I thank Nesterov SV [1] for the interest shown towards a management issue and, therefore, far from scientific activities, but which could improve our professional activity, but above all for having stimulated the comparison between clinicians. The “Lean management” is a tool like many others to improve the organization of work, even in the health sector. In view of improvement projects, no magic potions are needed, but only a staff motivated to improve themselves with will personal. Even in my personal experience, consulting firms are not adequate for introducing lean thinking into an organization due to the cost and resistance they can encounter in an established group. Instead, an enlightened management and personnel receptive to training and without barriers to improvement are needed. Even if supported by the company management, if the project is born as a bottom-up, it is in the interest of the operators to be able to improve their business by reducing the activities that must not be exploited. I believe that staff training is necessary to be able to independently carry out projects within the health facility. Furthermore, I disagree with the views expressed by Nesterov on Nuclear Medicine Departments; in fact, due to its small size and its autonomy, each Nuclear Medicine unit represents an ideal environment to propose an important change. The different professional figures can in fact bring their contribution in the various activities, with a greater mental openness. The Nuclear Medicine Department involves several processes that can be analyzed and improved, but also clinic, laboratory and warehouse activities, where specific Lean tools are applicable. Although differentiated in the different professions, the health staff is represented by a small number of people who could more easily share the project in a synergistic way. The article by Burroni et al. [2] wants to be of a popular nature and aims to encourage improvement processes with lean tools, easy to implement without specific skills. Articles cited that did not get the expected results, have never entirely concerned the Nuclear Medicine Departments, where instead the projects were carried out in a superficial or incomplete way. Finally, it cannot be assumed that a failure can intervene in the improvement process before undertaking it: this is only a barrier that must be avoided in an improvement program. Nor can we assume the presence of wizards, charmers (or humbugs) in a health improvement process, when one tends to improve work of operators to optimize performance. Instead, we must build internal paths with the participation of everyone so that we can reach an improvement in working conditions, avoiding any type of waste. This can be achieved by adopting tools such as those of Lean but above all with the conviction of people willing to break the paradigm, if necessary.