Abstract Background: Lean is the systematic removal of waste by all members of the organization. Aims: assess nurse manager's perception of lean system factors at Assiut University Hospitals. Study design: A descriptive correlational design. Setting: The study was conducted in all Assiut University Hospitals. Subject: Convenience sample of Nurse Managers (N= 251). Methods: It including personal characteristics data sheet, Lean system questionnaire that included nine factors. Results: the highest mean scores regarding "Education and training" factor among the studied subject in all hospitals, the highest mean scores regarding all factors in Al-Orman hospital. Conclusion: There were statistically significance differences regarding all factors of lean system among studied nurse mangers' in Al Orman hospital. Recommendation: Policy makers who are responsible for healthcare management by Lean system factors should become standard procedures at all healthcare institutions can also limit the maximum time and maximum walking distances for patients to reduce the waste.