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In 2011, the Veterans Health Administration (VHA) engaged a small set of interested VA healthcare systems in the integration and deployment of Lean Enterprise Transformation strategies. Based on the success of these systems, a journey to deploy an enterprise-wide quality improvement strategy with a core foundation of patient safety was initiated in 2014. Aligning with core principles from High Reliability Organizations, the goals of this program are to 1) develop an enhanced safety culture; 2) facilitate integration with new technologies to enhance practice; 3) ensure that, when appropriate, Evidence Based Practice is the basis upon which all clinical care is administered; and 4) provide the highest levels of effective and efficient administrative processes through implementation of Lean Management Tools and Methods. This paper overviews the initial development and evolution of the VHA enterprise-wide quality strategy; the successes and challenges of deploying this program; and the status of the program to date. We conclude with a proposed model for further research in this area.