- Email: [email protected]
Applying Lean in Healthcare
REVIEWS
www.aornjournal.org
throughout the book that are distracting for the reader. In addition, Dr Roth advocates for nonpolitical approaches to managing the health care system but is critical of those people he labels as “conservatives” for the views that he attributes to them. All in all though, the book will help readers understand the current state of the US health care system, as well as the state of other countries to which the United States is often compared. This book would be useful for policy makers as well as for graduate students in various health care and related fields. Although there are many omitted details, the book provides a starting point for discussions about US health care reform without the emotional misrepresentations that are, unfortunately, a part of the debate about health care in this country. YVONNE FORD PhD, RN, CNOR ASSISTANT PROFESSOR WESTERN MICHIGAN UNIVERSITY BRONSON SCHOOL OF NURSING KALAMAZOO, MI doi: 10.1016/j.aorn.2010.11.023
Applying Lean in Healthcare Joe Aherne and John Whelton, eds Productivity Press 2010, 247 pages $49.95 hardcover Many people in health care facilities have heard the buzz word “Lean” in regard to providing patient services. As a nurse, I count myself as one of the health care providers who wonders what a Lean Green Belt or Lean Black Belt person in my organization does and how Lean affects my daily practice. This book started to answer some of those questions.
Editors Joe Aherne and John Whelton, working through the Leading Edge Group, which provides consulting services and Lean thinking educational programs for health care organizations as well as other businesses, have compiled 11 case studies from the United States and abroad. Through these detailed case studies, the editors show the reader how Lean can be used. Through each case study, the reader learns that Lean thinking is a continuous pursuit of perfection, a never-ending journey rather than a once-and-done project. The reader, however, is not immediately plunged into these sometimes-technical case studies. Aherne and Whelton take time to introduce what Lean is. According to the well-written introduction, Lean processes started in the Toyota Corporation in the 1960s. The final chapter gives further detail, noting that Lean thinking was developed in the Toyoda family textile business in the 1800s before it was applied to what has now become the well-known Toyota automobile manufacturing business. (Toyoda is the Japanese family name behind the Toyota Corporation.) Lean thinking is not new; it is just relatively new to the health care sector. In a nutshell, Lean thinking is a philosophy that encourages constant re-evaluation of business practices to reduce waste; provide more efficient, responsive customer service; and increase service and revenue. The editors note that applying Lean thinking to health care practices is not intended to decrease staff numbers but rather to help staff members reach their maximum potential. Lean thinking in health care can be used for several purposes: decrease costs while elevating patient satisfaction (eg, by reducing waiting room time), improve quality of health care services with the current workforce, increase employee motivation and job satisfaction, and maintain the highest quality of service to patients.
AORN Journal
309
February 2011
Vol 93
The case studies included here show how Lean thinking is being applied to preadmission testing areas, supply rooms, and outpatient clinics, as well as for delivering food to patients and reducing OR cancellations. Each case study is organized in an easy-to-follow SBAR format (ie, situation, background, assessment, recommendation), which is commonly used in health care communication. Illustrations, architectural schematics, photographs, tables, and worksheets that were used throughout each institution’s Lean project are included. Each case study concludes with a helpful section on results and lessons learned from the facility’s Lean thinking implementation. Nearly every case study notes that a Lean thinking project is an ongoing process and that all employees within an organization should be able to share in Lean thinking implementation. Although this book contains some technical jargon, there is an easy-to-use glossary to explain the terms. There is also a section at the end of the book that gives brief biographies of all those who contributed their institutions’ case studies. Readers interested in learning more about Lean thinking are directed to obtain further information at [email protected]. This book serves as an introduction to how Lean can be applied in health care, and it emphasizes that Lean principles can be tailored to meet the needs of corporate, manufacturing, service, food, and health care industries. For help in becoming fully immersed in the Lean philosophy and able to get a Lean program started in the workplace, readers are invited to contact the Leading Edge Group for a description of class programs: Lean Healthcare Yellow Belt Program, Lean Healthcare Green Belt Program, Lean Healthcare Black Belt Program, and others. For nurses, specifically, this learning philosophy reinforces the nursing process—assessment, diagnosis, planning care, implementing care, and evaluating/ re-evaluating patient care outcomes—that we use in our daily practices. This is a good resource 310
AORN Journal
REVIEWS
No 2
for those looking to improve patient-centered care. ELIZABETH K. MOFFATT BA, RN, CNOR STAFF NURSE PINNACLE HEALTH, HARRISBURG CAMPUS HARRISBURG, PA doi: 10.1016/j.aorn.2010.11.007
The EKG Handbook Theresa Ann Middleton Brosche Jones and Bartlett Publishers 2010, 250 pages $37.95 spiral bound This publication is well suited for the health care professional who needs to reinforce his or her knowledge of electrocardiography (EKG). As the title indicates, this is a handbook and not an exhaustive treatment of the subject. Because there is only a cursory review of fundamental concepts, it is unlikely that this reference would prove beneficial for the beginning learner. In contrast, people such as the RN, nurse practitioner, nurse anesthetist, physician, physician assistant, EKG technician, and paramedic would likely find this text useful. This book would be particularly helpful to the perioperative nurse who is responsible for administering conscious sedation, which would require monitoring and analyzing cardiac rhythms. The perioperative nurse who performs assessments in the preoperative and postoperative area, which may involve the need for cardiac rhythm monitoring, would also benefit from the information in this publication. In addition, this handbook would be practical for the nurse working in critical care, emergency/trauma, and telemetry. The reader should have a good knowledge of cardiac anatomy and physiology, and some previous exposure to EKG education would be valuable.
www.aornjournal.org
throughout the book that are distracting for the reader. In addition, Dr Roth advocates for nonpolitical approaches to managing the health care system but is critical of those people he labels as “conservatives” for the views that he attributes to them. All in all though, the book will help readers understand the current state of the US health care system, as well as the state of other countries to which the United States is often compared. This book would be useful for policy makers as well as for graduate students in various health care and related fields. Although there are many omitted details, the book provides a starting point for discussions about US health care reform without the emotional misrepresentations that are, unfortunately, a part of the debate about health care in this country. YVONNE FORD PhD, RN, CNOR ASSISTANT PROFESSOR WESTERN MICHIGAN UNIVERSITY BRONSON SCHOOL OF NURSING KALAMAZOO, MI doi: 10.1016/j.aorn.2010.11.023
Applying Lean in Healthcare Joe Aherne and John Whelton, eds Productivity Press 2010, 247 pages $49.95 hardcover Many people in health care facilities have heard the buzz word “Lean” in regard to providing patient services. As a nurse, I count myself as one of the health care providers who wonders what a Lean Green Belt or Lean Black Belt person in my organization does and how Lean affects my daily practice. This book started to answer some of those questions.
Editors Joe Aherne and John Whelton, working through the Leading Edge Group, which provides consulting services and Lean thinking educational programs for health care organizations as well as other businesses, have compiled 11 case studies from the United States and abroad. Through these detailed case studies, the editors show the reader how Lean can be used. Through each case study, the reader learns that Lean thinking is a continuous pursuit of perfection, a never-ending journey rather than a once-and-done project. The reader, however, is not immediately plunged into these sometimes-technical case studies. Aherne and Whelton take time to introduce what Lean is. According to the well-written introduction, Lean processes started in the Toyota Corporation in the 1960s. The final chapter gives further detail, noting that Lean thinking was developed in the Toyoda family textile business in the 1800s before it was applied to what has now become the well-known Toyota automobile manufacturing business. (Toyoda is the Japanese family name behind the Toyota Corporation.) Lean thinking is not new; it is just relatively new to the health care sector. In a nutshell, Lean thinking is a philosophy that encourages constant re-evaluation of business practices to reduce waste; provide more efficient, responsive customer service; and increase service and revenue. The editors note that applying Lean thinking to health care practices is not intended to decrease staff numbers but rather to help staff members reach their maximum potential. Lean thinking in health care can be used for several purposes: decrease costs while elevating patient satisfaction (eg, by reducing waiting room time), improve quality of health care services with the current workforce, increase employee motivation and job satisfaction, and maintain the highest quality of service to patients.
AORN Journal
309
February 2011
Vol 93
The case studies included here show how Lean thinking is being applied to preadmission testing areas, supply rooms, and outpatient clinics, as well as for delivering food to patients and reducing OR cancellations. Each case study is organized in an easy-to-follow SBAR format (ie, situation, background, assessment, recommendation), which is commonly used in health care communication. Illustrations, architectural schematics, photographs, tables, and worksheets that were used throughout each institution’s Lean project are included. Each case study concludes with a helpful section on results and lessons learned from the facility’s Lean thinking implementation. Nearly every case study notes that a Lean thinking project is an ongoing process and that all employees within an organization should be able to share in Lean thinking implementation. Although this book contains some technical jargon, there is an easy-to-use glossary to explain the terms. There is also a section at the end of the book that gives brief biographies of all those who contributed their institutions’ case studies. Readers interested in learning more about Lean thinking are directed to obtain further information at [email protected]. This book serves as an introduction to how Lean can be applied in health care, and it emphasizes that Lean principles can be tailored to meet the needs of corporate, manufacturing, service, food, and health care industries. For help in becoming fully immersed in the Lean philosophy and able to get a Lean program started in the workplace, readers are invited to contact the Leading Edge Group for a description of class programs: Lean Healthcare Yellow Belt Program, Lean Healthcare Green Belt Program, Lean Healthcare Black Belt Program, and others. For nurses, specifically, this learning philosophy reinforces the nursing process—assessment, diagnosis, planning care, implementing care, and evaluating/ re-evaluating patient care outcomes—that we use in our daily practices. This is a good resource 310
AORN Journal
REVIEWS
No 2
for those looking to improve patient-centered care. ELIZABETH K. MOFFATT BA, RN, CNOR STAFF NURSE PINNACLE HEALTH, HARRISBURG CAMPUS HARRISBURG, PA doi: 10.1016/j.aorn.2010.11.007
The EKG Handbook Theresa Ann Middleton Brosche Jones and Bartlett Publishers 2010, 250 pages $37.95 spiral bound This publication is well suited for the health care professional who needs to reinforce his or her knowledge of electrocardiography (EKG). As the title indicates, this is a handbook and not an exhaustive treatment of the subject. Because there is only a cursory review of fundamental concepts, it is unlikely that this reference would prove beneficial for the beginning learner. In contrast, people such as the RN, nurse practitioner, nurse anesthetist, physician, physician assistant, EKG technician, and paramedic would likely find this text useful. This book would be particularly helpful to the perioperative nurse who is responsible for administering conscious sedation, which would require monitoring and analyzing cardiac rhythms. The perioperative nurse who performs assessments in the preoperative and postoperative area, which may involve the need for cardiac rhythm monitoring, would also benefit from the information in this publication. In addition, this handbook would be practical for the nurse working in critical care, emergency/trauma, and telemetry. The reader should have a good knowledge of cardiac anatomy and physiology, and some previous exposure to EKG education would be valuable.