Case twelve. Positioning a small rural hospital to respond to the requirements of a recently enacted state-wide medically indigent assistance act.

The case hospital was required to strategically respond to significant environmental challenges brought into play by the legislative enactment of a new Medically Indigent Assistance Act (MIAA). Publicity surrounding the debate leading up to the passage of the new law by the state legislature placed the hospital under unprecedented scrutiny by local taxpayers, healthcare recipients, elected officials, advocates for the poor and other local providers of healthcare services. This case reports the implementation of a highly desired strategy on the part of the hospital and the necessary roles of multiple stakeholders in the realization of hospital strategy. The case also illustrates the spill-over effects of stakeholder relationships developed in pursuit of particular strategy on the organization's ability to pursue future strategy.