Lean success story: applying Lean leadership at a hospital in Foz do Iguaçu

More than any method or tool, the real competitive edge lies in the daily behavior of those who guide teams. When leaders connect purpose, method and results, they create the conditions for everyone to see problems clearly, learn faster and deliver growing value to patients.

In the hospital setting, this means turning hours of waiting into minutes of care, preventing errors that cost lives and building a culture of respect that embraces families at critical moments. Investing systematically in developing lean leaders stops being a cost and becomes the most powerful lever for the hospital's clinical, care and financial sustainability, since every improvement directly affects the care experience and the capacity to innovate continuously.

In this context, the leader acts as an architect of improvement: building invisible structures, such as culture, habits and trust, that sustain visible results – from more agile flows to better-served patients.

The seven practices that sustain lean leadership

1. Go see – conduct constant gemba walks to understand reality before deciding. In lean thinking, gemba is the Japanese word for “the place where the work happens”; in the hospital, it means being in the emergency room, the ICU or the clinical pharmacy, directly observing the flow and listening to those who do the work. Going to the gemba shows what really blocks the flow and reveals bottlenecks that often do not appear in reports.
2. Challenge – set bold yet achievable goals that push the team to move beyond the status quo. The challenge works like a lighthouse at sea: it does not make the crossing for you, but it gives direction, lights the way and keeps the organization from drifting.
3. Listen and ask – replace one-sided orders with genuine dialogue. Each question works like a key that opens doors to new possibilities, widening the space for the team to discover its own solutions.
4. Teach – act as a leader-coach, using the A3 Process and PDCA as instruments for reflection. Teaching is like planting trees: it does not bear fruit immediately, but it builds autonomous teams capable of facing complex challenges in the future.
5. Support – remove barriers quickly, like a cultural andon. Supporting the team is like being a safety net: it gives people the confidence to dare to improve and innovate, even in the face of the risk of failure.
6. Work as a team – align nursing, hospitality, pharmacy and supply around the value stream. It is like orchestrating different musicians so that they play in harmony, creating a patient-centered symphony.
7. Learn – cultivate the humility to revise hypotheses and learn from failures. Learning is like the cycle of the seasons: each phase brings new challenges and new harvests. What is a solution today may be a problem tomorrow – and vice versa.

These practices form a cycle of continuous learning, in which leadership is not a hierarchical position but replicable, visible behavior in day-to-day work.

From theory to practice at Hospital Itamed

Figure 1 — Leader guides a healthcare team in front of a visual board, applying lean leadership practices in the hospital.

Located in Foz do Iguaçu (PR), Hospital Itamed is run by the Fundação de Saúde Itaiguapy and was founded in 1979, initially to serve workers at the Itaipu Dam. Over the decades, it has established itself as one of the largest hospital complexes in Western Paraná, and today it is a reference for the entire 9th Health Region.

With more than 26,000 m² of built area, the hospital brings together more than 40 medical specialties; 400 accredited physicians and about 1,400 employees; adult, neonatal, pediatric and coronary ICUs; a 24-hour emergency department, surgical center, oncology, blood center and clinical laboratory, among other high-complexity services.

Given its size and complexity, the hospital faces the typical challenges of high-complexity institutions: reconciling quality of care, financial sustainability and patient experience. It was in this scenario that Itamed , with consulting and support from Lean Institute Brasil, experts, implemented a lean leader development program structured on three fronts.

1. Immersive workshops

Hands-on workshops were held for 35 leaders – from the executive team to care coordinators – in which the seven practices were discussed, simulated and tested in the classroom.

2. Initial and final assessment

The initial diagnosis assessed how the seven practices were being applied. The result showed leaders who were strong in relational aspects but weak in “Go see” and “Challenge”, a sign of still-reactive leadership. The second assessment, after the intervention, measured progress and confirmed significant advances.

3. Coaching in PDCA cycles

For four months, leaders were accompanied in coaching sessions in which they were challenged to choose a real problem, apply a new leadership practice, measure the impact and reflect. This cycle ensured that new habits were consolidated before old ones could prevail again.

Results that start with behavior and reach the bedside

After the coaching cycle, the hospital observed visible changes:

• Behavioral evolution – the previously critical dimensions, such as taking the lead in the gemba and encouraging people development, showed remarkable progress. The group demonstrated a change in profile: from a reactive, relational model to a more proactive and practical leadership, balancing listening, action and learning.
• Collective maturity – The average assessment score rose 17% — which, in practical terms, means that leaders began to apply the seven habits of lean leadership much more consistently in their daily work. In addition, the improvement was uniform across managers, a sign that this was not just individual progress but a leap in collective maturity.
• High engagement – the initiative's NPS (Net Promoter Score) was above 94%, a level considered excellent in any industry. This means that practically all participating leaders would recommend the experience to other colleagues, reflecting not only satisfaction but also the perception of real value of the process for their leadership practice.

These results show that developing lean leaders is not just training people, but transforming the way the organization learns and delivers value.

Lean leadership is not a project, it is a journey

Figure 2 — Multidisciplinary team reviews a patient chart at the bedside, aligning care with the support of lean leadership.

The Hospital Itamed experience shows that building lean leaders sustains strategy and drives clinical and operational results. When practices such as Go see, Challenge, Teach and Work as a team stop being concepts and become everyday behaviors, strategy is not only executed but evolves with the hospital's collective intelligence.

In Itamed's case, this journey is already translating into leaders who are more present in the gemba, greater consistency in structured problem solving and collective gains in maturity.

Investing in this journey means ensuring that the hospital's next strategic objectives find leaders prepared to make them a reality sustainably — ensuring that every improvement is directly reflected in the patient experience and in the strengthening of the health system.