ou are John Smith, chief operating officer of Regional Hospital, part of the Regional Health System of 15 hospitals in Eastern State. You have just read Clayton Christensen's (2009) book The Innovator's physicians, and chronic care organizations. But his ideas are far different from the realities you face in managing operations at Regional Hospital. You wonder about changing the hospital organization from a "solution shop" to a "focused factory." According to Cook and colleagues (2014, 746), "the full-service US hospital has been described organizationally as a 'solution shop,' in which medical problems are assumed to be unstructured and to require expert physicians to determine each course of care." This model leads to unwarranted variation and results in lower quality and higher costs. Mayo Clinic determined that a focused factory model-which emphasizes a uniform approach to the delivery of a limited set of high-quality services-was appropriate for 67 percent of cardiac surgery patients. Implementation of the model reduced resource use, length of stay, and cost. Variation was also markedly reduced, and outcomes were improved. You are convinced, but how do you get other managers at Regional Hospital and Regional Health System to actively consider a focused factory model for implementation? Case Questions 1. What are the facts of the situation? 2. What are the reasons that an implementation structured similarly to the one at Mayo Clinic will or will not work at Regional? 3. Certainly, you will encounter stakeholder concerns about the costs of making the change, questions about how the change will affect reimbursement, and push-back from surgeons who are against the practice of "cookbook" medicine. How might you overcome other key stakeholders' opposition to the change? 4. What should you do now, and why? 5. How can you get buy-in from the system CEO while protecting your own job and not "biting off more than you can chew"?