Purpose The purpose of this paper is to study the factors influencing doctors' involvement in Lean change initiatives in public healthcare organizations in Canada. Design/methodology/approach An inductive research was conducted over a three-year span studying Lean implementation across three healthcare organizations in Canada. Various interviews were conducted with healthcare actors. Through analytical induction, analysis of the data allowed for multiple factors to be triangulated from which a conceptual model was developed. Findings Fifty-four interviews with 18 Lean healthcare actors allowed for the identification of ten factors possibly influencing the commitment of doctors towards Lean change. These factors are categorized into pre-change antecedents and change antecedents. Also, the level of transformational leadership demonstrated by a project manager was shown to potentially moderate the effect of medical behavioral support for change on change outcomes. These findings allowed us to develop a conceptual model of medical commitment and its impact of Lean change outcomes. Originality/value The paper investigates the role doctors play in Lean implementation, currently an important issue discussed among healthcare actors and researchers. Yet, very little academic research has been published on this subject.