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This study aimed to analyze the process of implementing lean healthcare in three Brazilian hospitals that have played a pioneering role in the implementation of this system. We adopted the case study approach and collected data through interviews, document analysis, and observation. The results showed that the processes of implementation of lean healthcare in the hospitals shared many similarities in terms of the flow of patients, materials, or information. Finally, it was possible to obtain some guidelines for the application of lean principles and techniques in order to facilitate the implementation of lean healthcare in hospital operations. [ABSTRACT FROM AUTHOR]