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Even with a lean IT staff, ITIL can be done, but:

A) The processes need to be CLEARLY defined
B) Every stakeholder must understand the process and implement it.

The prime example is Change. Many IT shops are HORRIBLE at Change. Why? Simply because there is no process behind it. How do you update a server? Meh, just throw on the patched...That's not Change, that's seat of your pants.

So the lean shops benefit the most. Sure the up front cost is large, but long term, you'll have an easier time dealing with the day to day.