The health care industry in the United States is increasingly pressured to improve safety and quality performance and increase revenue. In response, many health care institutions are moving to redesign their processes and practices in an effort to decrease costs and provide safer, higher quality, and more efficient care. The purpose of this paper is to document the Lean implementation strategy and progress in implementation at a large teaching health care organization undergoing Lean transformation in order to understand enterprise transformation strategies and the impact of leadership involvement on culture development and Lean implementation. Through direct observations and involvement and transformation activities, the methodology for Lean transformation and progress in implementation were documented and analyzed. The organization employed an outside consultant to assist with transformation activities, and underwent a three-pronged approach to implementation, which included model area development, team member problem solving training, and management-led problem solving activities. It was found that leadership involvement was lacking, especially at the highest levels, and the organization struggled to build the culture necessary to support transformation and develop an operational model area, though successes were realized in efforts to train employees in Toyota’s 8-Step Problem Solving method and in management-led problem solving activities.