For more than 80 years, Hope Medical Center had serviced its local residents as a privately run, not-for-profit
community hospital. However, with the rapidly escalating cost of medical care, last year, Hope’s board of
directors agreed that, for the hospital to survive, it was in their best interest to partner with the Greater Valley
Hospital Alliance (GVHA)—a for-profit hospital management group. Under GVHA’s management, resources
could be used more efficiently, the hospital would have more financial security, and patients and doctors alike
would have access to other facilities in GVHA’s network of hospitals. GVHA had promised that Hope’s daily
operations would remain untouched after the merger. When announced in the local newspaper, nearby residents
and the hospital staff enthusiastically supported the partnership.
Stella Brindle had worked for Hope for the last 8 years in its community relations department. She helped
publicize the hospital’s services, success stories, and awards. She also helped the hospital raise money, and she was
particularly proud of her work directing the most recent fund-raising campaign that helped finance the hospital’s
pediatric unit renovations. Stella was excited by the merger; by sharing resources, she believed the partnership
would free her from some of the more tedious job duties and allow her team to focus more on fund-raising and
developing the hospital’s services.
Additionally, Stella’s team had spearheaded an initiative called the Beacon of Hope, a mission statement and
motto for all employees. Called the Beacon for short, its purpose was to “inspire all members of the Hope
community to realize what it means to be truly exceptional caregivers.” The Beacon had emerged after the
American Medical Association named Hope as “the nation’s most compassionate hospital.” The director of
community relations, Devin Au’berge, wanted to formalize this standard of care and assigned Stella to lead the
Beacon initiative.
With support from the entire hospital community, the Beacon was to serve as a code of conduct for all
physicians, nurses, staff members, and volunteers. Stella ran a number of focus groups and sought input from
various stakeholders. As a result, Hope employees were quite proud of the Beacon and what it stood for. The
mission statement appeared prominently on all of the hospital’s promotional materials, and a framed copy hung
in each patient’s room. The hospital gift shop even sold a variety of items with the Beacon’s logo. Hope’s
physicians were invited to use the Beacon in their patient office areas, and the Beacon logo was stitched on all
hospital lab coats and scrubs.
Despite the Beacon initiative’s success and the initial community support for merging with GVHA, however,
tough times were on the horizon for Hope. Six months into the merger, Stella and many other employees had
serious regrets about joining the GVHA network. When initially proposed by the board, Hope employees were
led to believe that a partnership with GVHA would have minimal impact on their day-to-day tasks. The CEO of
GVHA even told hospital staff that “a partnership would not disrupt the wonderful community culture of Hope
Medical Center.” However, only days after the deal was signed, this promise seemed moot. First, a bright red and
purple GVHA banner was hung, overshadowing the Beacon. Next, GVHA administrators sent an e-mail
informing Hope employees that as part of the GVHA network, Hope employees must wear the GVHA-approved
uniforms or lab coats. Although seemingly a trivial issue, Stella and the rest of the community relations team were
upset. Not only were they being forced to wear a uniform, but the demand also meant the Beacon logo could no
longer be worn because it wasn’t “consistent” with the other GVHA hospitals.
Transformations appeared in the gift shop, too. The Beacon merchandise was still there but on a back shelf where
it was hard to see. And several weeks after that, Stella noticed changes to the hospital’s website. The Beacon was
no longer featured prominently; instead it was a tiny link, buried halfway down the page. Stella was confused;
normally, her department managed the website and all changes were made as a team. Yet, no one in community
relations knew anything about the changes. When Stella called GVHA to find out about the new website, she was
told, “Oh, you don’t need to worry about maintaining your site anymore. We’ll do all of that for you so you have
more time to work on fund-raising.” Stella felt conflicted. On one hand, no one in community relations liked the
tedious task of constantly updating the website; however, she wished the team would have been asked, or at least