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Leading a major institution like the Duke University Medical Center and Health System necessarily involved both communication and reputational issues both within and beyond the institution. Under his tenure, Duke rose to be perceived as among the most innovative medical institutions. Inevitably crises arose as well. One of these involved the temporary suspension of Duke’s large program of clinical trials by a division of the Department of Health and Human Services. Another involved the organ transplantation error that resulted in the death of a 17 year-old girl. Both incidents made national news and pushed the medical center leadership into emergency management mode and ultimately growth.

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