One hospital's trip up the down staircase.

This study illustrates one hospital's response to fiscal restraint. An Edmonton facility was able to reduce its budget while changing its strategic direction. During a planning process the hospital identified clinical needs that were not being met and, subsequently, reduced less utilized programs while allowing funding of new programs. This article identifies notable features of the budget reduction, provides information required to duplicate the process, and concludes with an analysis of the merits and shortcomings of such an approach.