During the second visit to the Derby hospital, the researcher had an opportunity to
observe the Leadership and Management – middle managers training course Day 6
– Change Management. The Lean Simulation Game made by the NHS Institute for
Improvement and Innovation was used as one of the teaching methods for the
course. The day began with a lecture on Lean principles which mainly concentrated on wastes, added and non-added value tasks and visual management. The lecture
was followed by the game playing session.