Happy Valley Hospital is a community-based facility with 288 acute care beds, a twelve suite family-oriented birthing center, a forty four bed long-term care inpatient facility, and a fourteen bed inpatient rehabilitation unit. Happy Valley has a major competitor, GH, which has two hundred beds, a small cancer center, and a kidney dialysis unit.

The medical director of the internal medicine department, along with the director of nursing for this department, is considering establishing a new hemodialysis service. GH has a small hemodialysis unit but they do not have enough beds to properly accommodate the needs of this community.

The medical director at Happy Valley has surveyed the six nephrologists on staff and determined that all six agree there is a need for additional hemodialysis beds in this community. The nephrologists have medical staff privileges at both facilities. They would prefer that the new beds be added to the existing dialysis unit at GH. However, GH has no expansion plans for at least the next five years for this unit. Presently patients are being referred to a dialysis unit in a community, thirty minutes south of Happy Valley Hospital. Patients and their families find this site and its location to be unacceptable.

Based on your understanding of the above case, express your views on the following:

• How should the medical director at Happy Valley Hospital convince the patients who are being referred to a dialysis unit in a community, thirty minutes south of Happy Valley Hospital?
• What steps should the medical director at Happy Valley Hospital take to ensure that the patients are being provided proper care and facilities in the other dialysis unit in the community?
• Is the approach of GH for not having any expansion plans for the next five years for their unit justified, keeping in mind the interest of the community? Why or why not?