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The Midvale Healthcare System case explores the impact of complexity, uncertainty, volatility and ambiguity (CUVA) on leadership decision making and prioritization. Midvale, a traditionally stable healthcare provider, is experiencing an escalating cascade of internal and external challenges. These include shifting patient demographics, reimbursement uncertainties, workforce shortages and evolving competitive pressures. Amid this whirlwind, CEO Sarah Martinez must grapple with the uncertain future of healthcare policy and rapid technological advancements while striving to maintain Midvale's core focus on quality patient care. The case highlights the complexity of interconnected problems facing many business leaders today and the importance of recognizing, prioritizing and mobilizing to deal with emerging challenges and opportunities. It is a vehicle for exploring the key elements of strategic thinking, including pattern recognition, systems analysis, mental agility, structured problem solving, visioning and political savvy as presented in the book The Six Disciplines of Strategic Thinking.