Our journey around the implementation of lean production methods has drawn on pioneering work by the Virginia Mason Institute in Seattle and their passion that "Zero-Defect Health Care Is Achievable". The application of "Zero Defects" has to start with the individual patient and their putting their needs at the center of what we do. Zero-defect care can be realised where a lean health care system in which engaged health care leaders, providers and staff learn to put the patient first and where collaboration and organisational change focus on delivering a defect-free service every time. Diane Miller, Executive Director, Virginia Mason Institute says, “Zero defects, zero infection rates, zero any defect. Or 100 percent satisfaction. This is a game of zero and 100 percent, and if we have a vision less than that, it’s the wrong vision.” NHS Highland have followed a similar line. "A lean approach focuses on getting each and every process right, in the belief that we cannot make care perfect until we make each and every process perfect" said Hugo van Woerden, Director of Public Health, NHS Highland. "This requires a clear understanding of care pathways and attention to detail so that every action utilises high quality standard work."