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Facing reduced government funding, yet committed to broadening access to its services, Sankara Eye Care, a chain of hospitals in India, was at a crossroads in 2015. Over the years it had developed a lean operational model to provide free care to approximately 80 percent of its non-paying patients (cross-subsidized by paying patients). Continuous improvements and further innovation, however, were needed to achieve its ambitious goal of expanding from 9 hospitals to 20 by 2020. The case highlights Sankara's key decisions, including issues of intrinsic and extrinsic motivation, moving from a charity to a business mindset, and determining the expansion strategy.