This case, a follow-up to "The University of Virginia Health System: The Next Generation of Quality Care and Patient Safety (A)" (UVA-OM-1608) continues to follow the University of Virginia Health System's (UVAHS's) transformation into a leader of operational excellence focused on both patient outcomes and the well-being of health care team members with Be Safe, its new signature quality improvement and safety program. This case gives students an opportunity to engage more deeply in class discussions in several areas, including managing organizational change, understanding supportive leadership actions on multiple levels, and implementing Lean principles and methods in service line-structured operations. It also exposes students to issues currently facing the health care industry, particularly from an academic hospital standpoint. The case first follows UVAHS's realignment of hospital team members, physicians, and the School of Medicine into service lines for performance management. In the case, a closer look at a successful service line, Neurosciences & Behavioral Health, gives students an opportunity to examine key management decision points involved in executing a new organizational vision. The case then presents a current management challenge; how to improve Leader Standard Work (LSW) for 300 midlevel managers?assistant nurse managers, nurse managers, and medical directors?to provide mechanisms for reinforcing accountability during performance management in service lines.