Different studies have been published in recent years describing the experiences of adopting Lean thinking in healthcare institutions. However, the analysis of Lean implementations in hospitals located in emerging economies is lacking. Besides, Lean implementations are usually reported based on a single case study. This study analyses Lean adoption in four Brazilian surgical centres, using a multiple-case approach using semi- structured interviews. Results suggest that Lean implementation reduces the duration of operations and the time the patient stays in the hospital, improves the punctuality of procedures, reduces losses, errors, materials' usage, preparation time, and increases collaborators' satisfaction. Primary challenges to implementing Lean include changes to organisational culture and involvement of multidisciplinary teams. By using a multiple-case design, it is possible to compare different outcomes and more confidently generalise these results to other surgical centres. We expect this study stimulates the implementation and analysis of Lean adoption in other emerging economies.