Despite numerous articles reporting the application of Lean in the health sector, the methodologies to implementing the paradigm in hospitals are described in few articles. Most of the research focuses more on the results of the Lean approach than on the approach itself. Embarking on continuous improvement by navigating without compass and without guidelines can be frustrating and in the best case could lead to silver bullet solution, spending resources without generating the "culture of change" or increasing the ability to "project management". The purpose of this paper is to describe the case study of a Puglia hospital in which a Lean project was activated to the clinical pathway of patients over sixty-five with fracture of the femur. The originality is to detail the framework to support Lean implementation and offer a guideline to practitioners. The project was implemented through the Report A3, involving a hospital team work and an external consultant. The results show a reduction in the rate of the patients who cannot undergo surgery in 48 hours and the spreading of continuous improvement culture in the organization.
Keywords: Lean, Case Study, Report A3, Continuous Improvement, Organization, Healthcare