The health care industry worldwide is besieged by multiple problems to which there does not seem to be clear answers. There are issues of affordability, quality, patient safety, etc. with many suggestions about how to improve things. One such approach is the idea that what health care needs is more business management and industrial techniques, of which one is the application of the Toyota Manufacturing System, or lean as it is called in the West. This book is about lean, what it is, whether it works, and what its consequences are for workers in manufacturing and services. It is about its application in health care and whether it can work in an industry as biologically, socially, and technologically complex as health care. A fundamental problem with the lean debate is that there is none. For some reason having an open honest dialogue about lean and lean health care is a problem, and what this book seeks to do is to stimulate and contribute towards that dialogue.