PUBLIC MONEY & MANAGEMENT FEBRUARY 2008 13 © 2008 THE AUTHORS JOURNAL COMPILATION © 2008 CIPFA Recent increases in UK public spending have increased the pressure on public services to focus on productivity and waste reduction. The Gershon report, published in July 2004, called for £20 billion annual efficiency gains for departments across the English public sector to be realized by 2007–08 (Gershon, 2004). These efficiency gains were detailed for the various departments with targets focused on both cash and non-cash savings. However, it could be argued that not only in the UK but around the world, governments want to deliver better education, healthcare, tax services and local services including refuse, public transport and housing. This pressure to improve the performance of public services has led to many calls from industrialists, management consultants and policy officers for the transfer of industrial practices into the public sector. In particular, Lean has been proposed as one way to achieve substantial cost savings and quality improvement. This article reflects on the findings of an in-depth study, funded by the Scottish Executive, into the appropriateness of Lean as a methodology for achieving real, sustainable cost savings in the public sector (Radnor et al., 2006a and 2006b). This article looks at case study evidence in order to understand what and how public sector organizations are implementing under the ‘Lean’ banner. Do organizations regard Lean merely as a set of tools and techniques without considering either the underlying conditions or Lean as a philosophy? Zoe Radnor is Associate Professor in Operations Management at Warwick Business School, University of Warwick, Coventry, UK. Paul Walley is Associate Professor in Operations Management at Warwick Business School. Application and implementation of Lean Lean principles have been adapted and adopted in various public sector organizations, although the way that they have been implemented differs depending on the organization. As reflected in this themed issue, the most extensive examples of Lean applications in public services appear to be in healthcare, although there is no reason that it could not be applied to the wider public sector. Lean in healthcare A study assessing the suitability of Lean in the UK and Swedish health service looked at how a performance measurement system called the ‘flow model’ was designed to identify key performance indicators that measure changes towards Lean (Kolberg et al., 2007). The study concluded that Lean is applicable in healthcare settings and that the flow model is a suitable tool for following up these initiatives. The healthcare sector has a record of adopting Toyota Production System principles, especially in the mainly independent US healthcare system. The prime example of this is the Virginia Mason Medical Center, an acute care hospital in Seattle (Weber, 2006). They use tools such as Rapid Process Improvement Workshops (RPIW), 5S, value-stream mapping (VSM), ‘Everyday Lean’ and Kanban to extensively improve quality and flow including reducing staff walking distance by 38% (34 miles), inventory by half and lead time by 53% (708 days) (Weber, 2006). Spear (2005) also provides examples of hospitals that have attempted to implement aspects of Toyota’s Learning to walk before we try to run: Adapting Lean for the public sector Zoe Radnor and Paul Walley This article considers whether public sector organizations regard Lean merely as a set of tools and techniques without considering either the underlying conditions and principles or regard Lean as a philosophy. The authors analyse a series of case studies of Lean in the public sector around four themes—process-based view, focus on value, elimination of waste and employee-driven change—before considering the implementation approach taken and outcomes achieved. The outcomes were significant, but the authors warn against an implementation approach which focuses solely on Lean tools.