THR's goal of exceptional performance will have to be accomplished with cost savings, growth, and stakeholder value that may be in tension with quality and patient outcomes. This paper will examine the culture of THR, its contribution to the future success of THR, the present status of the strategic plan, and the future opportunities and obstacles facing THR.
One of the primary assets that THR has as an industry leader is its mature and highly focused culture. The culture at THR is primarily based on the three pillars of being a faith-based organization, customer centered care, and the strength of its commitment to physician engagement. THR believes strongly that culture is the 'key driver to THR's competitive advantage" (Texas Health Resources 1, 20). Being a faith based health organization has several cultural aspects that define THR. Faith based, and primarily Christian, organizations have a long historical record of quality health care within the United States. In addition, they have traditionally shared "a passionate commitment to improving the quality of life of vulnerable populations" (MJ DeHaven et al. 1034). This aspect has created an attitude of patient oriented care to those that are most needy with less regard for a profit motive than for patient outcome. Faith based is also regarded as a system that places a high value on life and the positive aspects of spirituality in healing. These faith-based traditions are deeply engrained in THR's culture and THR is committed to maintaining these aspects as they move forward during the next 10 years.
Bolstering the faith-based culture of THR is the long-term goal of its commitment to patient value and its dedication to working with physicians who have a good cultural fit. THR expresses this aspect of their culture as the Promise and the Value. The Promise is the pillar of their culture that emphasizes the importance of the individual "which can be easily lost in a larger organization" (Texas Health Resources 1, 6). Value relates to delivering the highest level of outcome, safety, and service in accordance with the cost of care. In addition, THR has made a formal commitment to creating physician and hospital relationships that will forge a physician partnership "in leading and managing key aspects of the THR 10-Year Strategic Focus and Transformational Themes" (Texas Health Resources 1, 23). Together, the faith based foundation, the promise to the individual, the concept of greatest value, and the physician partnership form the core concepts of THR's culture.
While a great degree of THR's culture is in place and simply needs reinforced, the goal of integrating physicians as active managing partners will be a progressive process. Initially, physicians will be engaged based on a strategy of mutual benefit. Of course, while much of this benefit will be economic in nature, the long-term strategy also has some intangible benefits for the physician. The 10-year transformational plan calls for physicians that have a proud association with THR's brand, advanced clinical outcomes, as well as "tangible economic, clinical, and operational performance" (Texas Health Resources 1, 24). In addition, new employees are oriented into the strong culture of THR by highlighting their strategic statement which promises "to deliver outstanding value