The argument running underneath this entire session is one Mark Graban has made for years and stated again at the top: Lean is not a system for building cars. It is a set of methods, a management system, a philosophy, an integrated system and culture that can be applied across very different settings — government, finance, law firms, healthcare, manufacturing. Lean is lean.
Graban opened with a story that sharpens the point. About two years before the webinar, he spent a week doing an assessment at a university medical center that teaches and trains veterinarians — specifically in what they called the large animal clinic, working with horses, cows, pigs, and llamas. When the staff there heard about his healthcare background, they told him the same thing every industry tells him: we're different. It was the week Graban first heard the phrase "human healthcare." He had always just called it healthcare. The phrase showed him how differently people view the same thing through different lenses. He also learned that some in veterinary medicine call what they do "multi-species medicine" — and that reframes the complexity. In human healthcare people say every patient is unique, but at least they are all one species. Veterinary medicine carries more variation than that, not less.
The session is Chip Ponsford's account of where Lean stands in veterinary medicine — which is to say, very early — and why he believes the profession needs it. It is also, honestly, a session about a frustration: Ponsford has spent years trying to get his profession to listen, and the central obstacle is exactly the one Lean practitioners know well. People keep encountering Lean as a couple of tools rather than as a system, and a couple of tools is not Lean.
Chip Ponsford, DVM graduated from Texas A&M in 1980 and owned a small animal hospital in El Paso for 27 years. He spent five years with a national corporate practice as chief of staff and was a top-20 producer for several years. He has studied the Toyota Production System and how Lean might apply to veterinary medicine, and he started what he says was the first blog dedicated to Lean in veterinary medicine, at leanvets.com.
Ponsford and Mark Graban have collaborated on articles about Lean in veterinary medicine and presented together at the 2016 Texas Veterinary Medical Association convention. At the time of the webinar, Ponsford lived and worked in the Dallas-Fort Worth area and was writing a book to introduce veterinary medicine to Lean. Graban, who had visited and observed Ponsford's practice, introduced him by praising his questions, his learning, and his diligence in exploring how Lean applies outside the settings where it is already established.
Ponsford framed the session around a concept he said Graban taught him early — Taiichi Ohno's idea of starting from need. The first half of the talk is Ponsford building the case that veterinary medicine genuinely has a need. He was candid that the related Lean principle, pull, has been his real frustration: there is not enough information about Lean in circulation for veterinarians to be asking for it. Without the pull, the work becomes pushing information out and hoping it lands.
The current-state picture he painted, drawn partly from the 2016 TVMA presentation, is of a profession under economic pressure. Veterinarian compensation has been declining, while the cost of becoming a veterinarian has climbed dramatically. Ponsford put himself through all of college and veterinary school, including room and board, for roughly $50,000. New veterinarians now graduate with hundreds of thousands of dollars in debt — and that debt shapes what they can do.
When Ponsford started out, the idea that veterinary medicine was a business was brand new, and the emphasis was on marketing the field as a legitimate profession whose practitioners deserved incomes comparable to other professionals. He noted the competition is intense — applicants take the same prerequisite courses as medical school applicants, but Texas has one veterinary school admitting 144 students against five or six medical schools. His honest worry: the profession may have swung too far. In raising income and professionalism, it created a void.
Two forces, in Ponsford's account, have hollowed out the traditional practice.
The first is "Dr. Google." A growing share of pet owners go to the internet first — 39% report looking online before they talk to a veterinarian, and 15% report relying less on their veterinarian. The practical consequence: when a pet's clinical signs resolve in a day or two, the veterinarian never sees that animal at all.
The second is price-driven loyalty. Ponsford pointed to the Bayer Veterinary Care Usage Study finding that 26% of veterinarians' clients would switch practices for a lower price. The loyalty is not to the practice — it is to the price. And one of the two lowest scores practices received was on "value for service." That stung, because if Lean is about anything, it is about delivering value to the customer. He also flagged a benchmark from longtime practice consultant Mark Opperman: a retained-client rate of 60% at 18 months. Ponsford found that target far too low. The profession should strive for perfection and aim much higher.
Ponsford described real structural change in the profession, some of it good. When he started, becoming a board-certified specialist effectively meant committing to academia. Now there are emergency clinics with board-certified critical care veterinarians and large multi-discipline referral hospitals with veterinary neurologists, ophthalmologists, surgeons, and internists — sophisticated small animal referral centers he genuinely welcomed as good for the profession.
But other changes have pulled work away from the traditional practice. Low-cost spay and neuter clinics took one of the old bread-and-butter services. Low-cost vaccination vans park outside pet stores and malls, offering injections only — no sick animals, no surgery, no help with a real problem. Clinics inside pet stores spread, with Banfield first, then Petco's arrangement with a corporation, and word of Walmart wanting in.
He also described a demographic shift. When Ponsford entered veterinary school the population was roughly 60% male; the profession is now nearly 95% female. He was careful to say he was not calling that good or bad, only that it has changed how practices can be run — newer graduates, in his experience, place a higher value on a balanced life, which makes full-time practice ownership harder, and the heavy school debt all but precludes ownership anyway. Newer graduates tend to be more technology-oriented, wanting digital x-ray, ultrasound, and laser surgery. The practice Ponsford opened decades ago would look like the Stone Age now — and yet it was functional, and he suggested the profession may need to return to at least some of that leaner model.
To make the need concrete, Ponsford told a deliberately fictional composite story — a conglomerate of a typical practitioner, with a caveat that any resemblance to real persons or his current employer was coincidental.
The practitioner graduated several years ago and has owned a small animal hospital in a growing suburb for ten years. A couple of full-time vets, some support staff, a freestanding hospital, reasonably furnished and equipped, progressive and quality-oriented, with the social media presence that now seems required. His fees are above average for the area, but he is not comfortable raising them. Expenses keep rising. The practice is growing but leveling off — as businesses do when they are not continually improving and innovating. Returning clients are slightly down. He is becoming more frustrated, and it is starting to affect his physical and emotional health.
Ponsford paused on a hard fact here: of all professions, veterinary medicine has the highest suicide rate. He offered no single explanation, only that it is a fact worth knowing.
The practitioner has recurring staff and client issues, higher-than-normal turnover, difficulty getting staff engaged to take initiative, training that seems harder than it should be, and communication between doctors and staff that never quite lands on the same page. He wonders whether there is a new paradigm that could help solve problems and improve systems and culture. Ponsford's answer, of course, is yes — and it is called Lean.
Ponsford reviewed the conventional sources of help and found them wanting. An AVMA economic survey identified the same problems he sees and quoted a veterinarian and practice manager saying veterinarians need leadership, management, financial, and communication skills — that many resources exist and veterinarians are still struggling. Ponsford's point: Lean is a system, standardized, teachable, learnable, and complete, and it addresses exactly those struggles.
He cited an AAHA survey in which 53% of respondents who raised prices did so because of cost. And he relayed the position of an economist who argued, in a veterinary economic journal, that if inflation is 3% or less a practice has no right to raise fees — it needs to find ways to reduce expenses. Ponsford noted that the head of the AVMA's economic committee liked the Kaizen idea and the idea of starting from need, and described the gap between need and what is actually happening as "all blue ocean" — a fivefold greater space than what is currently occurring.
The training that does exist — practice management institutes from AAHA and the AVMA — Ponsford described as teaching the traditional way of practicing: the veterinarian as the leader who does everything, very much command and control. The idea of involving staff in decisions is simply not present. He gave one piece of credit: early practice management did push veterinarians to delegate routine tasks — running a fecal, pulling blood, taking an x-ray — to trained technicians, and learning to trust skilled staff has helped the profession tremendously. But the bigger picture of engaging staff as problem-solvers has not arrived.
Ponsford used the blue ocean / red ocean framing to describe what has happened to the profession's economics. Veterinary medicine, as he sees it, has spent his career chasing the upper economic levels of clientele — everyone marketing to and competing for roughly the top 25% by income. That has concentrated the whole profession into one space, a feeding frenzy at the top. What used to be the "red ocean" at the bottom — where there were fewer competitors and practices did reasonably well — has been left behind, becoming bluer as that clientele goes underserved. And the genuine blue ocean, the new and innovative and creative approaches, is something Ponsford argued the profession needs all along the spectrum, top and bottom. His conclusion on the state of play: Lean in veterinary medicine is still extremely embryonic.
The deepest worry Ponsford expressed is one any Lean practitioner will recognize. What he has seen, in the few places veterinary medicine has touched Lean, is Lean implemented on a tools basis — and when an organization uses one or two tools from the Lean arsenal, the system does not work, because the point has been missed.
This is why his two-and-a-half-hour TVMA session, which he was thrilled to get, turned out not to be enough time. His fear about short conference slots is specific: a one-hour talk might get the word "Lean" recognized, but it leaves people thinking Lean is 5S, or reorganizing an area. He wants veterinarians to understand that Lean is a system, standardized work, a mindset, a culture — and that without all of it, it will not work. And if it does not work, he does not believe veterinary medicine will give Lean a second chance. He pointed to evidence of the tools-level treatment: a convention session on Lean lasting all of one hour, and a Lean subtopic occupying a small subtitle in chapter three of an expensive benchmarks book.
Despite the embryonic state, Ponsford had real examples — and a clear pattern in them.
The university veterinary teaching hospitals are adopting Lean ahead of small animal practice. Cornell has done successful Lean work. At North Carolina's veterinary college, hospital manager Samantha Perret spent nine or ten years trying to solve a chronic conflict between the anesthesia and surgery departments — veterinary surgeons staying too long, work not finishing on a reasonable timeline. She finally convinced them to try Lean. They went to the gemba, did a value stream map, and saw where communication was breaking down between departments that did not realize what the other was doing. In a single iteration — one trial — they increased the surgeries they could do during the day by 36%.
Ponsford's read on why the teaching hospitals lead is sharp. They are more similar to human healthcare than a typical practice is: they have departments — anesthesia, surgery, internal medicine, radiology, oncology — and therefore they have silos that are not communicating well. A small animal practice with two or three veterinarians on the floor all the time does not have the silo problem. Its problem is different: getting staff involved, recognizing staff as an asset, and through that getting them engaged. Auburn University, in an email Ponsford received, described a Lean experiment focused on the discharge process — making sure clients leave with the information they need to care for their animals at home. They started cross-training, used more visual communication, and got more employee involvement in identifying and fixing problems.
Ponsford also noted he is no longer the only veterinary Lean website. Christian Bamber has started one in the United Kingdom — and the striking thing in Bamber's email was that Ponsford could have sent Bamber's own email back to him with only "US" swapped for "UK." The same problems: 99.9% of people do not know about Lean, veterinarians tend to be closed to new ideas and independent and convinced they know everything, the corporate structure is not amenable, and the people trying to introduce Lean cannot get a chance to speak at conventions.
Ponsford walked through concrete things he has tried or sees value in, deliberately small.
A crude value stream map of bringing an animal in for a morning comprehensive exam, annual tests, and vaccinations, to get that flow down. A small experiment born of a question he had long wondered about: groomers can clip nails, bathe, and clip a dog with one person, yet it always seemed to take two technicians to work on one animal — so he bought a grooming table, and found one technician could indeed do it alone, which improved flow. An inventory kanban for drugs, in a practice that previously had no system and kept running out — after the kanban went in, he does not think any drug on that shelving unit ran out again. A 5S organization of a workspace. A treatment board as visual management — showing which animals are hospitalized, which doctors are responsible, what treatment orders are posted and what has been accomplished, so anyone walking by can know the condition of every hospitalized animal. A simple kanban file flag indicating a client is in a room and which doctor they want to see.
He described the book he was writing as built on a deliberate bridge: Lean is based on the scientific method, and so is veterinary medicine. Veterinarians know what the ideal looks like — a healthy pet — know how to recognize disease, already think in terms of systems (respiratory, cardiac, every system affecting the others), know how to diagnose and how to plan therapy. What they have not done, Ponsford argued, is apply that same process to a sick practice. His hope was to make Lean relevant by entering through that familiar door — and, having had too much time on his hands one day, he even drew a set of value stream mapping icons specifically for veterinary medicine.
Ponsford closed his presentation with the future he is hoping to build: workshops around the country, possibly with sponsorship from drug manufacturers and distributors rather than corporate practice; enough private practices embracing Lean to generate real data comparing Lean practices to traditionally managed ones, so the profession can make a legitimate decision about whether Lean helps; Lean entering the standard veterinary management lexicon; an annual Lean veterinary summit, like the gatherings in Lean healthcare; and a community of Lean veterinary practitioners. That last one matters to him because, as he put it, there is a lot of unadmitted competition between veterinarians — a tendency to keep a good way of doing something secret. He hopes Lean will create a sharing environment instead.
His blog traffic offered one small sign of pull beginning to form. A year before the webinar, the blog had recorded an all-time total of about 10,000 page views. The morning of the webinar, it stood at 22,000.
Asked what practical first steps he would recommend for a practice brand new to Lean, Ponsford gave a clear answer. Many people start with 5S because it is simple and introduces the idea of flow, and he had no objection to that. But he would rather start from Kaizen. He would have the practice set up a Kaizen board, get the staff to understand that they are being asked to be involved, that the practice considers them its greatest asset — the only asset with the potential to appreciate, through training and learning. He would start with small Kaizens to build PDSA and A3 thinking, nothing complicated, just enough to get the culture started. Then, working from need, introduce value stream mapping or standardized work only when a specific problem calls for it — tools as needed, not tools first.
Graban raised a definitional trap. Ponsford had a slide about veterinary practices getting "leaner" in bad economic times — but in common usage, "leaner" means getting smaller and cutting. Ponsford clarified: a genuinely Lean practice uses slow times to work internally, build its structure, improve value streams, cross-train, and get more Kaizen projects finished — so it emerges more competitive. Graban sharpened the point. In human healthcare, "get leaner" too often defaults to sending people home, cut-cut-cut. What Ponsford was describing is the alternative. Ponsford agreed — a foundational point of Lean is that it is not about firing people or massive layoffs. When staff are not fully engaged in the business, there is real, valuable work they can do that pays dividends later.
Asked how to incorporate and sustain Lean alongside the normal demands of veterinary work, Ponsford was direct. Left to its own devices, time fills itself somehow. For a Lean culture to take hold, the leadership has to treat it as a real priority and make time for it — a webinar, a consultant introducing the concepts, then a Kaizen board and the work of showing staff they are trusted and valued as the thinking part of the practice, not just the grunt work. It is, he said, like anything else: either it is a priority or it is not.
This session is about a profession at the very start of its Lean journey, and Ponsford was not selling software — he was trying to get veterinarians to take the management system seriously at all. But the obstacles he named map closely onto what improvement infrastructure addresses.
Ponsford's central worry is the tools trap: Lean encountered as 5S or a value stream map, a couple of disconnected tools rather than a system, which then fails and gets no second chance. A practice that adopts Lean as a system needs a way to hold the whole of it — the Kaizen ideas, the small experiments, the A3s, the value stream maps, the standard work — in one connected place, so the work reads as an ongoing management system rather than a scatter of one-off events. A Kaizen board on a wall is a fine start; what keeps it from fading once initial enthusiasm passes is infrastructure that captures every idea, gives it an owner and a response, and tracks it through to a measured result. The thing that turns a tool into a system is continuity, and continuity is a tracking problem.
The small-practice problem Ponsford named most often is staff engagement — recognizing staff as the asset, getting them to bring ideas forward, getting them to feel part of the practice. His own recommended first step is a Kaizen board for exactly that reason. The failure mode he wants to avoid is the suggestion-box dynamic he and Graban have lectured on: ideas submitted into a void, never acknowledged, never acted on, which teaches people to stop bothering. An idea system that guarantees every submission gets a response, shows the person where their idea stands, and records its impact is the operational difference between a Kaizen board that engages staff and one that quietly dies. For a small practice where the whole engagement problem is whether staff believe their input matters, that responsiveness is the point.
Ponsford's teaching-hospital examples are silo-and-flow problems. North Carolina's anesthesia-and-surgery breakthrough came from departments seeing, through a value stream map, what the other department was actually doing. Auburn's discharge work came from cross-functional visibility into a process that crossed roles. Larger veterinary hospitals with real departments have the same cross-silo visibility problem human healthcare has — improvements happening in one department invisible to another, the same problem re-solved in parallel. Infrastructure that makes improvement work visible across departments is what lets a multi-discipline referral hospital spread a fix rather than rediscover it.
And Ponsford's future state depends specifically on something infrastructure does: he wants enough data comparing Lean practices to traditionally managed ones to let the profession make a legitimate decision about whether Lean helps. That is an impact-measurement argument. The case for Lean in veterinary medicine, by Ponsford's own framing, will be won or lost on whether the results can be measured and shown — and measured, tracked improvement is exactly what separates an anecdote from evidence.
None of this changes Ponsford's argument. Veterinary medicine has a genuine need. Lean is a system, not a toolkit. Staff are the asset, and engaging them is the small-practice's central work. What infrastructure does is give the system somewhere to live — hold the Kaizen ideas and experiments together so Lean reads as a management system, make every staff idea visible and answered so engagement holds, surface improvement work across departments in the larger hospitals, and capture the measured results that the profession's eventual decision about Lean will rest on.
Does Lean apply to veterinary medicine? Yes — that is the core argument of the session. Lean is not a system for building cars; it is a set of methods, a management system, a philosophy, and a culture that applies across very different settings. Mark Graban opened by noting that every industry tells him "we're different" — manufacturing, healthcare, government, finance, law firms — and Lean applies anyway. Veterinary medicine, sometimes called "multi-species medicine," carries even more patient variation than human healthcare, but the principles of seeing waste, improving flow, and engaging the people doing the work apply directly.
What does "start from need" mean, and does veterinary medicine have a need? "Start from need" is Taiichi Ohno's principle that improvement should begin from a genuine, identified need rather than a desire to apply tools. Chip Ponsford spent the first half of the session building the case that veterinary medicine has a real need: declining veterinarian compensation, enormous student debt, rising expenses, price-driven client loyalty, low "value for service" scores, and competition from low-cost clinics, vaccination vans, and in-store practices. He also noted the related principle of "pull" is his real frustration — there isn't yet enough awareness of Lean for veterinarians to be asking for it.
Why does Ponsford warn against treating Lean as just "tools"? Because in the few places veterinary medicine has touched Lean, it has been implemented on a tools basis — one or two tools like 5S or a value stream map — and a couple of disconnected tools is not Lean. When Lean is reduced to tools, the system doesn't work, the point gets missed, and it fails. Ponsford's specific fear: if Lean fails in veterinary medicine because it was only ever tried as tools, the profession won't give it a second chance. Lean is a complete system — standardized work, a mindset, a culture — and it only works as a whole.
What is "Dr. Google" and why does it matter to veterinary practices? "Dr. Google" is Ponsford's term for pet owners turning to the internet for information before or instead of seeing a veterinarian. He cited figures that 39% of pet owners look online first and 15% report relying less on their veterinarian. The practical consequence: when a pet's clinical signs resolve in a day or two, the veterinarian never sees that animal at all — lost visits and weakened client relationships.
What is the "blue ocean / red ocean" problem in veterinary medicine? Ponsford used the framing to describe the profession's economics. Veterinary medicine has spent years chasing the upper income tier of clients — everyone competing for roughly the top 25% — concentrating the whole profession into one crowded space, a feeding frenzy. The "red ocean" at the lower end, once less competitive and reasonably profitable, has been left behind and underserved. The genuine "blue ocean" — new, innovative, creative approaches — is something Ponsford argued the profession needs across the whole spectrum, not just at the top.
Why are veterinary teaching hospitals adopting Lean faster than small practices? Because, as Ponsford explained, teaching hospitals are structurally more like human healthcare — they have distinct departments (anesthesia, surgery, internal medicine, radiology, oncology) and therefore have silos that don't always communicate well. Lean's flow and value-stream tools speak directly to silo problems. A small practice with two or three veterinarians on the floor doesn't have a silo problem; its challenge is staff engagement. The North Carolina veterinary college example — a 36% increase in daily surgical capacity from one value stream mapping iteration — came from departments finally seeing what the other was doing.
What practical first steps does Ponsford recommend for a practice new to Lean? He would start from Kaizen rather than 5S. Set up a Kaizen board, and use it to show staff they are being asked to be involved and that the practice considers them its greatest asset — the only asset with the potential to appreciate through training and learning. Start with small Kaizens to build PDSA and A3 thinking, nothing complicated. Then, working from need, introduce value stream mapping or standardized work only when a specific problem calls for it. Tools as needed, not tools first.
What are some examples of Lean improvements in a small veterinary practice? Ponsford shared several small, concrete ones: a value stream map of the morning comprehensive-exam process; a grooming table that let one technician handle an animal that previously seemed to require two; an inventory kanban for drugs in a practice that kept running out, after which no drug on that shelf ran out again; a 5S workspace organization; a treatment board as visual management showing every hospitalized animal's status; and a simple kanban flag showing a client is in a room and which doctor they want.
Does getting "leaner" mean cutting staff? No — and Ponsford was explicit about clearing up the confusion. A genuinely Lean practice uses slow economic times to work internally: build structure, improve value streams, cross-train, finish more Kaizen projects, so it emerges more competitive. That is the opposite of the common default, where "get leaner" means sending people home and cutting. A foundational principle of Lean is that it is not about layoffs. When staff aren't fully engaged in the business, there is real, valuable improvement work they can do that pays dividends later.
How can a busy veterinary practice make time to sustain Lean? Ponsford's answer was direct: left to its own devices, time fills itself somehow, so Lean has to be a deliberate priority set by leadership. That means leadership treating it as something with real potential and making time for it — starting with education (a webinar, a consultant introducing the concepts), then a Kaizen board, then the ongoing work of showing staff they are trusted and valued as the thinking part of the practice. It is like anything else: either it is a priority or it is not.
How does the scientific method connect Lean and veterinary medicine? Ponsford built his forthcoming book on this bridge. Lean is based on the scientific method, and so is veterinary medicine. Veterinarians already know what the ideal looks like (a healthy pet), how to recognize disease, how to think in systems (respiratory, cardiac, each affecting the others), how to diagnose, and how to plan therapy. What they haven't done is apply that same diagnostic process to a "sick practice." Ponsford's hope is to make Lean feel relevant by entering through that familiar scientific-method door.
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