Many public hospitals have adopted Lean management methodology, but little is known about the extent of Lean adoption or the relationship between Lean adoption and hospital performance. Using data from the 2017 National Survey of Lean/Transformational Performance Improvement in Hospitals, linked with data from the American Hospital Association 2015 Annual Hospital Survey and 2015 Centers for Medicare & Medicaid Services data on hospital performance, we compare public hospitals with nonprofit and for-profit hospitals on the rate of Lean adoption and the extent of Lean implementation. We also assess the associations between Lean adoption by the end of 2014 and measures of public hospital financial performance, patient outcomes, and patient satisfaction measured in 2015.Among the 288 public hospitals that responded to the survey, 54.2% reported that they had adopted Lean. The average length of time of Lean implementation was 4.58 years. The mean number of units in which Lean was implemented was 11.9 out of 29 possible hospital units, with the emergency department (ED) being the unit in which Lean was most frequently implemented. The most common Lean practices used were daily huddles, plan-do-study-act cycles, visual management, and use of standard work. Lean adoption by 2014 was significantly associated in the direction predicted with earnings before interest, taxes, depreciation, and amortization margin (b = .042, p < .020) and percentage of patients leaving the ED without being seen (b = -0.610, p < .068). No significant associations were found between Lean adoption and patient outcomes or patient satisfaction.