The document discusses the author's journey with lean + BIM and two hospital projects in California. For the first project, Castro Valley Hospital, using BIM and lean principles like integrated project delivery resulted in a 6-week schedule gain and on-target costs. However, the second project, Alta Bates Hospital, was 6 months behind schedule and $20M over budget due to lack of trust and communication between teams. The author emphasizes that BIM is just a tool and success depends on the people and processes used.