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When Mr Liak Teng Lit officially assumed the post of CEO of Singapore''s Alexandra Hospital (AH) in February 2000, he perceived the general mood in AH to be somewhat pessimistic and lethargic. After all, the Singapore government had already announced that a comprehensive hospital in the western part of Singapore would replace AH in 2006. There were complaints in the press of bad services, and the physical infrastructure was in a state of disrepair. The negative public perception was a concern for AH, but the hospital before restructuring operated under a different set of parameters with a limited budget and various civil service constraints. Under the old premise, the hospital''s existence was not dependent on its profitability or numbers of patients'' visits. The CEO had to decide on the next course of action after his initial assessment. With the mandate to restructure the hospital, he and his management team had to consider for its survival, the question of how a limited facility hospital should compete with two nearby full service hospitals, namely the National University Hospital (Singapore) and the Singapore General Hospital with similar hospital charges. What should be done to make Alexandra Hospital relevant to Singapore or at least to its community? The teaching note was written by YT Tien Hua.