Purpose - The purpose of this paper is to examine the relationship between four organizational cultural types defined by the Competing Values Framework and three Lean Six Sigma implementation components - management involvement, use of Lean Six Sigma methods and Lean Six Sigma infrastructure. Design/methodology/approach - The study involved surveying 446 human resource and quality managers from 223 hospitals located in Maine, New Hampshire, Vermont, Massachusetts and Rhode Island using the Organizational Culture Assessment Instrument. Findings - In total, 104 completed responses were received and analyzed using multivariate analysis of variance. Follow-up analysis of variances showed management support was significant, F(3, 100) = 4.89, p<0.01, eta(2) = 1.28; infrastructure was not significant, F(3, 100) = 1.55, p = 0.21, eta(2) = 0.05; and using Lean Six Sigma methods was also not significant, F(3, 100) = 1.34, p = 0.26, eta(2) = 0.04. Post hoc analysis identified group and development cultures having significant interactions with management support. Practical implications - The relationship between organizational culture and Lean Six Sigma in hospitals provides information on how specific cultural characteristics impact the Lean Six Sigma initiative key components. This information assists hospital staff who are considering implementing quality initiatives by providing an understanding of what cultural values correspond to effective Lean Six Sigma implementation. Originality/value - Managers understanding the quality initiative cultural underpinnings, are attentive to the culture-shared values and norm's influence can utilize strategies to better implement Lean Six Sigma.