Purpose This paper presents a case study of the implementation of lean/ six sigma techniques through a series of student projects carried out in a hospital setting. Design/methodology/approach The five projects were carried out by teams of masters student taking a module on operations and quality management. The students were all staff members of the hospital. The study analysed each of the five projects under a number of headings: setting and context, approach, key success factors, benefits and lessons learnt. The analysed projects were then examined to identify patterns among the projects. Findings All student projects adopted a single foundation methodology as the basis for the project but supported this with additional techniques from the lean/ six sigma stable. The primary methodology was lean in the case of three projects, six sigma in the case of one project and mistake proofing in the case of the final project. The most commonly used supporting techniques were process mapping, 7 wastes, 5S and logic tree/ root cause which were each used in two of the five projects. Other techniques used were control charts, checklists and theory of constraints which were each used by one project team. Support from top management and regular communication with stakeholders were identified as key factors for success by three of the five project teams. All of the projects, although implemented during a time period of less than three months and by relatively novice users of lean six sigma techniques, yielded practical benefit to the hospital. Practical implications Lean / six sigma offers a variety of methodologies and techniques for use on a process improvement project. It is vital that the project team select for use those techniques which are most appropriate to the particular context of the project. Adoption of an overall methodology (philosophy) supported by specific techniques proved to be an effective approach. Exposure to the various lean six sigma methodologies and techniques through education appeared to result in project teams selecting and using an appropriate set of techniques. Originality/value This paper provides useful information for practitioners who are introducing the lean six sigma approach into a hospital setting. The study demonstrates that relatively novice users of lean six sigma can provide value to the organization in a relatively short period of time. The study suggests that education and training in lean six sigma techniques is useful as it enables users to choose the right technique for the context and to use the technique in an appropriate manner. The paper also demonstrates that lean six sigma can be used and provide benefit in a variety of settings within a hospital.