Purpose The purpose of this paper is to examine leadership behaviors associated with lean healthcare (LH) implementation and how they develop throughout the change process. Design/methodology/approach After a systematic literature review of 107 peer-reviewed articles on lean leaders’ behaviors, the authors undertook a one-year mixed-methods study of 12 leaders within a Brazilian public hospital undergoing LH implementation. Multivariate data analysis techniques were employed. Findings The literature review showed some convergence between effective lean leader behaviors in both manufacturing and healthcare work settings, implying that lean leaders’ behaviors are generalizable to other contexts than manufacturing. The empirical findings suggest that LH implementation needs leaders to demonstrate a set of task-oriented behaviors, especially if short-term results are mandatory. More mature lean leaders should also continue developing their relations-oriented behaviors. Research limitations/implications While the contingency theory assumes that contexts influence (lean) practices adoption, leadership behaviors may not be bound to the work context. The finding resembles the augmentation effect of leadership whereby more mature lean leaders adopt both task- and relations-oriented behaviors. Originality/value Longitudinal studies in this field are scarce, regardless of the industrial setting. Many manufacturing and healthcare organizations crave for knowledge about lean leader behaviors throughout the lean implementation journey in order to enhance the effectiveness of their often-struggling lean initiatives. The insights derived from this study could help organizations to adjust their expectations as well as identify behavioral gaps and needs in terms of soft skills development among their leaders.

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