I'm excited to see responses.

My advice would be to focus on culture. A healthy, constructive culture will allow an organization to react and respond appropriately to industry challenges. While it takes time to transform a culture, there are more immediate benefits. The key to transformation, like most successful initiatives, is ownership from the top.

A healthy culture will allow valuable and scare resources to focus on what is important to the organization - patient safety, quality, growth, etc. since it isn't having to address the dysfunction that comes with silos, ineffective communication, power plays and politics.

I agree with the other comments. I would also encourage leaders to reach out to colleagues facing the same challenges. Perhaps through an association like the local Hospital Association, Medical Society or the Community Clinic Association. THen of course there ar ethe state and nationwide associations and councils.

I would agree with all the above comments. Be willing to be honest with your employees. Have town hall meetings to keep your hospital in the loop. Have the right people at the meetings when changes need to be made.

I agree with all of the comments above. I would also revisit the mission and vision statement and the strategic plan. Many times we get caught up in dealing with a number of different issues that we forget or neglect our foundation principles.
I would also evaluate the specific amount of community involvement and define what is and is not effective. I know in our health system we have employees volunteer their time (in which they are paid for) to mentor children at local schools. Things like this speaks volume in a small community.
The medical staff is tough. Depending upon your situation, you may want to look for a physician champion to help you achieve your goals.