Includes bibliographical references and index.

The East Hawaii Region of the state-owned Hawaii Health Systems Corporation (HHSC) aims to achieve what few "safety net" health systems even dream of--performance excellence on par with the best hospitals in the U.S. Anchored by its mission, Hilo Medical Center and the other facilities that are part of the HHSC region that serves the east side of the Big Island of Hawaii, have achieved significant milestones toward this ambitious aim. This case outlines the significant challenges associated with operating a public, unionized healthcare system where there are severe physician shortages, describes the key leadership actions taken to improve performance, and invites students to analyze potential future actions that would further advance this organization toward achieving its vision.

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