Reviews FEBRUARY 2009, VOL 89, NO 2

AORN JOURNAL • 427

Lean Hospitals: ImprovingQuality, Patient Safety, andEmployee Satisfaction Mark GrabanTaylor & Francis Group, LLC2008, 280 pages$45 hardcover

This book details concepts ofthe Toyota production system,drawing parallels betweenissues in manufacturing andthose in health care. The authorspent several years in the man-ufacturing field and then devel-oped an interest in applyingmany of the successful Toyota

methods to health care. While Toyota did notdevelop Lean, it has been used successfully toimprove Toyota’s manufacturing process, fromcost cutting to positive employee relations.

The book begins with a description of

Lean—a tool set meant to reduce health carecosts and waste, while valuing employeeinput—and explains how issues in manufactur-ing are similar to those in health care. The ulti-mate goals of Lean are improved quality andflow processes, decreased costs, and increasedproductivity. The book’s 12 chapters each buildon the previous one and end with take-awayideas and thought-provoking questions.

The book contains some charts, which helpto create a visualization of the ideas. The chartsare not overwhelming to the reader, however.

Lean methods need to be applied to healthcare, according to the author. This is especiallytrue given the current environment of in -creased health care costs and nonpaymentfrom the Centers for Medicare and MedicaidServices for care necessitated by preventablehealth care-associated injuries, two majorforces that will contribute to shrinking reim-bursement dollars for hospitals.

The author recognizes that implementingLean can be a challenge given the existinghealth care management cultures. Although it

for myocardial infarction. As I read throughthe book, however, I kept changing my mindabout the benefits of this type of interviewing.Then I began to realize that I already use someof the MI interviewing techniques with pa -tients. In the OR setting, it is common to askclosed questions to get answers in a conciseand timely manner. Even though the MI tech-nique uses open questions, the authors showthat it takes no longer than any other inter-viewing technique. The authors demonstratethis with actual patient interviews that guidethe patient to become more of a participant inhis or her treatment.

In addition to getting patients more involvedin their own care, the MI technique can be usedto facilitate positive change in an environment.The authors used an example of public healthpromotion. The MI technique was used to pro-mote the use of chlorine for water purification inregions of Zambia. The team that used the MItechnique to promote public health showed anincrease in chlorine sales in their area.

At the back of the book, there is an extensive

bibliography that is divided into several sub -titled sections. Also, summaries of each page arewritten on many pages for quick reference andare useful for referring back to specific sections.

The list of health care workers that could ben-efit from this book is extensive. To quote theauthors, it could help “any health care practi-tioner who spends time encouraging patients toconsider behavior change.” I would recommendit to nurses in the clinical area who have patientswho need to modify their behavior for optimalhealth and to managers who could benefit fromthis type of interviewing to promote positivechange in their staff and department. Theauthors are well qualified in both education andexperience. They have written several otherbooks on MI, but this one is specifically forhealth care workers.

PAMELA G. ZIMMERMANRN, BSN, CNOR

STAFF NURSE

EAST JEFFERSON GENERAL HOSPITAL

METAIRIE, LA

FEBRUARY 2009, VOL 89, NO 2 Reviews

428 • AORN JOURNAL

is a fairly new concept to hospitals—intro-duced in the 1990s—the author des cribes sev-eral hospitals across the country that have hadsuccess using Lean principles. The book exam-ines waste in health care (eg, poor design ofpower supply storage layout) and offers sug-gestions to improve, including having man-agers observe what is or is not working intheir respective departments so they will real-ize that they require interdepartmental collab-oration to meet the desired outcome. Hos -pitals must emphasize quality, which ulti-mately leads to better outcomes and improvedpatient safety.

While hospitals currently are implementingerror-reduction strategies (eg, time outs, surgi-cal site marking, do-not-use abbreviations), theymust continually strive to do better becauseerrors still occur. Hospitals need to look at prob-lem areas, such as patient safety and units withcontinual staff shortages. They also need to lis-ten to physicians and engage their talented staffmembers to come up with ways to make workflow and optimize existing pro cesses. Hospitaladministrators and managers must engage their

staff members to want to make improvements,as well as provide coach ing. Admin istratorsalso must place people in management posi-tions who know how to lead and who alwayshave the big picture in view, as opposed tomanagers who do not seek other opinions.

The trend is for costs to increase and reim-bursements to shrink; therefore, Lean method-ologies are something hospitals cannot affordnot to implement. This book, although not ahow-to guide, will provide hospital leaderswith ideas and ways to eliminate waste as wellas control costs while providing quality servicesto both patients and employees. Hospitals con-tinually need to achieve quality and lower costsgiven the current economic climate of financialcutbacks and the competition for health caredollars. This book can provide the steps neces-sary to get the process started.

SANDRA LASHRN, CNOR

OR CLINICAL EDUCATOR

EPHRATA COMMUNITY HOSPITAL

EPHRATA, PA

Arecent study by the Centers for Disease Controland Prevention (CDC) indicated that using assist-

ed reproductive technology (ART) may increase therisk of infants being born with certain birth defects,according to a November 17, 2008, news releasefrom the CDC. The study looked at 281 births con-ceived with ART and 14,095 births conceived with-out infertility treatments.

Compared to infants born without the use offertility treatments, infants born with the help ofART (ie, any procedure that involves surgicallyremoving eggs from a woman’s ovaries, combiningthem with sperm in a laboratory, and returning themto the woman’s body or donating them to anotherwoman) were • two times more likely to have heart defects, • two times more likely to have a cleft lip with or

without cleft palate, and • more than four times more likely to have various

gastrointestinal defects. The study examined single births separately

from multiple births because ART often results inmultiple births, which automatically increases therisk of certain birth defects. Although the risk ofbirth defects is higher using ART, the chances ofdeveloping these defects remains low with a risk ofapproximately one in 425 infants conceived withART being affected by a cleft lip with or withoutcleft palate in the United States.

National birth defects prevention study shows assistedreproductive technology is associated with an increased riskof certain birth defects [news release]. Atlanta, GA: Centersfor Disease Control and Prevention; November 17, 2008.

Birth Defect Risks Rise with Assisted Reproductive Technology