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This paper addresses the relationship between lean thinking and mathematical optimization. We discuss the roles of the two approaches, using as a reference case study the appointment scheduling process in a hematological center of a large Italian hospital. We report on how lean tools have been deployed to improve the process, we present a mathematical optimization model and discuss its implementation. Our aim is to show that the joint use of lean thinking and mathematical optimization candoi:10.1016/j.orp.2019.100110 fatcat:vyhjszfk2zghrocs2v5iaxdyzi