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This case is about the history, achievements, and problems of a uniquely run medical institution. It has become an award-winning, world-class institution through emphasis on and nurturing of talented, hard-working, and salaried doctors; a culture of excellence and innovation; and teamwork. In recent years, as competition for patients grew, funding and reimbursement diminished, and patients demanded better service, the center has had to find ways to provide better patient service in order to maintain its competitive edge.