Encompassing two tertiary care hospitals, 31 community-based primary care centers, a homecare agency, and a physician/medical center joint venture, Bronx, New York based Montefiore Medical Center is located in one of the country's poorest neighborhoods. The Center's mission is to provide patient care and services that meet the needs of its diverse community--which includes 400,000 children. Montefiore also aims to provide educational experiences for physicians, nurses, social workers, respiratory therapists, and high school students. Community service and research are two additional components of Montefiore's mission. Using the Balanced Scorecard, Montefiore was able to go beyond cost reduction to provide high quality, cost effective patient care. The scorecard helped Montefiore grow volume and market share, rebalance its academic and clinical staff, upgrade its facilities--including its information and technology systems--and set targets and achieve them. A part of the Bronx community since 1884, Montefiore's specialized care now attracts patients from beyond its environs who come for treatment at its cancer and cardiology units and to take advantage of its health services for women and children.