Felipe Izcaray, the new general manager of the Clínica Santa Sofía in Madrid, a hospital specializing in gynecological and pediatric care, was put in charge of improving management and increasing profitability. Although the company was well-managed in terms of processes, it did not have its objectives clearly defined. Although the company has improved in terms of operational efficiency and cost control, their profits had not gone up. Izcaray decided to hold a meeting with the Board of Directors to present his analysis of hospital management. He proposed making changes in the departmental structure and drawing up a new department-by-department organizational chart, providing 24-hour emergency service and treating customers in a way that their stay is a true pleasure. The conclusions from the meeting were that profitability needed to be increased by attracting high-value customers, comprehensive service needed to be provided in order to achieve cross-sales to the customer, they needed to continue arrangements with the public health system, and to improve the clinic’s reputation. The clinic’s new management committee then got together to draw up a strategic control chart. The committee was made up of managers from different departments who did not totally agree on what the clinic’s strategy should be and who all had different concerns. The managing physician emphasized that although the company was seeking profitability and economic results, they could not spare measures or restrict the use of resources. They needed to avoid giving precedence to profitability above patient health. The head of sales and public relations also mentioned that excellent service is important since word of mouth will get them new customers and positive references could create cross-sales. The nurse mentioned that the employees’ level of satisfaction also needed to be taken into account to achieve a low turnover. Someone else mentioned that they could use referrals from renowned physicians or public figures to gain more customers. When the head of management control brought up reducing costs, the managing physician strongly disagreed and said he would not ask professionals to concern themselves with cross-sales, bed turnover, etc. Izcaray knew that the support of the managing physician was essential. He needed to be sensitive to ideas from all the areas and reorient those that did not fall within the objectives of the company in order to prepare and implement a strategic control chart. The case discussion is centered in the difficulties of balancing profitability with excellent healthcare service.