The US economy is volatile. Only clear leadership can affect the trend. In the early days, small groups worked together to produce a product or deliver a service. They rallied around a tribal banner. Look to the caveman heritage of hunter/gatherer that led to the development of small community groups, seen only a few hundred years ago, to see the genetic imprint we carry. University of Minnesota research says fifty percent of personality is genetic. For example:

 The fleetest of the group became the scout/chaser.

 The keen eye became the tracker/spotter.

 The most skilled archer or spear-chucker was the hunter.

 The hunters discussed the method to track and attack the prey. Our species survival strength was in the coordinated effort of the team.

 Each person was used for a particular strength and was not elevated to another position on the team just because they had been on the hunt before.

 Those who did not hunt, gathered the resources needed to support the hunters.

 Gatherers developed other skills, such as baker, clothing maker, or flint knapper that could be bartered for other food stuffs.

Then the industrial revolution came and we moved to a system of hundreds doing the same mechanical thing. Corporate logos replaced tribal banners. We lost the ability to speak within the total group. Each worker became a number on a massive assembly line. Each person was protected from individual responsibility for the quality of the finished product. Labor unions were developed around the concept of the workers' take-home pay and benefits, rather than the quality of the finished product. In the same method, education became an assembly line basis. The three Rs (Respect, Responsibility, Recognition) taught at home or in the village school for proficiency gave way to the public/private school system, with grades awarded to increase the evaluation capabilities. Now, in veterinary medical training, many "new thinkers" are starting to ask, "If we are selecting the best of the best, with the highest drive, why should there be losers and winners in our professional education system?"

The Commitment

It would be unrealistic to expect a national reversion, but things can be changed to increase personal responsibility at the practice level again. Taking the competition out of the life of students and workers by eliminating grades, as well as merit pay, would devastate the average American. Teaching team cooperation and goal achievement can be implemented concurrently with existing programs, and eventually, people will shift their paradigms based on the management three Rs (Respect, Responsibility, Recognition) being equitably applied on a daily basis. Giving workers the opportunity to do their job right means giving them the charter to make it better each day. This is called Total Quality Management, as read in works by Juran or Deming for TQM concepts and principles, or Continuous Quality Improvement (CQI) in healthcare delivery, explained further in Chapter Seven of this text.

Put solid values and standards into the framework of your practice image (flag) and promote systems that will bring achievement and recognition back into the practice.

The methods and philosophies to use were originally tested and promoted by W. Edwards Deming, the driving force behind Japan's economic growth. In fact, the highest award that the Japanese developed to recognize outstanding quality is called the "Deming Prize for Quality Control." James Barksdale, Chief Operating Officer of Federal Express, states the only permanent piece of paper on his desk is the Deming management principles.

We know from Tom Peters that Federal Express has developed a cutting, competitive edge by empowering its people to act for the good of the company without prior permission. This is the human resources commitment that underlies the American industrial success stories of all the leading companies of the 1990s. These commitments to human resource excellence will become the mandate in the new millennium for every business.

While the Western industry standards declined, W. Edwards Deming was the moving force to establish quality as an industry standard in Japan. I have taken the liberty of slightly modifying the original fourteen management principles developed by Deming and have come up with key elements for veterinary practices.

Deming's Steps to Quality, Modified for Veterinary Practices

1.  Create a constancy of purpose, in the areas of innovation, research, education, and continuous improvement and maintenance, to improve healthcare delivery and client-centered service to become competitive, stay in business, and provide jobs.

2.  Adopt a new philosophy of total quality management (TQM) that matches this economic age. That is, reliable quality service reduces costs. Awaken to the professional competitive challenge, learn the practice management responsibilities, and address the internal leadership that can be used to make changes occur.

3.  Cease dependence on mass inspection, inspecting bad quality out. Eliminate inspection for mistakes. Start to build in new quality. Effectively train, with a caring attitude, and help them to learn to do it right the first time.

4.  End the practice of awarding business on price tag alone, the mind-set that contaminates internal operations.

5.  Putting out fires is not important. Collectively and individually, improve constantly, and forever, the system of production and services.

6.  Institute training and retraining by skilled and knowledgeable trainers. It is very difficult to erase improper training.

7.  Institute leadership. Discover the barriers that prevent workers from taking pride in what they do and eliminate the causes. The aim of leadership should be to help the paraprofessional staff to do a better job.

8.  Drive out fear! Preserving the status quo is safe, secure, and an economic disaster. Admit mistakes, allow people to take risks, then build on discoveries, rather than habits.

9.  Break down all barriers between front and back staff. Management creates the teamwork responsibility for system improvements, rather than dividing the blame for some learning opportunity of the past, as in "a mistake".

10.  Eliminate the slogan of the month, exhortations, and numerical targets for the work force. Center on quality of healthcare delivery. If they can't reach production targets, they will come to ignore them. Give them gain-sharing, and they will pursue the excellence that causes it to recur.

11.  Eliminate the numerical quotas and quantity goals that are based on other people's performance within the practice or veterinary industry. They impede quality more than any other single factor. Define the expected quality and promote personal pride, not numbers. Always be the patient's advocate and speak for the needs. All else will follow this quest.

12.  Remove barriers that rob staff of their right to take pride in their workmanship and performance. People are hired because they are motivated. Build on this trait.

13.  Institute a vigorous program of paraprofessional continuing education, both on-site and at central meetings, self-improvement, and retraining. The education must fit people into new jobs and responsibilities.

14.  Take action to accomplish the transformation. Put everybody to work to accomplish the practice transition. Use the PDCA cycle: Plan, Do a test/trial, Check results, and Act.

Deming states that the above concepts, used together, will result in a continuous quality improvement, but it takes management courage. It is now becoming more than just "client-centered patient advocacy". It is becoming the rate and volume of the improvements made to the client-centered patient advocacy. The most management courage I can perceive of, for a veterinary practice or veterinary association, is offered in Chapter Nine of this text, "Models and Methods That Drive Breakthrough Performance". The elements have been used individually, or sequentially, in the business marketplace, with high success rates. A few in human healthcare facilities have individually used each of the three systems, but no one has implemented the new Chapter Nine model from just reading about it, although companies like USAA think they may. I believe that only about forty percent of the veterinary practices today are ready to use the Chapter Nine models and methods as their improvement doctrine.