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Describes how two US hospitals, members of an integrated health system, took different routes to achieve radical constructive change, one of them ‐ an urban community hospital ‐ through what is described in detail as core process redesign; the other ‐ a full‐service, research and teaching hospital ‐ devised and implemented a process described, again in step‐by‐step detail, as re‐engineering of clinical services and business operations.

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