Dominion Medical Center (DMC) had improved its total profit margin, operating profit margin, and cash flow margin in the last 2 years because of improved quality of patient care and patient experience. Yet, to sustain and grow, the nonprofit DMC needed to maintain a safe and inviting campus, its inpatient acute-care hospital needed a renovation to reduce noise levels, and its children's hospital needed a kids' play area to be more competitive. Facing a razor thin operating margin and limited capital sources, DMC's board and CEO had to make evidence-based choices and decisions that would have a positive impact on its employees, patients, and the surrounding communities
