 Faced with a growing patient population amid financial cutbacks, many healthcare facilities today are going lean. Lean management, a business strategy that originated in the Japanese manufacturing industry, has been adopted by the healthcare sector as a way to shed wasteful practices and focus on quality of patient care. But more than simply implementing the management tools that lean has to offer, going lean requires organizations to understand their capacity for change and commit to making a cultural transformation. In this study, researchers set out to determine which organizational qualities reported to be crucial to this transformation actually make a difference on the work floor of an operating theater implementing lean management. Although several healthcare organizations have found success in implementing lean practices, many have found it difficult to achieve sustainable, long-term results while lowering costs. Part of the problem is that these organizations often implement lean through a trial-and-error process. They focus on reaching the short-term benefits of lean practices simply by applying the tools of lean management, tools such as value stream maps and human-supervised automation. The result is a large gap between the transformation an organization desires to make and what the organization is actually able to achieve. In the healthcare industry, committed leadership and a supportive institutional culture have been shown to foster true transformation. But what specific features of leadership and culture should healthcare leaders focus on in their own organizations? In this study, researchers surveyed employees of an operating theater at a medical university to determine whether three features enhance the transformation toward a lean organization, transformational leadership, team leadership, and workforce flexibility. The transformational leadership describes the leadership style of a manager who can create a clear vision for change that inspires employees, encourages desirable behavior, and strengthens an organization's capacity to change. Team leadership refers to a dynamic partnership through which individuals lead one another to achieve team goals. And workforce flexibility is defined as the ability of an organization to adapt employees' knowledge, skills, and behavior to changing environmental conditions. As a highly complex and high-risk environment within a healthcare organization, an operating theater provides an ideal test bed for examining these factors. Employees were surveyed 18 months after a shift toward lean had begun. Results showed that all three factors contribute significantly to enhancing a lean transformation. That's because, the researchers explain, these factors align well with what's called the change competence model. This management model helps organizations balance their vision for change with their capacity to change based on five different elements. Here, workforce flexibility corresponds to focus, and transformational leadership and team leadership correspond to energy. These factors therefore promote an organization's capacity to change. As this capacity increases, it becomes more likely that a healthcare organization can move beyond the trial and error approach to lean and toward a successful lean transformation, yielding positive long-term results for patients. The researchers expect that these success factors identified in their study can also be adopted in other parts of the patient care process to strengthen the change capacity of entire healthcare organizations that implement lean management.