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Dr. Snyderman describes his view of the operation of the medical center when he arrived in 1989 and his establishment of plans to maintain and enhance the functions of the institution. He learns the details of all the departmental structure, operating units, develops strategic planning, and begins to realize the need for major change. He did this, for example, through an experiment called “follow the sheet,” which enabled him to learn the unacceptable conditions under which the hospital laundry employees labored. Duke’s legacy of segregation and racial inequality came to the fore in this and subsequent efforts to reform and improve the institutional environment of the medical center.

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