Recent changes in the external healthcare environment have greatly altered the landscape in which hospitals operate. Strategies that may have worked for institutions in the past are no longer viable. Hospitals are being forced to do more with fewer resources, straining management and employees alike. The pace of change is accelerating, and traditional cultural expectations in many organizations represent an obstacle to success in this new environment.

Historically, hospitals have operated with a strict division of activities such that decisions impacting physicians were made separately from those impacting everyone else. In fact, in many organizations, decisions that impacted physicians and their practice of medicine could only be made by other physicians. However, as organizations seek to respond to the challenges that this current marketplace presents by making pricing more transparent through the bundling of services, the cultural norms that prevent administrators from assessing and intervening in clinical decisions must be reexamined.