A competitive healthcare environment in Boston was the backdrop to a merger between two large hospitals with differing cultures. This case study examines how the newly-merged and dysfunctional Beth Israel Deaconess Medical Center became valued by patients, staff, and referrers.

For many NHS leaders, there will be much that is familiar in the challenges faced by Paul Levy. When he became CEO of Beth Israel Deaconess in 2002, the organisation faced financial crisis, deep seated problems with the quality and safety of patient care, poor staff morale and fractious relationships, and all played out in the media spotlight.

Eight years later, Levy acknowledges that he still has much to do and that some of the journey has been through stormy waters. But there can be little doubt that with his leadership the organisation has salvaged its reputation and is now thriving in the unforgiving US healthcare environment.