The unfocused strategic vision

Integrated delivery systems are often seen as the answer to the question of how to deliver high quality health services to a defined population at the lowest possible cost. This case examines the birth, growth, and ultimate demise of one such system. At first glance, all of the elements necessary for a successful integration were present including visionary leadership and a well defined strategic plan. However, the senior managers did not foresee the problems that would result from a clash of organizational cultures, significant mistrust between and among staff and physicians, and inability to manage the emotional-cognitive landscape.