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As the country moves toward full implementation of the Affordable Care Act, one issue that many safety-net hospitals are grappling with for the first time is market competition. While it is still not clear how many states are going to go along with the reform law’s expansion of Medicaid, the thinking is that in areas where newly insured patients have options for where to receive care, safety-net facilities are going to have to compete with other facilities to be the hospitals of choice.

Clinical team leaders provide added heft in driving improvements, moving the ED culture toward a patient-centered approach