In the last decades, lean has been widely adopted and applied by health care organizations as a process improvement strategy, delivering significant impact on the quality of services provided. The existing literature agrees that the adoption of a holistic and system-wide approach to the change is vital to successfully implement lean in health care. The study aims to explore the organizational conditions that are relevant to develop and structure the whole system lean change initiative in Siena University Hospital, focusing on the role of the Lean office to sustain the improvement efforts over time. As emerged, the establishment of a new structure with specific functions towards the change (supporting bottom-up improvement projects, developing strategic top-down projects, providing training), and its continuous and active presence, helped professionals to internalize the new way of working. In particular, the Lean office contributed to balance the top-down and the bottom-u program, so that all the improvement efforts were kept towards the same intended direction.
Keywords: Lean thinking, health care, hospital, organizational change, leadership.