For several decades, healthcare has been linked to the economy, and with the current downturn, we see continued efforts to control and reduce overhead costs. Healthcare organizations, in their efforts to become more efficient and cope with changes in the industry, have modified their strategic business plans. Lee and Alexander (1999) studied organizational change in hospitals and their survival. In this article, I hope to discuss their results and add more examples to validate their findings. in hospital reorganization, the core and periphery are varied systems linked to the hospital's identity and its ability to obtain resources (Lee and Alexander, 1999). Fundamental changes concern mission and strategy, such as ownership or the type of service provided. Peripheral changes, on the other hand, are not as clear cut and some examples are changes in higher level management, restructuring and downsizing, as well as internal changes that do not affect the identity of the organization . Hospital sustainability and peripheral changes. Organizational changes in any context, whether in the core or at the periphery, must be planned and communicated before implementation. However, in many cases, larger-scale central changes appear to have a much better change process than the peripheral changes used by Lee and Alexander (1999). Lee and Alexander (1999) point out three limitations in their study that may have influenced the results: causal implications of the results were not used instead of definitive answers, the organizational changes used were not comprehensive, and the organizational change was different. ... middle of document ...... Transformation or change: some prescriptions for healthcare organizations. Service Quality Management, 10(5), 279-298. Retrieved February 1, 2011 from ABI/INFORM Global. (Document ID: 86065262). Coddington, DC, Fischer, EA and Moore, KD (2000). Characteristics of effective health systems. Journal of Health Forum, 43(6), 40-45. Retrieved February 1, 2011 from ABI/INFORM Global. (Document ID: 64766932). Lee, SY and Alexander, JA (1999). Managing hospitals in turbulent times: do organizational changes improve hospital survival? Health Services Research, 34(4), 923-946. Retrieved January 17, 2011, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1089049/ .Weber, DO and Weber, AL (1994). Reshaping the American Hospital. The Journal of Health Forum, 37(5), SS1. Retrieved February 1, 2011 from ABI/INFORM Global. (document ID: 18641).