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St. Luke's Hospital was the only hospital in town until 26 years before the time of the case. In the late 1950s St. Luke's Hospital was overcrowded and in dire need of renovation and expansion. Plans were devised and the hospital applied for Hill-Burton money to expand. At the same time, a group of local citizens decided to also apply for Hill-Burton money to build another hospital, County Memorial, in the community. The Hill-Burton money was divided and both received money. Both facilities opened within months of each other. For about 10 to 12 years, both hospitals prospered. At the time of the case, competition has heated up between the two facilities. Attempts at collaboration fail; the story is one of wasted resources and community pain because of the lack of ability of two competitors to put aside differences for mutual benefit. The case ends with there being only one hospital in town. Read alone, the case is instructive in terms of the difficulties created when organizations value survival in a known form above all else. Read and considered in concert with Case Eight, it encourages contemplation of the pros and cons of head-on competition versus collaboration.

The case hospital was required to strategically respond to significant environmental challenges brought into play by the legislative enactment of a new Medically Indigent Assistance Act (MIAA). Publicity surrounding the debate leading up to the passage of the new law by the state legislature placed the hospital under unprecedented scrutiny by local taxpayers, healthcare recipients, elected officials, advocates for the poor and other local providers of healthcare services. This case reports the implementation of a highly desired strategy on the part of the hospital and the necessary roles of multiple stakeholders in the realization of hospital strategy. The case also illustrates the spill-over effects of stakeholder relationships developed in pursuit of particular strategy on the organization's ability to pursue future strategy.

St. Martin's for many years enjoyed a friendly and supportive relationship with a small community hospital nearby even though it was the leading provider of healthcare in the other's market place. In the highly competitive environment reported in the case, it was clear that the smaller hospital would have to move aggressively to increase its market share, consider closure or merge with one of the larger competing hospitals. St. Martin's administration knew that it needed to decide whether to attempt to align itself with Community in some fashion or to compete aggressively enough with Community to so dilute Community's market that it could no longer function. One of these actions was required to avoid serious erosion of St. Martin's own patient base. The decision was made to pursue acquisition. This case presents the successful implementation of a carefully crafted and realized strategy. It provides the opportunity to consider multiple "what ifs" in terms of the alternative strategies not chosen.

Two hospitals sit together on a medical campus located in a large metropolitan area. The larger (746 beds) of the hospitals, St. Catherine's, was established in 1887 by a Catholic congregation of religious women. The other hospital (527 beds), Martindale, was established by a group of Lutheran pastors in 1916. The missions of the two hospitals are very similar. The hospitals are strategically located in the center of a metropolitan area. The marketplace is one which has been characterized as fiercely competitive, with 40 percent of the market enrolled in prepaid plans. The demand for hospital services continues to decline each year. There is significant over capacity in the metropolitan area, with an average occupancy around 50 percent. The hospitals have had a varied history of both cooperation and competition. In 1975, a joint venture organization was established to jointly share expensive technology and develop new shared programs. After a brief study of the declining volumes and profitability in both hospital emergency rooms and identifying that both were perceived as substandard by the public and by the physicians, the question became--"should two competing, neighboring hospitals consolidate their emergency services?" The case reports a problem commonly experienced by hospitals today--when to compete, when to collaborate and how to balance the two in pursuit of organizational competence and advantage.