Many healthcare institutions are being under the pressure to lower cost as governments are looking for ways to reduce healthcare spending due to the current economic climate. Lean thinking is getting more attention globally in attempt to achieve better result in healthcare. Through direct observations and involvement at an internal medicine department the methodology for lean improvements were implemented and documented. The objective is to implement lean methods at an internal medicine department to improve the processes. The work is expected to lower the cost and also have various positive effects such as diminishing the none value added activities, reducing medication errors and reducing the workload. One of the main challenges is to change the culture within the hospital. The culture needs to be focused on improvements and improvements activities become part of the daily routine for all employees. The workers at the internal medicine department were afraid that the lean work was intended to decrease cost by cutting back on staff which needs to be addressed when the implementation work will continue. The managers are confident that this project will show good results and plan to use the results from this pilot project for future lean projects at the hospital and to implement lean at all departments in couple of years. This is a unique project, not only for the hospital but for lean healthcare in general as there is little evidence of a healthcare organization that has applied lean thinking completely.