Given the scope and scale of the project and the commitment of resources, the Provincial Leadership Team (PLT) of the health system identified the need for a rigorous evaluation of the Lean initiative. [...] Both the selection of the regions and the focus on RPIWs and 5S were endorsed by the Steering Committee and the HQC. [...] Lean implementation mapping); • Visits to each of the four focus regions to conduct a set of semi-structured interviews with patients, service providers, and leaders; • An iterative process of theory development which identified the key mechanisms to be explored in the multi-year evaluation and the outcomes indicators to be collected; • The first stage of an economic evaluation, examining the cost [...] This has certainly been the experience of the first phase of the evaluation, and it is a feature of the design of the multi-year evaluation as well. [...] The aim of the meeting was to select the best research team and approach for the Lean evaluation.