At a professional conference, the owner of a 100-bed assisted living facility learns about new ways to create patient-centered programming within assisted living settings. Intent on making care delivery at his own facility a more patient-centered experience for its residents, he asks the assisted living administrator to implement changes. The administrator has seen the effectiveness of a Six Sigma approach to improvement in a hospital where he was formerly employed. With the help of a consultant, he begins a Six Sigma project to make the residence more patient-centered. They progress through the design-measure-analyze-improve-control (DMAIC) phases of Six Sigma. In obtaining "the voice of the customer" during the design phase, staff learn that different stakeholders have different values. The residents most value their freedom, the residents' families most value the residents' safety, and staff most value efficiency. During the analyze and improve phases, staff are able to identify solutions that create more patient-centered programming with only minimally increased risk to the residents and that uses fewer resources (e.g., providing interactive videos for patients that identify options and the relative benefits, risks, and costs of each option). The goals are that residents are pleased and their families agree that the improved quality of life for their loved ones is worth the minimally increased risk. Who are the relevant stakeholder groups? That is, who will be affected by the change? What are each group's most important values? What techniques could be used to enable the stakeholder groups to learn each other's values and concerns and to identify shared values and priorities? What role should the administrator play in helping the stakeholder groups reach a resolution that also respects his values and integrity? Who has the final decision-making authority? Some staff members believe the resolution is not consistent with their commitment to "first, do no harm" and are at risk of moral distress. What can the administrator do to reduce this risk?