BACKGROUND: With healthcare, Lean Thinking encounters a world, not devoid of value, but awash with sophisticated and mutually unconnected concepts of value. DESIGN: Given a shortage of systematic analysis in the literature, this paper provides a preliminary analysis of areas where the read-across from other sectors to healthcare is relatively well understood, based on a broad review of its impact on care delivery. It further proposes areas where conceptual development is needed. In particular, healthcare, with its many measures of value, presents an unusual challenge to the central Lean driver of value to the customer. CONCLUSION: We conclude that there is scope for methodological development, perhaps by defining three themes associated with value-the operational, the clinical and the experiential.