Olga Zimmerman was the clinical operations director of the Quincy Lake Clinic (QLC), a provider-based primary and specialty care clinic. For the past four months, Zimmerman had been learning her new role and trying to change the organization using Lean concepts. She had many process-improvement opportunities and had been recording her observations during her frequent gemba walks. She had created a pile of sticky notes of various issues she thought she should address and had some possible solutions in mind. Zimmerman wanted QLC to double its throughput rate while improving delivery, safety, and quality at the same time. Students must identify and prioritize the key issues for Zimmerman to address.