Fragmented services that create problems with access. Chronic disease management. Reduction of overcrowding in emergency rooms. Implementation of electronic health records. These are just a few of the critical challenges faced by healthcare leaders.

Some of these initiatives have been undertaken with mixed results, plagued by delays, budget overruns or missed expectations (Smith 2002). However, there have also been stunning successes. One of the key factors that make these initiatives so complex is the need for co-operation between functional areas and between internal and external stakeholders.


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