Lean, a relatively new approach in Canadian health care, is quickly becoming the pre-eminent means of improving health care services in many other parts of the world. This briefing provides an overview of the current state of Lean in Canadian health care, based on information obtained from surveys of health regions and ministries as well as a review of the literature. There are large regional differences in Lean’s application with some provinces mandating the approach and others not applying it at all. Where applied, it is mainly in secondary and tertiary hospitals, starting in many of them in “manufacturing type” departments such as laboratories and emergency rooms although it is being more broadly applied across clinical care areas today. There are, however, large differences in the approach being used that suggests different philosophical views of Lean. Some view Lean as a tool to improve processes and others see Lean as a philosophy to transform management and operational practices. By all accounts, Lean is having a very positive impact on the effectiveness and efficiency of health care services and has been well received by physicians and staff. Despite this, most Canadian health regions are investing modestly in its efforts.