EXHIBIT 28 Strategic Thinking Questions for Validation of the Strategic Assumptions

1. Has the organization 's performance been adversely affected by unexpected or new trends or issues in the general environment?

2. Has the organization 's performance been adversely affected by unexpected or new trends or issues in the health care environment?

3. Have new opportunities emerged as a result of new trends, issues, or events in the external environment?

4. Is the strategy acceptable to the major stakeholders?

5. Are there new technological developments that will affect the organization?

6. Have there been social or demographic changes that affect the market or strategy? Changes in the ethnic mix? Language barriers? Family structure?

7. Has the legislative/political environment changed?

8. Are there new local, state, or federal regulations or laws being introduced, debated, or passed that will affect operations or performance?

9. Are there new economic issues?

10. Have new competitors outside the industry considered entering or actually entered into health-related areas?

11. Is the strategy subject to government response?

12. Is the strategy in conformance with the society 's moral and ethical codes of conduct?