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In November of 2010, the board of Stanford Hospital and Clinics announced that Amir Dan Rubin, at the time chief operating officer of the UCLA Hospital System, would become the next CEO at Stanford Hospital and Clinics. Although by 2010 Stanford hospital had largely recovered from a failed merger with the hospital of the University of California, San Francisco, and was financially stable, Rubin would lead an organization that still faced significant challenges. These included creating a focus on patient care and improving operational performance, especially in the wake of an increasingly competitive health system landscape. Rubin’s success depended on obtaining the support of a large existing internal staff as well as the medical center faculty. The faculty reported to the dean of the medical school, not to Rubin. The case describes what Rubin did to transform the culture and operations of Stanford Health Care and, specifically, what he did to build support among the various constituencies so critical to his being successful: the medical school physicians, the board of the hospital, and the colleagues already at Stanford. The case also looks at the next steps that Rubin planned in 2014 for continuing to move the hospital forward and the challenges with which he would need to grapple. The case is useful in classes on leadership, organizational culture and culture change, and in classes on power and influence where outside succession and the task of building internal support is a topic.