What can Japanese car manufacturers teach the National Health Service? A bottom-up management style that gets workers to solve problems the boss may not have spotted, is the answer.

It's name may sound like a martial art, but it isn't just the NHS that is learning the technique. The "lean" management style, which turned Toyota from a small car firm struggling in a Japanese credit crunch into one of the world's biggest names, is now being applied in many areas of Scotland's public sector, as local authorities struggle to deliver more services within ever-shrinking budgets.

It's been used in the NHS from Lothian to the Highlands, at councils including Aberdeenshire and East Renfrewshire, in government agencies and even an RAF base.

Some in the public sector are suspicious of the philosophy, often dubbed simply "lean", seeing in it a desire to cut organisations to the bone. But the Japanese word for the same concept - "kaizen"- is more user-friendly, translating as "change for the better".

NHS Lothian, which is now embarking on its second phase of kaizen activity, attributes the successful reorganisation and rationalisation of its breast cancer care and CT scans to the philosophy - both areas where the focus is on getting results to patients as quickly as possible and cutting out beaurocracy. At the other end of the central belt in East Renfrewshire, similar strategies are being put in place and staff report that the time taken to repair roads is down by three quarters.

How does it work? At Toyota, the focus was put into improving the "flow" of work and information between different departments and the guiding principle was to put energy only into features that customers liked and valued.

There is an emphasis on cutting out waste - of energy as well as of money and materials.

Trying to put the patient's needs and wishes at the heart of the process, has, according to NHS Lothian modernisation manager Libby Tate, led to huge improvements in services.

These include reducing waiting time for CT scans from 21 weeks maximum to at most four weeks and urgent cancer referrals waiting time cut from nine days to the same day.

In an attempt to reduce patient anxiety, check ups for women who have suffered from breast cancer in the past have been reorganised so that the stressful wait for results is cut from several weeks to a few days.

"There used to be a lot of what is called batching'," explains Tate. "Things would be left to sit and pile up until there was a whole heap that could be dealt with at the same time. Now we try to deal with everything right away as soon as it comes in.

"Whenever a department feels that they could improve things in terms of the way patient care is organised, we go in to help them to do that. It isn't about getting rid of people. There is a limitless demand for health care. It is about using people's time more effectively and making their jobs more rewarding."

This kind of approach has helped NHS Lothian to achieve record lows in the number of people stuck in hospital because of a lack of suitable onward accommodation - this was achieved by consulting front-line staff over the best way to manage beds.

They came up with a range of initiatives, including better communications with services in the community, reorganisation of staff time to enable more speedy home assessments for patients and better work to encourage the use of alternatives to hospital admission. In most cases, staff were able to both identify and implement the necessary changes themselves.

Last month, staff were invited to present details of their work at the prestigious International Forum on Quality and Safety in Healthcare, in Paris.

Dr Paul Allan, Clinical Director for Imaging, NHS Lothian, said: "Examination of the CT scanning referral process by a kaizen team enabled a dramatic cut in patient waiting times, which has been sustained for 12 months since the kaizen. Staff satisfaction, patient equity and productivity have all increased." But it isn't just managers who enthuse about the scheme. Health service union Unison rep David Forbes is broadly supportive too. "I would say that the feedback I've had from the unions and staff is nothing but positive and no one has contacted me to even express doubts," he says.

"If I have a sceptical thought at all it is whether the improvements and benefits are able to be maintained over a longer period. That will need to be part of the evaluation and time will tell. I am pleased that the board has developed its own expertise and capacity to allow the lean exercises to be carried out in-house."

At East Renfrewshire, network manager Charlie Armstrong is also a convert to "lean" management. He explains that under the old system "If someone phoned up to complain about a pothole in the road we would send an inspector out. He would make a report and pass that on to the direct labour organisation. It would be up to them to pass that on to a repair unit. It could take five weeks for someone to come out and fix it."

Under the new system, he explains: "If someone phones up the road department asking for a minor repair, the person who answers the phone can call up the schedule for the next working day and enter the repair into it. The foreman will get the schedule the next morning and it might get seen to the day after. Big repairs will take longer. But our average for all road repairs is now five days, down from 19."

The first step in the transformation was for the council to start monitoring all letters and calls from the public. "We started to really look at what the customers were complaining about and asking for," says assistant chief executive Caroline Innes.

Hugh Dougherty, communications manager at the council adds: "There are still constraints. For instance the amount of money we have is limited. The price of oil means that bitumen is getting more expensive. We are trying to do more road repairs with the same amount of money.

"But it is much better because the energy is going into repairing the roads instead of fending off complaints. Before, it was much more beaurocratic. A lot of people wrote in and phoned to complain. Letters were written back and sometimes excuses were made, things like blaming subsidence. It didn't really work because many people saw through the excuses and would point that out. Letters would go back and forth.

"The trouble now is that people are driving their two-tonne people-movers over 1930s' roads but if they see someone digging them up, even if it is to fix them, they get annoyed. Someone drove a car at one of our road menders recently."