Scenario 1: Placing the receiver back into the phone cradle, the chief executive officer has just learned that her hospital, along with six others in the community, are to be integratesd within the next 12 months into one region-wide system. Several of the hospitals are at various stages of planning, design and implementation

of reengineering processes. She immediately wonders what impact this new policy will have upon her hospital's reengineering project, which is only 10 weeks away from beginning its implementation phase. Will implementation of the reengineering project be put on hold? Will savings targets and process redesign plans for the various departments need to be reexamined? How can she best motivate her project design teams, without losing any of the momentum and commitment to the reengineering effort which has been so carefully established over the last several months? How will the new regional system's administration respond to the several hospitals' reengineering projects - will one be chosen as the prototype for the new system? What should she recommend to her Board about how to manage the project for the next nine weeks and beyond?

Scenario 2: The Acting Executive Committee of the newly established FeelGood Health System is exhausted. A bevy of eager and energetic consulting firms have pitched their strategies on how FeelGood can simultaneously reengineer and integrate their three hospitals and ambulatory-care centre. To determine which consulting firm can best assist them with the integration and reengineering effort, FeelGood's Executive Committee must begin evaluating the various approaches to project design and management, cost savings-targets and priorities, and strategies for clinical integration. Where do they begin?

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