This definitely was not the type of day that St. James Hospital CEO, Paul Ryan, was expecting. As the groundbreaking ceremonies for the Hospital's new addition were about to begin, Paul found himself facing an unsympathetic press and an angry group of protesters. Clearly, he had a crisis on his hands.

St. James Hospital in Parramatta (Western Sydney area of New South Wales, Australia) is a 400-bed multi-specialty community hospital providing ambulatory care, acute care, and psychiatric care services to residents living within the five suburbs of Auburn, Holroyd, Parramatta, Blacktown, and Baulkhaum Hills in the area of Western Sydney. The population of this area is multi-cultural with nearly one-third of the population born overseas and thirty percent speaking a language other than English. The area's population also differs from the population of New South Wales in other demographic characteristics. Table 1 shows some of these differences, although the data do not always allow direct comparisons. These differences have presented the management and staff of St. James Hospital with special socio-cultural, financial, and communication challenges.