This book provides insight into the initial deployment of a Lean Management System across VA, the nation's largest healthcare system. The book presents the origins of VA's Lean Enterprise Transformation (LET) in its 156 medical centers. The authors detail the clinical and administrative outcomes of these efforts, as well as the formative evaluation methods used to monitor and improve the VAs LET deployment and examines how the VA strives to provide the best patient experiences for our Veterans. The book takes a comprehensive, multi-level approach, revealing how innovation in VA healthcare is occurring through narratives from leaders, administrators, physicians and staff.