Case Study A 150 bed not-for-profit rural hospital serves two nearby towns, both of which help support the hospital through tax-based wh sidies. The hospital is recognized by the community as providing high-quality care, and this judgment is corroborated by data in the Hospital Compare online database published by the US Canters for Medicare & Madicald Services, One of the towns has had an Influx of Immigrants from Southeast Asian countries who speak very limited English. Hospital clinical staff have complained to the hospital's CEO that they are unable to provide high-quality care because of the language barrier, and they are afraid that soon a language-based serious adverse event will result in a patient's death. The CEO is sympathetic to staff's concerns and proposes to the hospital's board of trustees that the hospital's language inter- pretation services include hiring a full-time interpreter who speaks the most common of the languages used by the recent immigrants. The CEO points out that this proposal will help achieve equity in the quality and safety of care for the now diverse population served by the hospital. The board includes members representing each town served by the hospital. The board members from the town with the new immigrants support the proposal. The members from the other town do not; they believe that creating "equity" for the other town's immigrants will divert resources from the high-quality care their town's citizens currently receive. The CEO puzzles over how to develop a proposal that will achieve equity and also preserve the quality of care, and he initiates a QI project to develop better services for patients with limited English proficiency that will not sacrifice the quality of care for all. . 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 CEO play in helping the stakeholder groups reach a resolution that also respects the CEO's values and integrity? Who has the final decision-making authority