ABSTRACT
There are many thoughtful treatises on transformational leader ship. Although leader ship is not the central theme of this book, omitting a discussion of the role of the leaders could result in some believing that Lean transformation can occur in the absence of active leader ship, commitment, and engagement, which is the antithesis of the truth. Leadership is essential because transformation is not tweaking. Transformation is radical change in what the health system believes, what it values, and what it does. It is not becoming a bigger caterpillar-it is becoming a butterfly.
