staff member who is dependent on the tasks of another staff member in order to perform their own duties. For instance, the receptionist is the first person in the chain who greets the client and patient, and pulls the medical records. When a vet tech takes the patient’s chart from the receptionist and invites clients to the exam room, the tech becomes the customer of the receptionist. When the vet tech introduces the doctor, the doctor is now a customer as the vet tech provided a specific service to him or her.

The value stream in a practice starts with the first contact with the client which is actually on the phone when they call for an appointment and ends with the paying of the invoice, or maybe the routine recall to the client the next day. This has been called “bell to bell”; from the telephone ring to the cash register bell.

Dr. Chip Ponsford

A value stream is a high-level sequence of steps that you need to take to provide a full, meaningful service to your clients and patients. With a value stream, you not only find the value for the patient but also reveal silos that interfere with providing this value. We can apply Lean methodology and map out the value stream to the process of a patient’s annual physical examination. The way to start is to take a sample of patients and review their physical exam results. Choose a mix of animals that were seen for routine services such as vaccination updates and were otherwise healthy, as well as those that presented with a condition for diagnosis and treatment. Go through the process step-by-step as this will identify the areas that are the most crucial and shed light on other tasks that may be unnecessary or repetitive.

There are definite steps you have to take to determine the value stream of the physical examination process:

1. Get together with your team. Receptionists, technicians and other stakeholders also should be present at the meeting and participate in the discussion.
2. Using each staff member’s expertise and experience, review the annual exam results from your sample of patients. During this step, try to get to the root cause of each problem in the cases where the pet owner presented with a complaint, as it is the only way to find an effective treatment. Ask several times, “Why was that happening?” until you can get to the root cause for every case.
3. Map out and visualize the results. A discussion will bring up important points and expose unnecessary procedures staff undertook during the physical examinations.

Once you map out the value stream, do not forget to apply another crucial Lean principle, Kaizen. Kaizen is a Japanese term that means “continuous improvement.”  Its concept means partnering with staff to continually improve value. Here is what the Kaizen process looks like:

Just in time (JIT) is another concept that is used by Toyota and has also been applied in other industries. It is usually referred to in inventory management systems; however, its meaning and functions are not limited to inventory, and you can apply it in different settings.

The JIT concept is taken from the 1950s era of how U.S supermarkets restocked inventory; replacing what was sold on the previous day. This approach perfectly fits in the veterinary setting as well. In an ideal environment, the clinic’s resources should be delivered exactly where they are needed, when they are needed, and in the amount needed. It can be anything from supplies to procurement, from information to patients. One of the most valuable resources is time. Vets use resources wisely when diagnosing diseases and treating patients rather than running laboratory tests or invoicing clients. Through delegation, other clinic personnel can effectively perform a job that is not part of the doctor’s responsibility. Giving the veterinarian the freedom to perform the tasks they trained for is the best way to establish the most efficient workflow.

Consider getting familiar with Lean and applying these processes to your practice. If you empower your staff  and trust them, you establish a healthy environment in the clinic and contribute to the collective success of an organization and the whole veterinary industry in general.

If you want to know more about the Lean methodology in the veterinary space, we recommend a book by Emanuel “Chip” Ponsford, DVM, Lean Veterinary Practice Management: Higher Quality, Less Waste, Better Resource Utilization and Continuous Improvement, that will guide you through the main concept of  Lean on the practice level.