Book excerpt: This book is an implementation manual for lean tools and principles in a healthcare environment. Lean is a growth strategy, a survival strategy, and an improvement strategy. The goal of lean is, first and foremost, to provide value to the patient/customer, and in so doing eliminate the delays, overcrowding, and frustration associated with the existing care delivery system. Lean creates a better working environment where what is supposed to happen does happen. On time, every time. It allows clinicians to spend more of their time caring for patients and improves the quality of care these patients receive. A lean organization values its employees and encourages their involvement in organizational initiatives which, in turn, sustains hospital-wide quality improvements. The opportunities for lean in healthcare are limitless. This is not a book to be read and forgotten, nor is it meant to sit on a book shelf as another addition to an impressive but underutilized collection of how-to books. As the name implies, it is a guide; a companion to be referenced again and again as the organization moves forward with its lean transformation.