Hospital wards in the National Health Service (NHS) are sometimes beset with numerous problems including long waiting times and perceived unhelpfulness of staff. Cash wastage occurs in departments that are overstaffed and swamped with paperwork. Lean thinking may be the way forward for improving working efficiency and driving change towards the enhancement of services. We propose unique models of whole-system thinking of the principal operations in surgical assessment practice, and the desired innovative care parameters with examples of nephrourologic units. We suggest a strategic innovative approach using an eight-R approach: responsiveness, reliability, resources, respect, relationships, responsibilities, roles and reassurance. Our proposed model aims to manage the realisation of lean benefits of renal care in a disciplined and systematic manner, which is just as important for any other aspect of a hospital care business.