In both the corporate and not-for-profit healthcare worlds, the capital markets have long favored larger organizations. Is this view by investors, rating agencies, and bond insurers justified and does size and growth drive exceptional and sustained organizational success? Using data from publicly-rated hospitals, realize the impact of scale on profitability, leverage, capital spending, and credit rating. Identify common characteristics of organizations that have achieved successful growth and scale and take home a plan for action, identifying the key steps your organization must take to create a sustainable growth initiative.