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The advent of health care reform means new pressures on American hospitals, which will be forced to do more with less. In the next decade, increased use of "Lean" principles and practices in hospitals can create real value by reducing waste and improving productivity, costs, quality, and the timely delivery of patient care services. In 2010, the Institute of Medicine recommended that nurses lead collaborative quality improvement efforts and assume a major role in redesigning health care in the United States. In this article, we provide an overview of the use of Lean techniques in health care and 2 case studies of successful, nurse-directed Lean initiatives at the Robert Wood Johnson University Hospital. The article concludes with some lessons we have learned and implications for nursing education in the future that must include the concepts, tools, and skills required for adapting Lean to the patient care environment.

Translating into undergraduate nursing curriculum, it will lay a foundation for improving health care of patients and decreasing the health risks of nurses as care providers.

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The Selfish Herd hypothesis, as proposed by Hamilton in 1971, is a powerful hypothesis to explain emergent grouping behaviour by individuals acting in their own selfinterest. However, immediately after prey detect a predator, the prey group may undergo a rapid disassembly, called a flash expansion, which might be considered a "repulsive herd". Although flash expansion occurs in bird flocks, fish schools, and insect swarms, few empirical or simulation studies have directly examined it or tested if there are differences among its members. Additionally, flash expansion is typically thought of as a nearsimultaneous movement of individuals away from the group centre, little data has been collected to verify this. We performed an empirical study to test whether the overall movement of individuals within a flash expansion is away from the 1) first individual to startle; 2) geometric centre; or 3) point of highest density. Replicate swarms of marked whirligig beetles (Gyrinidae: Dineutes) were videotaped during flash expansion and their trajectories determined. Overall, individuals were found to move away from the geometric centre, more strongly than for the density maximum or the first to respond (starter). The geometric centre hypothesis was also supported by the lack of polarization of the group and that the bearing angle was away from the geometric centre. It was found that the starter was more likely to be a female at the edge of a group and that she moved more quickly than others and favoured the centre of the group. This is one of the first detailed examinations of flash expansion and the individual differences within it. Future empirical and simulation studies of the movement rules and emergent properties of flash expansion are needed to better understand the collective motion of other animals.

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As the physician learning environment becomes more global, the importance of a common language for CME/CPD is becoming increasingly important in order that physicians, the regulatory community, and the public may grasp the meaning of particular terms and understand the context in which they are being used. Establishment of a common language for continuing professional development is essential for developing substantive equivalency agreements among regulatory jurisdictions and improving the quality of CME/CPD systems worldwide. The International Academy for CPD Accreditation (IACPDA) developed a glossary of commonly used terms and consensus-based definitions of those terms. There is not an expectation that accrediting bodies must change their terminology to conform to the glossary. Rather, the intent is for the glossary to facilitate greater understanding and potential for harmonization of standards among CME/CPD accreditors, certifying boards, medical regulatory authorities and other stakeholders, thus enabling improvement worldwide in the quality of CME/CPD activities in which health professionals participate, and therefore improvement in their competence and practice performance. This article highlights synergies created by a standardization in CME/CPD terminology and summarizes the methodology used, and design of, the new glossary of terminology by the IACPDA. While the IACPDA has identified modifications and enhancements to be incorporated into future updates, the current glossary is already publicly accessible. The IACPDA welcomes comments from all stakeholders, including the medical regulatory community.