Dr. Laurie Gianturco ("Dr. G."), Chief of Radiology at Baystate Health and President of the private imaging practice Radiology & Imaging, Inc. ("R&I"), and her partner for this project, Suzanne Hendery, VP of Marketing & Communications at Baystate Health, considered their new assignment. With Baystate leadership's full executive sponsorship and support, but no additional budget, they were tasked with consolidating two competing practices-one operated by R&I, the other by Baystate Medical Center-to form a new breast services center under the Baystate umbrella. The consolidation would simplify redundant Baystate-affiliated breast services offerings, making the system less confusing for patients and providers while giving Baystate the opportunity to offer more patient-centered services as well as reducing its operating costs and boosting revenues. They knew it would be a complicated project, involving two competing physician practice cultures, three clinical specialty orientations, the potential disruption of existing referral networks, and the merger of imaging services for healthy women along with treatment for women with breast cancer. Despite these challenges, they banded together to define a patient-driven culture, create an integrated program, and build a strong brand anchored by the new facility. Their goal was to gain a competitive advantage by developing a relationship-based approach that would exceed customer (patients and referring physicians) expectations for service. "The financial argument was the easy part," Dr. G reflected. "How to actually design a model of care is where we came to an impasse."

After extensive negotiation, Baystate Health (BH) and the private Radiology and Imaging (R&I) hammered out a clear business plan to consolidate their two practices in a new breast center in a new location. Despite a clear business plan, however, tensions among the two staffs remained high. Project leaders Dr. Gianturco and Suzanne Hendery carefully crafted an internal communication and implementation plan, detailed to the hour, and enlisted a consultant to help to unify the "warring factions." The consultant worked with Dr. G and Ms. Hendery to plan and hold a retreat with all of the stakeholders-clinicians, management, and staff-from all locations and from both legacy organizations, with the goals of constructing a new cultural blueprint and designing a new patient experience.