The aim of this study was to analyze motivations and strategies of a Swedish hospital for why and how to implement lean. A case study, including interviews with key actors, observations and document analysis, was performed. Lean was in the studied hospital viewed as tools to deal with suggestions from employees on how to improve the delivery of care. Process leaders employed for a limited time were responsible for implementing lean in the different units. The hospitals future choices of implementation strategies, including training of managers, can be seen ascritical for motivating unit-level managers to sustain lean over time.