Tag: personal

Lean Management Theory

Lean Management Theory

 

  1. “The concept of 5S is just one of several key elements of the lean principle, which is designed to improve efficiency in the workplace while promoting organization and cleanliness.”

 

I can remember my teenage years. I started working at the age of 12 as a ranch hand and continued to work through this day. During those years, I worked as much as I was needed, because $20 was more attractive than anything else that I was doing with my time. My room was a disaster. I had trails in order to go from the door to the bed and another trail to get to the dresser. Fast forward 7 years, I was working at Sam’s Club 8298 during the overnight shift. I was nicknamed “The Tornado”. I could stock off a pallet faster than anyone else in the club. At times, they had to have someone come behind me to clean up after me, because it was faster to let me do all of the heavy work and pay someone else to do the “easy” stuff”. Continue to fast forward to one year ago, I was the most productive therapist in the clinic, priding myself in how many patients I could treat in a day, and still get good results of course. Fast forward to today, I realize that none of that matters. If I can teach people to do what I do, then I can help to create systems, which is now more interesting to me than simply stocking shelves, feeding horses, or treating patients. Don’t get me wrong, I enjoy treating patients, but I can only effect one person at a time. That is not as productive as creating systems to treat 10’s of patients at once, with the same treatment philosophy and outcomes. I now realize the importance of cleaning up my room, 36 years later.

 

  1. “The 5 “S’s” in Japanese are Seiri (tininess), Seiton (orderliness), Seiso (cleanliness), Seiketsu (standardization), and Shitsuke (discipline)”

 

Am I the only one imagining Myagi-son saying these words with emphasis? It sounds do formal and warrior-like.

 

  1. “In its simplest form it is designed to keep the workplace safe and organized without regard to size or pace”

 

When I worked at Sam’s, I could do aisles per night without ever tiring. Now, I left all of the cleaning until the end of the night (unless of course they had someone come over and clean up after me). What was the problem with waiting until the end of the shift to clean? I made everyone else’s jobs harder by taking up so much space that it was hard to get a forklift down my aisle during the shift. It was very productive for me, but I slowed down the entire team. It took years to figure this out, but my zealousness of productivity may be a detriment to the team.

 

  1. “The goal of the 5S is to remove waste, both actual and conceptual, by eliminating excess inventory and out-of-stock supplies, and reducing wasted time searching for, getting to , and waiting for supplies”

 

This is but one example. Think of the 20,000 foot view of eliminating waste (both in terms of stuff not used, and time spent on stuff not needed). I try to listen to multiple podcasts per day, and this concept is spoken of in many shows such as EntreLeadership, Barbell business, Tim Ferriss, and The School of Greatness.

 

  1. “Keep only what is necessary”

 

This is hard to do, especially when thinking of “what if”. I have like 8 pairs of jeans, but will only wear the jeans that don’t restrict my squat, namely 2 pairs. This means that at the end of my closet, I have 6 pairs of jeans that haven’t been worn in a long time, just in case I need to wear a third pair of jeans. The clutter in the closet would be removed if I just donated or sold the other pairs of jeans. Parting with any thing that we “own” is hard because we can always create scenarios in which those “things” are needed. Unfortunately, that same scenario never plays out in real life.

 

  1. “…identify, organize, and arrange everything in the work area, so that items can be efficiently and effectively retrieved…Everything should have a place and a purpose”

 

I suck at this step. Good story. I am on a team that is very close in terms of trust and partnership at work. There is a long running joke that I am Oscar and my supervisor is Felix. Hang out with us enough and it becomes obvious to those that understand the metaphor. I am learning that I need to become more like Felix in order to improve professionally. (For those that don’t understand the metaphor, go look up the Odd Couple…and nothing that was produced after 1990).

 

  1. “Once you have everything sorted and set, it is important to keep it that way…requires regular cleaning”

 

Because I suck at the previous step, this is also not a strong point for me. I know where I want to keep things, but for some unknown reason my way is not always the best way for everyone else. I struggle with the regular cleaning step. When I worked at PT and Spine, Bill was a stickler for standard operating procedures (SOPs). It wasn’t written, but he had a way that he like the clinic cleaned every night before locking the door. There was a proper way to open and close the clinic. Because I don’t have that type of standard at the place I work now, it makes it difficult to put everything in its place. I know that it sounds corny to think that there should be a standard operating procedure for the little things, but go back and listen to barbell business’ SOPs episode and it will all make sense.

 

  1. “Develop written structures and standards that will support the new practices and turn them into habits”

 

I am hard headed at some things. When it comes to organization, I have the ability to learn it, but I am a slow learner. I can spout off statistics on back pain, I can assess/treat darn near anything coming into the door, but performing organizations skills and all of a sudden…DUH? In Bill’s clinic, I was there for 2 years and by the time I left, I was able to leave the clinic in the exact way that I found it.

 

Funny story though: My dad is a Vietnam Vet (101st Airborne medic) and he could tell if something in his room moved while he was at work. Needless to say, if I wanted to be discreet, I could be. Unfortunately, this same discreetness doesn’t carry over to other situations.

 

  1. “Standardize is one of the harder steps in 5s as it calls for changing habits”

 

If I were a clinic owner, I would only hire new graduates that performed a clinical with me. It just seems much easier to teach what I find works best than to unteach stuff that I don’t like or research doesn’t support and then teach what I do prefer. This being said, being in a clinic with people who have much “experience” makes creating new standards difficult. Clinicians can be set in their ways and change can be scary. It is less scary for those that don’t know any better.

 

Excerpts taken from:

Spradling SC. Practice Management Systems: Add value to your practice by “5S’ing”. Impact. June 2016:31-32.

Unleashed upon the world

I work in a small community hospital. At this hospital, I have been blessed to work with people that are really good at what they do. We all expect excellence with our specific niches, and it’s great to call them colleagues.

In this location, I also get many students (physical therapy students) and volunteers (hopeful to get into PT school). There are some students that I wonder how they got into the program and they force me to worry about the direction that our profession is going. This has nothing to do with knowledge, but with passion, excitement, initiative, confidence, and people skills.

Every once in a while I come across students that make me sit back and enjoy. It’s like watching a Picasso at work. They have people skills mixed with passion, integrity, knowledge and time spent in the books.

It’s disheartening to hear of some student’s clinical internships. For instance, a recent student’s experience was nothing more than that of a PT mill. The student reports doing the same intervention to all patients with a similar diagnoses. There was no classification, there was no critical thinking and the student then passed the patient off to an aide once the manual therapy portion of the session was over.

This is why I am an CI. Students deserve to learn the craft of Physical Therapy. There are many short-cuts. There are ways to maximize profit, but the ways to maximize profit, by performing said short-cuts, doesn’t typically translate into proper patient care.

We all have what’s called the sniff test. If it smells bad…it probably is. I take mine a couple of steps further and call it the “I’m disappointed in you” test. I’m 36 years old and can remember the one and only time that I heard these words from my Dad. It hurt enough that I don’t want to hear those words again. When I am practicing and treating patients, I think to myself; “Does this pass the sniff test? Would my Dad be disappointed with how I treated a patient?” It doesn’t take much people.

We recently were required to take 3 hours of ethics courses per renewal period (every 2 years). I know…it doesn’t sound like much, and it isn’t, but these 3 hours that I spend “learning” ethics are 3 hours that could be spent learning the latest/greatest interventions to treat problems. You know why we have to take ethics courses? Because there are some in our profession that are not practicing in an ethical manner. Mr. Pelligrini from Providence (my high school), on day one, wrote a big dollar sign on the chalkboard (do they even use these anymore?) and he proceeded to walk up to the $ and bow to it. This was day one. In high school, he was probably the hardest teacher that I had, but having grown a little older and more mature, that guy was so full of knowledge that is coming true during these times. I won’t go into it, because I am trying to avoid political blogging, but just know that he was wise beyond his years.

Unfortunately, many in our profession are bowing down to the almighty $. Why? When I poll students, they are graduating with over $150,000 of cumulative student loan debt. These students have a house payment…without the house. Therefore, these students will be forced to make decisions that take salary and bonuses into account. I have listened to over years of Dave Ramsey on the Podcast and unfortunately most students don’t live by his principles. Hard at first, but allows for ethical decision making professionally. When students don’t have to worry about how they are going to pay back their student loans, they can make more altruistic and personally satisfying decisions in his/her career, instead of chasing the $.

If you are applying to PT school, do your research! How much is that school going to cost you in total? Are there scholarships? How much is that school going to cost you per month when you graduate? Can you graduate without taking on any debt? How much will your starting salary be? What type of lifestyle do you want to lead and will this profession allow for that type of lifestyle?

Having lectured to many students prior to getting into the profession, many students have never even considered these questions. It’s sad, but it becomes easier for companies to play the puppetmaster because it is known that the students have to pay that loan monthly and they can’t do it without a high paying job.

Schools need to hear this and start offering financial planning courses. It’s sad that we take a student and have them rack up $150,000 in debt, but never prepare them for how to start paying that money back, saving for retirement, choosing an ethical job position, etc.

I went on a rant, but it’s on my mind this morning.

Master of all or jack of none

A lifetime of exercise when compared to an IRA versus starting late comparing to lost interest.
You know…I spent a heck of a lot of time studying the spine. Over the years, reading at least 1 hour per week since 2007, I would anticipate that I read over 900 journal articles since entering the profession. Since more than 80% of those are on orthopedic issues, I would say that I have a put a lot of deposits into my bank of ortho care. At this point, I am just reading spine stuff for fun. 
I liken this to putting in deposits, over the course of time, into a retirement fund. After much time, you can see how the little deposits over time add up to millions of dollars. That’s how I feel about spine stuff. 
Now, I am trying my darnedest to learn vestibular stuff. It is taking an inordinate amount of time in order to learn the basics. I am so far behind those that are experts in the field that I feel like a baby on the subject. I liken this to the person that hasn’t saved for retirement. I have to frantically read and learn as much information in as short a time period as possible in order to be even minimally competent to treat these disorders. I am learning, but the process is slow. 
There is an argument regarding training your weaknesses in order to get better or making your strengths stronger. 
I have to spend a lot of time to get a little better at treating one disorder, when I was so used to spending a little time to make huge jumps treating others. 
The struggle is real. It’s hard to find that master of all trades. Usually you’ll just find the jack of none. 

Whatcha lookin at? Part III

Whatcha lookin at? Part III

 

The topic of the day is overall wellness of the individual and of society as a whole. I have some strong opinions regarding this and if you disagree with what I right, that’s your prerogative. Please leave a comment stating why you disagree.

 

  1. “ Work Well-Being Dimension satisfies the thirst for purpose…need for fulfilling a purpose in ones’ vocation”

 

This is important. Think of all of the people on disability, whether short or long-term. If there is no purpose, then how empty are we? This reminds me of a story: My dad…my Superman retired in 2005-ish. When he retired, he asked me about some symptoms he was having. Coughing up blood and difficulty sleeping. He attributed it to getting kecked by a horse in the previous week. I saw red flags. One thing led to another and he was initially thought to have lung cancer. The man didn’t smoke and as long as I can remember never smoked. After retirement, he spent his time sitting around watching Bonanza. He had a surgery and removed a mass from his left lower lobe, which was non-cancerous, but was due to a bacterial infection. This is a moot point, because the bacterial infection would have killed him also. Anyway, after the surgery, my brother bought him a horse. He found a new passion…a new purpose. My dad is healthier now than I have seen him in a long time. My mom doesn’t particularly like his spending time with the horses, but he has a purpose. My mom still searches.

 

We all need a purpose…we all need a why. If you don’t have one, keep looking because someone we all have talents and can all be helpful to someone else if we take the time.

 

  1. “Play Well-Being Dimension acknowledges that play provides the individual

with laughter, cheer, energy, and balance”

 

From the work well-being to the play well-being. I think that we have confused busyness with work and/or play. For instance, many of us say that we are busy when asked how we are doing, as if busy-ness implies that we are working. This is not always the case. I am way more productive when I am not busy. Play is difficult for many people because we, I , forgot what it means to be “unbusy”. This time of laughter and cheer. Having a daughter has greatly helped, a I recently went down a sslide for the first time in a long time. If you know me, then you can image “big guy in a little coat”. That’s how it felt going down the slide.

 

  1. ‘Well-Being of Our World Dimension reflects an individual’s perceptive on living in a healthy environment and protecting natural resources…broad overview of the world…responsibility, justice, an earth-caring lifestyle, a desire of well-being for all”

 

I don’t know if I agree with this dimension totally. As much as I am for a “green” environment, I don’t know how much someone’s throwing away electronics affects me personally. I won’t judge someone taking plastic over paper. Short story: While in Poland, we went to the grocery store weekly. We had to pay for every bag that we used. It was about a nickel in US dollars. Although it wasn’t much, remember that people there don’t make as much as we do here, so this is a major sacrifice in order to carry the groceries out of the store.

 

  1. “Even when a individual presents with signs and symptoms of pathology, education of secondary complications prevents further signs and symptoms leading to disability”

 

I see many patients with low back pain. Most of these patients come into the clinic looking for one thing (and research shows this is the number one thing that patient’s want): education. They want to know why they are experiencing symptoms and how can they go about fixing themselves. If we can educate patients or society as a whole regarding normal compared to abnormal experiences, there may be less disability.

 

  1. “Prevention practice encompasses health care designed to promote health, fitness, and wellness through education and appropriate guidance designed to prevent or delay the progression of pathology”

 

Those promoting health should also demonstrate a healthy lifestyle. Without a doubt, if I passed you on the street, you may ask “Do you even lift bro?”, but I can squat with the best of them (drug free of course). Many therapists don’t allow for time in their day to exercise and to me this is hypocrisy, seeing as exercise is the intervention charged the most in our profession.   It’s like a Doctor telling you to quit smoking though you see the stains on the fingernails. Hypocrisy!

 

  1. “Preventive care also includes instruction to minimize or eliminate injurious forces throughout daily life. This instruction includes recommendations to optimize conditions for performance, whether the performance is related to simple activities of daily living, work activities, leisure activities or activities related to competitive sports”

 

Robin McKenzie, Shirley Sahrmann, Stuart McGill, Brian Mulligan, Florence Kendall, Geoff Maitland, Stanley Paris: These are the giants of the previous century. They took therapy and principles of health to the health care practitioner. Giants of today are: Grey Cook, Kelly Starrett, Quin Henoch, Therapy Insiders, Barbell Shrugged guys, because they are taking healthcare to the patient.

 

As a PT, I can affect one patient per hour. Writing this blog, I have already affected twice as many people and I only hope for exponential growth.

 

Excerpts taken from the following:

 

Thompson CR. Prevention Practice: A Holistic Perspective for Physical Therapy. In: Prevention Practice: A Physical Therapist’s Guide to Health, Fitness, and Wellness. Thorofare, NJ: SLACK Incorporated:2007.

 

Whatcha lookin at? Part II

Whatcha lookin at? Part II

 

7.”Physical wellness is the positive perception and expectation of health…the ability to effectively meet daily demands at work and to use free time”

This is what my job mostly entails.  As a PT, I get to give people their physical wellness back.  Typically, we see patients because some aspect of their life is giving them pain and therefore preventing them from living their life as they would like.

  1. “Spiritual wellness is the belief in a unifying force between the mind and body…establish values and act on a system of beliefs as well as to establish and carry out meaningful and constructive lifetime goals”

When things get put into this perspective, it means more than simply religion.  What is your end-goal? We have a beautiful family with a daughter and hopefully many more on the way.  My end-goal is to leave a legacy that my family can be proud of.  I look at my dad, Sal Gutierrez, and see my Superman.  I want my kids to be able to look at me and say, “There goes my Superman.”

I want to leave my mark on this world.  The words that I write today will outlive me by centuries.  This is my journal.  Although this article is much different than the previous ones, this is much more enjoyable to reflect upon than simply the cause and treatment of back pain.

  1. “Social wellness is the perception of having support available from family or friends in times of need and the perception of being a valued support provider…establish meaningful relationships that enhance the quality of life for all people involved”

I think back to the book “The Prince” by Machiavelli (sp?).  A leader can either be feared or be loved.  I think of my family (by either blood or experience) and know that if they ask me to jump, I will ask when, where, and how high.  This is out of love, but not fear.  I know that I have family that will do this, as evidence by our wedding and people flying across the country at short notice.  I hope that I am the same type of family to those that I surround myself.

  1. “Psychological wellness is a general perception that one will experience positive outcomes to the events and circumstances in life…positive outlook about life…qualities of optimism, determination, and hope”

This one is huge.  I have had many patients tell me that the most important thing that I give in the treatment is hope.  This is emotional for me because although it is great to be able to change someone’s pain, it is much better to be able to change someone’s outlook.  Hope, determination and optimism.  I think of how the tale of two lives.  Growing up on the East side of Joliet, life wasn’t white picket fences. My life could have turned out completely different, but thankfully my parents were determined to give me better and we moved to a small farming community.  The nature vs nurture debate couldn’t have been stronger internally.  As much as I like to think that I did the whole bootstrap thing, I have to fully acknowledge that the environment I was in allowed for hope and optimism.  Thankfully, I have a circle around me that also shares in these traits.  Many have said it, from Tim Ferriss to Dave Ramsey, ” we are an average of the 5 people that we choose to spend our time with”. I am grateful my 5 guys made me better instead of brought me down.

  1. “Emotional wellness is the progression of a secure self-identity and a positive sense of self-regard, both of which are facets of self-esteem…ability to cope with daily circumstances and to deal with personal feelings in a positive, optimistic and constructive manner”

I think of this portion of wellness frequently. It is not uncommon that I am treating a child with a parent present or an elderly parent with a middle age child present. The patient may not be able to cope with the situation that brought them into the clinic, but the caregivers can either break or heal the situation. Some caregivers come across as apathetic, which makes sense as to why the patient doesn’t want better for him/herself. No offense if you are a caregiver, but please step outside of the situation and look into the situation with a fresh perspective. If you were watching as a third party, would you be proud or ashamed of how you act?

Some people don’t have the capabilities to deal with daily circumstances. Like I said previously, my brother died of a drug overdose. His life was full of obstacles…whose isn’t. Just my opinion, but I don’t think that it is a major event that causes people to lose hope and spiral downward, but more of a “straw that broke the camel’s back”. I think that there were too many straws in my brother’s case. Looking back though, as his brother, there is shame and guilt that I didn’t see this coming. Think of how this comes full circle. One person’s emotional wellness, or any wellness for that manner, can affect those that are in close proximity (either physically or emotionally). When at work, I do my best to ensure that my wellness is overpowering to those around me in order to bring up the other person’s wellness aspects. When there is a patient whose emotional, physical or social wellness overpowers my own…I sit back and allow that person to bring me up.

Good story. I had a patient that was in his 90’s. He was coming to therapy for balance issues. He noted that his “balance wasn’t what it used to be”. I agreed and said that my balance probably isn’t as good as it was 10 years ago. He then proceeded to stand on one foot for two minutes and stand on one foot with his eyes closed for a minute. My jaw dropped. At this point, I realized that this guy didn’t need me. If anything, I needed to learn from him. I asked him; “What did you do for a living and how did you get to be in this good of shape at your age?” He gave me a history lesson and noted that the year the Olympics were boycotted by the US, he was in the trials for the 100 m dash. He trained and trained for years in order to qualify for the Olympics, only to have his dreams squashed that year. He then quit sports and went on to a physical job as a track coach. He was still performing sprints into his 80’s. This also reminds me of another athletic relic in our country, Zygmunt Smalcerz. Look him up now! I’ll wait.

  1. “Intellectual wellness is the perception of being internally energized by an optimal amount of intellectually stimulating activity…not so overwhelming that there is no time for mental repose…includes a person’s ability to learn and use information”

This is very important in our society today. Everyone speaks of the watering down of higher education, in that you have more difficulty obtaining work with a BA/BS today than you did 30 years ago. More students are moving on to MA/MA or DPT’s (in my own case) than ever in the history of our country or my profession. The reason for this is that a job is not waiting at the other end. Our current kids (mine included) has more screen time than any generation previously. This screen time, although we can rationalize why it is good for our child, is really a way to allow for us to have a cheap babysitter.

  1. “Howard Clinebell” introduced other dimensions of well-being with the addition of the relationship, work,play and well being of our world dimensions.
  2. “Relationship Well-Being Dimension represents the most important factor for our healing and general wellness…need for nurturing and love, for giving and receiving, for empowering others, and for creating interpersonal bonds”

It has been said by Dave Ramsey that next year we will the same person as we are this year except for the people that we meet and the books that we read. People change us. I meet some patients at work that just completely upset me and make me make changes due to some of their perceptions on life. I meet others, like that track star, that make me think there is no reason not be healthy as an elder…other than decisions that we make in our younger years.

I try my best to be a positive influence to those people that I come in contact with, but sometimes it is not easy.

Everyone needs love in his/her life. Personal Story: My parents divorced when I was young. I don’t remember my mom much as a kid because my dad took care of us, and he did an awesome job with me…in my opinion. Again, my superman. Back to the point, when one is devoid of love, a cynical or angry perspective of the world can seep into our being. I was angry for a very long time because I stopped having contact with my mom when I was still young. She walked away. I was angry and had trust issues for a very long time. Think about it…if the person that you are inherently supposed to be able to place all of your trust into does something so terrible as to destroy that trust, then who can you trust. In the words of Stone Cold Steve Austin DTA. It took me over 2 decades to come to terms with the situation that happened when I was still a kid. Life is good now and I very much understand the concept of the “need for nurturing and love”

Excerpts taken from the following:

 

Thompson CR. Prevention Practice: A Holistic Perspective for Physical Therapy. In: Prevention Practice: A Physical Therapist’s Guide to Health, Fitness, and Wellness. Thorofare, NJ: SLACK Incorporated:2007.

Stay tuned for part III