The integration of Lean and Six Sigma methodologies provides a powerful combination to achieve operational excellence, improve quality of patient care and bring value to stakeholders. This integrated and increasingly common approach to organizational performance improvement is usually called Lean Six Sigma. There is a great deal of overlap between Lean and Six Sigma but generally speaking, Lean is associated with efficiency, speed and elimination of waste, whereas Six Sigma is focused on improving quality, reducing process variation and elimination of defects. To increase the likelihood of success, Lean Six Sigma must be synchronized with the strategic, tactical and operational planning processes in the organization while ensuring meaningful involvement of key stakeholders at every stage of implementation. Seamless integration with a number of complementary disciplines, management systems, functions, business processes, and other improvement methodologies is also required to implement and sustain positive changes.