Objectives: To analyse and detail surgical process improvement activities that achieve the highest economic impact. Methods: Over 4 years, a team of technicians and healthcare professionals implemented a set of Lean surgical process improvement projects at Vall d’Hebron University Hospital (VHUH), Barcelona, Spain. These projects now form part of the daily routine in the surgical process. The economic impact on the hospital's surgical activity budget was analysed. Results: Process improvements have led to annual operational savings of over € 8.5 million. These improvements include better patient flow, better management of information between healthcare professionals, and improved logistic circuits. Conclusions: The current cultural shift towards process management in large hospitals implies shifting towards results-based healthcare, patient-perceived value (VBHC) and value-added payment. A Lean project implementation process requires long-term stability. The reason a considerable number of projects fail to complete process improvement projects is the difficulty involved in establishing the project and improving management routines. Few studies in the literature have investigated the economic impact of implementing Lean management a posteriori, and even fewer have examined actual cases. In this real case study, changes to surgical block management were initiated from zero. After being carefully thought through and designed, changes were carried out and subsequently analysed.