The purpose of this study is to explore how representatives of the pilot projects teams and dissemination practitioners, belonging to several hospitals in Apulian hospitals in Italy experienced the implementation of Lean over 3 years. An exploratory and qualitative design was drawn based on data triangulation from semi-structured interviews, documentation analysis relating to Lean implementation and direct observation. The main implementation drivers of the methodology in hospitals were increasing patient value and improving workplace well-being. The panel highlighted three pivotal implementation stages: introduction, spontaneous and informal dissemination, and strategic-level implementation. Critical success and failure factors emerged for each of these stages. During the introduction, expert training and coaching from an external consultant are among the most impactful factors in the success of pilot projects, while time constraints and the adoption of process analysis tools are the main barriers to implementation. However, the absence of managerial expertise to support implementation and organisational constraints, such as departmental organisational structure, do not allow for systemic adoption of the methodology.