What do you think were the underlying reasons for the performance problems that Virginia Mason Hospital was encountering early 2000s? Which of the four building blocks of competitive advantage did lean production techniques help improve at Virginia Mason? What do you think was the key to the apparently successful implementation of lean production techniques at Virginia Mason? Lean production was developed at a manufacturing firm, Toyota, yet it is being applied in this case at a hospital. What does that tell you about the nature of the lean production philosophy for performance improvement