Senior management links the Board and the community to the administrative and medical staffs by being accountable for the organization’s directions and communicating the mission to all. Senior management is the appropriate place for monitoring the interaction of the medical staff and the other parts of the hospital. Managed Service Restructuring (MSR) requires that managers should be capable of taking a comprehensive or global view of the organization so that senior managers work in concert with the medical staff and others to bring each plan to fruition. Middle management has an obligation to continuously apply the MSR approach to all services offered in order to keep pace with changes in the environment and the availability of resources. In order to avoid the exclusion of external points of view, there should be some person or department responsible for the acquisition of competitive intelligence and a community advisory board that can represent the community’s needs and feelings.