Happy Valley Hospital is a community-based facility with 288 acute care beds, a twelve suite family-oriented birthing center, a forty four bed long-term care inpatient facility, and a fourteen bed inpatient rehabilitation unit. Happy Valley has a major competitor, GH, which has two hundred beds, a small cancer center, and a kidney dialysis unit.

Happy Valley's director of internal medicine, along with the director of nursing for that department, are considering establishing a new hemodialysis service. GH has a small hemodialysis unit, but they do not have enough beds to properly accommodate the needs of this community.

The Happy Valley medical director has surveyed the six nephrologists with staff privileges at the hospital and has determined that all six agree that there is a need for more hemodialysis beds in the community. Moreover, these nephrologists all have staff privileges at both Happy Valley and GH and would prefer that the new beds be added to the GH unit. GH, however, has no plans to expand their unit for at least the next five years, and presently, new patients are being referred to a dialysis unit in another community thirty minutes south of Happy Valley Hospital. Those patients as well as their families find this alternative site and location to be unacceptable.
Based on your understanding of the above case, express your views on the following:

• How should the medical director at Happy Valley try to convince patients now being referred to the dialysis unit thirty minutes to the south to switch their care to Happy Valley Hospital?

• What steps should the Happy Valley medical director take to ensure that patients will get the proper care and facilities at the Happy Valley Hospital hemodialysis unit, when it is established?

• Is the approach of GH for not having any expansion plans for the next five years for their unit justified, keeping in mind the interest of the community? Why or why not?