Purpose - The objectives of the study are to identify and understand the environment, relationships and barriers for the key stakeholders in changing their workplace environment, and to negotiate and create an action plan to address the effectiveness issues in relation to rolling out CANDO across the Trust. Design/methodology/approach - This study has adopted a multi-method approach using action learning/research, questionnaire, participant observation, and reflexive analysis. Findings - The results indicate that there are individual, group and system improvements, but to achieve these the training in CANDO has to be action based as the 'knowing-by-doing' (not just the theory) has to be experienced, learnt, shared and disseminated to other teams. Research limitations/implications - As this is a pilot study, the findings are at a preliminary stage and therefore limit the generalisibility of the results. However, there has been an opportunity to test methodological instruments that will enable us to understand the overall effectiveness of CANDO as a mechanism of change within the health setting. The implications of this research are discussed at three levels: individual, department and strategic. Originality/value - Undertaking research in the health sector is a break from the Lean Enterprise Research Centre's roots in manufacturing, distribution and retail/service sectors. The importance of improving quality and performance are key to all sectors and we wish to contribute to understanding the transferability of good practice and organisational change. This is the first time CANDO implementation has been reported in a health setting as a means of change within the NHS.