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The real danger is that NHS staff are urged to deploy 'lean' as a means of pure busyness' - working hard as usual but without the changes Umesh describes. Then, lean = mean & efficiency = cuts.

When it comes to systems thinking, one of the simplest changes the NHS could make would be to better understand & use its data at a tactical level. You need to see the stories it tells you, especially about the patient's journey & experiences.

By all means adapt (not merely adopt) lean thinking from manufacturing to our national health service, but will staff accept it means a lot less variation in choice of equipment, processes, & procedures if it delivers less variation in outcomes away from the best?

Also, bear in mind that car manufacturing, for example, is so predictable that mere robots can do it. Whereas, patients are inherently variable in their responses to treatment for a variety of physical, psychological, and social reasons.

The NHS would be a better place if instead of 'lean' thinking or even 'systems' thinking it turned everything around to PATIENT thinking. Optimise all of your resources (including time, money, & talent) for the advantage of your patients and see what that might do for better outcomes, happier staff, and healthier finances.

There can be no silos & no space for poor leadership or weak accountability in a NHS dedicated to a culture, values, and metrics forged in PATIENT thinking.