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The narrative centers on Dr. Peter Kohler's transformative leadership at Oregon Health & Science University, which faced severe operational and financial challenges in 1988. With a visionary plan, Kohler and his team restructured OHSU into a semi-independent public corporation, freeing it from state constraints. This shift led to unprecedented growth: the expansion of facilities, a significant increase in staff, and a remarkable rise in research funding. The book serves as a case study for other academic institutions grappling with similar challenges.