The Bloomington Hospital board of directors faced several choices in its move to begin an open-heart surgery program. The medium-sized not-for-profit hospital wanted to expand its services to become more of a regional health-care provider. However, its efforts faced opposition from two key groups, area employers, including the two largest employers in the region, and area physicians upset over several issues relating to hospital administration. The physicians demanded the ouster of hospital administrators. The board had to decide what to do about both the open-heart unit and the physician's demands, all the while keeping in mind the demands and needs of other stakeholders as well as the changing health-care environment.