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Lean’s primary focus is the elimination of waste – both wasted resources and wasted time and effort. Six Sigma’s focus is on process improvements which can assist in increasing efficiency.

Both have since moved from manufacturing on to more service-focused industries, including customer service, human health care, and even veterinary medicine.

For this installment of the Ethos Exchange, Kelli Boswell, Hospital Director at TOS Richmond, led a discussion among our leadership about Lean and Six Sigma, and how they might both help our industry thrive.

Lean as a Bottom-Up Approach

One might think of process improvements as something lead by the heads of organizations, for the rest of the organization to follow. A closer look, however, reveals that Lean is often best implemented with a bottom-up approach.

“The people who are closest to the work are more aware of what failures or areas of opportunity there are for process improvements, because they do the jobs every day.” – Margot L., Vice President Supply Chain Operations at Ethos.

Your Team Knows Best

Because it is the employees who have the most interaction with daily processes, they are the ones most likely to realize where something is off, where waste is occurring, and what processes might benefit from adjustments. Employees can also be a great source of ideas for solutions. They may even come to you with a proposed resolution before you are aware of a problem that needs fixing!

“Our staff have been working to arrange schedules in the ER to facilitate 4 days a week 12 hour shifts, at their request. We have not implemented this quite yet, but are working to figure out how we can for the people who are interested in it.” – Kellie G., Hospital Service Manager at WVRC Waukesha.

“There was a lot of frustration around the efficiency of rounding with our day and overnight technicians, and information being missed on patient care.  One of our senior technicians developed a rubric sheet that’s being used now to pass on to the next technician, which is more efficient and saves time.” – Wil M., Hospital Manager at SAVES.

Getting Your Staff On Board: Encouragement and Receptivity

If employees may be the best source of solutions, how might leadership best promote a Lean Six Sigma mindset among their staff?

Offer Training to Your Team

One way may be the most obvious: offer training in Lean Six Sigma to interested and motivated employees, or those in whom you see a natural talent for such strategic thinking. Even the most basic classes can get them started thinking in the right direction, and Six Sigma White Belt training, for instance, is available free of charge. This can be a great investment into the future of your organization.

Listen to your team

Beyond official training, providing employees multiple opportunities to share their concerns and ideas is of utmost importance. If you are not listening to your employees in the first place, you’ll miss areas of opportunity. One of our locations, for instance, has a white board where employees can raise questions or ideas either named or anonymously. It’s also important to have a way to share new best practices across the organization.

“As a manager, make sure that you listen to all of your employees’ suggestions. Be an active listener, reward that behavior, and make sure not to do something that would shut that [discussion] down so that everyone feels comfortable with coming to you if they have a suggestion.” – Wil M.

“More than just actively listening, you have to go out there and ask your team. You have to not be afraid to put yourself out of your comfort zone and learn all the areas in which you fail.” – Andrew F., Hospital Director at VSH North County.

Getting Your Staff On Board: Transparency and Caution

Perhaps most importantly, you need to make sure your employees have an idea of what Lean and Six Sigma actually are before trying to implement them at your facility. Misunderstandings can lead to serious consequences, and may stop progress before it even begins.

Lean gone wrong

Jared K. (Senior Director, Talent Attraction and Acquisition) shared a story of a previous employer who tried to implement Lean processes, but failed because the employees rallied against it, with some trying to convince others that “lean” stands for “Less Employees Are Needed.”

On the contrary, waste elimination under Lean can even lead to more hiring, such as when pack room attendants were added to some of our facilities during the pandemic. This allowed technicians to focus more on their traditional duties, where they were most needed. The key is that your employees should know the goals you are trying to achieve with your process improvements, and have a clear understanding of how you plan to achieve them.

Transparency is key.

Lean Six Sigma in Veterinary Medicine

How can a Lean Six Sigma approach help improve veterinary care? Our leaders discussed areas in which they’d most like to see these process improvements implemented; areas of waste that could be cut back or simplified.

Improving Client Interactions

One major area was client interactions, in particular looking for ways to make them speedier, more efficient, and more useful to both clients and staff. As an example, one location used to have receptionists input data on new patients, but noticed a bottleneck here as other duties often slowed them down. A dedicated computer was set out specifically for patient intake, which made the process much faster and helped get patients in the door and to treatment more quickly.

Finding a Place for Odd Jobs

Another area which came up multiple times was job duties, especially making sure that those who were most qualified for a job were the ones to do it, avoiding situations where technicians or doctors may be doing odd jobs around the hospital. Some hospitals addressed this by hiring doctor assistants, to help take those odd jobs away from DVMs and allow them to focus on medical duties.

However, Wil at SAVES provided a counterpoint: at some smaller hospitals, staffing levels mean that it is arguably more efficient for everyone to pitch in for any job that needs doing. When everyone works together, the job is over faster and everyone can return to their usual duties. This just goes to show that what works for once facility may not work well for another; Lean Six Sigma improvements must be tailored to your own circumstances and staff.

The Importance of a Tailored Approach

The important thing is recognizing that every location’s needs and challenges are going to be unique, and thus will need unique solutions. The Lean and Six Sigma philosophies are meant to be a tailored approach. If you are listening to your employees’ troubles and ideas, you can work out how best to meet their needs. They are not a blunt force tool, but rather a precision instrument.

“Philosophies like Lean and Six Sigma, just like any other tool, can be used for evil or for good. So it depends on who is implementing it and why they are implementing it. I’ve heard both good and bad experiences, depending on who is trying to use it and what their intent is.” Jason B., Director of Programs and Process at Ethos.

Thanks to Kelli Boswell and Jared Katz for leading this discussion!

Written by: Alissa Murray, Talent Acquisition Coordinator at Ethos Veterinary Health