Objective. This paper tests the hypothesis that the value-stream mapping (VSM) method, based on Lean thinking, could help streamline the care process for patients with oesophageal cancer. Design. Case study. Setting and participants. One of the largest tertiary referral centres for oesophageal cancer in The Netherlands. Interventions. We applied and evaluated the principles and tools of Lean thinking, especially VSM processes, to improve the process of delivering care to patients referred for oesophageal cancer. Results. Evaluation at the start of the project revealed that the care pathway was unsystematic and might introduce medical errors. Application of VSM principles in the Lean context improved the process by cutting the number of individual steps needed to begin treatment from 128 to 103 and minimized variability by applying standardization. The implementation of Lean techniques improved the delivery of clinical care to our patients with oesophageal cancer by reducing the time it took to start treatment by 3.5 weeks. Conclusions. Our results suggest that the VSM method, based on Lean thinking, can help to better arrange the care processes for these patients. We believe that these principles can be applied to much of the care administered in this setting and to other areas of health-care delivery.