The balance between metrics and mission.

Culture and change are frequently linked in inquiries into the past, present and future of health care. However, an intimate relationship does not necessarily mean an easy marriage. Many predicted changes of the past decade (e.g., health care reform plans) failed to occur as expected because the culture's ability to resist was stronger than politics' power to transform. A force for change can also cause a health care entity (e.g., a small or rural hospital) to evolve into something very different in order to avoid its demise.