How Do Spanish Hospitals Use Lean? Insights from a Multiple-Case Study

<b>Background/Objectives</b>: The European Society for Emergency Medicine reports that emergency department visits have increased by nearly 30% over the past decade, yet resources have not kept pace with this growing demand. Lean Healthcare Management has emerged as a promising approach to optimizing emergency department operations. This study aims analyze the specific Lean Healthcare Management interventions implemented across three major Barcelona hospitals. <b>Methods</b>: Three Barcelona hospitals were analyzed. Revision of the Lean Healthcare Management tools, hospital staff observation and focus groups with nurses, physicians, and administrators were performed to evaluate impact of Lean Healthcare Management interventions. A cumulative SWOT analysis was performed as a synthesis of individual responses and focus groups for the three included hospitals separately. <b>Results</b>: The average adherence scores to implemented Lean Healthcare Management solutions were 87% at Vall d'Hebron, 85% at Sant Joan de Déu, and 89% at Hospital Clínic de Barcelona. Implementation of Lean Healthcare Management led to 20% fewer cancelations of scheduled surgical procedures, decreased patient hospitalization times for targeted pathways (from 8 h to 70 min) and significant increase in patient satisfaction. All centers shared a common foundation in Value Stream Mapping. Implemented Lean Healthcare Management solutions were personalized for each hospital. <b>Conclusions</b>: Lean Healthcare Management's effectiveness is contingent on aligning the Lean approach with the hospital's specific mission, constraints, and patient population. This contextual dependency explains the variation in the tools adopted and the outcomes prioritized across the three analyzed hospitals.