1. Harris, Catherine MSN MBA CRNP CNRN

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Going Lean: Busting Barriers to Patient Flow

A. C. Smith, R. Barry, & C. E. Brubaker, Chicago, IL: Health Administration Press, 2007, 191 pages, $72.00, ISBN 13:978-1-56793-281-2.


Going Lean: Busting Barriers to Patient Flow (Going Lean) is an easy-to-read book about improving patient satisfaction in healthcare through the principles of business economics. The book is geared to senior management of healthcare organizations but is accessible to a general audience. The authors have impressive credentials in business and medicine, which make their perspectives and contributions notable and worthy of attention. They are leaders in their area of expertise who not only have written extensively on this topic but also have first-hand experience in dealing with the situations they present.


The book is 191 pages and is broken down into three parts. In the first part, "Getting Started," the authors pose the question, "why is this patient still here?" They show how healthcare systems are erroneously designed to process maximal efficiency for locality instead of directing all resources to maximal patient flow. The authors argue that efficiency for the organization and what is best for the patient are not the same thing. According to the Going Lean method, initial costs and seemingly inefficient methods to improve patient flow are more than substantially made up in the overall organization, which is where healthcare administrators should benchmark their successes. In this first section, the authors explain the problems and costs of bottlenecks that inevitably occur in every system. These problems are caused by individual departments maximizing their own efficiencies, which comes at the expense of patient satisfaction and ultimately increased costs to the organization.


The second part of the book gives examples of improving bottlenecks through the application of the Going Lean method in the setting of clinics and laboratories. The overall message in this section seems to be knowing the structure and flow of the organization and discovering where the bottlenecks occur. There is little doubt that being better organized is the key to better patient flow.


Finally, in the third part of the book, the Going Lean method is applied and examined in the hospital setting. Chaotic departments, such as the emergency department, and the uncertainty of the operating room and the intensive care units are addressed in the chapters in this section. If you do not believe that patient flow can be predicted, organized, and facilitated, the book offers numerous success stories of hospitals who have used the Going Lean method effectively.


Overall, the book is easy to read and is accessible to a general population. Many parts of it read like an infomercial set on selling the reader something unbelievable. The book remains completely dependent and biased on select case studies that highlight only success stories. There is no self-reflection on institutions that may have had trouble implementing the Going Lean method or failed to find benefits with the method. In fact, the reader is left to believe that no such cases exist. The how-to methodology is vague and left to the imagination of the reader; although if one gets stuck, the authors provide names and phone numbers of reputable consulting companies to call, disclaiming any conflict of interest.


Overall, the book is interesting, providing an abstract conception of an idealized panacea for healthcare (dis)organization. It may not be the cure-all, but the book does provide useful insight into many everyday issues that plague healthcare administration in hospitals and clinics. Un-obstructing patient flow is a lofty goal in any setting and should receive serious consideration and thought from the entire organization.


Reviewed by Catherine Harris, MSN MBA CRNP CNRN, Jefferson Hospital for Neuroscience, Philadelphia, PA.