Lean quickly teaches us the art of spotting waste and helping in its removal. For many of us, our first years in Lean are spent eliminating waste with an almost religious zeal, and we become 'waste warriors' and do battle with the eight wastes wearing our 'waste goggles' so we can see it hiding. The impact, of course, is huge, and soon value is flowing, responsiveness to customers is up, and quality is soaring because of all the steps that have been removed. The other side of the equation, the creation or renewal of value, however, takes longer to register in the game plan of a Lean transformation. More than likely, reducing lead times and increasing quality is initially very good for the organization. Goods get supplied quicker, patients have easier and quicker access to treatment, and everyone's morale goes up when quality improves. The issue of 'value-up' becomes more serious when the removal of waste continues, and customers get used to quick, high quality service. Equally, as more and more people are liberated from wasteful steps inside the organization, we have to find something useful for them to do. If we don't, not many will want to continue the battle against waste. In the short to medium term there is nothing better than to have the people freed up by improvement provide extra horsepower to the Lean transformation, but soon we have to face the fundamental need for growth in order to find gainful and continuing employment.