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  1. Carrington, Beverly RN, BSN

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As a nurse leader in the ambulatory care setting, lean principles are used in the outpatient ambulatory care setting as well. In the recent article "From Toyota to the Bedside: nurses can lead the lean way in healthcare reform," the examples of nurse-directed lean initiatives were highlighted and there was a call for more lean training in nursing.1 While I agree that lean principles should have more emphasis in nursing curricula, I disagree that nurses are not prepared for this type of problem solving.


Nurses are taught critical thinking skills throughout their education. Critical thinking skills involve questioning and analyzing data to come to a meaningful conclusion. The nursing process is a pathway for critical thinking and step-by-step decision making, which compliments the lean process. As an assistant director of clinic operations in my organization and a nurse, I have headed up many lean projects. My nursing education, and critical thinking skills, has been an advantage over other disciplines or my business counterparts.


I do agree that nursing schools could enhance education on current specific process improvement methods, but the focus of nursing schools should be to teach foundational thought processes on which organizations can build. Health care organizations should expect to train nurses in process improvement methods consistent with their organizational goals. Magnet-accredited hospitals can facilitate and teach nurses lean methodologies through the use of shared governance.2 Other health care institutions may wish to explore and implement new and innovative process improvement strategies. Just as evidence-based medicine changes continually, so does evidence-based practice management. What works today may not work tomorrow, so a focus should be on the thought process of nursing and not so specifically the tool.


-Beverly Carrington, RN, BSN


Hutto, TX






1. Johnson J, Smith A, Mastro K. From Toyota to the bedside: nurses can lead the lean way in health care reform [serial online]. Nurs Adm Q. 2012;36(3):234-242. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 3, 2012. DOI: 10.1097/NAQ.0b013e318258c3d5 [Context Link]


2. O'Brien Y, Boat P. Getting "lean" the grassroots way [serial online]. Nurs Manage. 2009;40(9):28-33. Available from: MEDLINE, Ipswich, MA. Accessed September 3, 2012. DOI: 10.1097/01.NUMA.0000360770.82599.4a [Context Link]