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Even if these problems are addressed and lean delivers onits promises, the challenges to increasing the role of leanthinking are daunting. They require no less than the redesignof the health care system as we now see it. Perseverance,high quality leadership, dedicated professionals and patienceare surely needed. Scepticism and resistance will be high,success not guaranteed. Organizations may think twicebefore embracing on such a journey, or worse, superficiallyimplement lean thinking, adding to existing resistance andmaking it more difficult to improve health care in the longterm.Overall, we support the possibilities lean thinking offers toimprove health care. Lean is a hands-on improvementmethod, in line with suggestions made by leading authors onhow to improve health care systems worldwide [38]. Yet, iflean thinking over the next decades will be hailed as the‘machine that changed the [health care] world’ [39], more rigorousand balanced research and reporting is needed.
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