As a first step, figure out what the main causes of the problem are. Accurate diagnosis is essential for selecting the right treatment and getting the patient’s (your government’s) support for the treatment regimen. When diagnosing, it is advisable to emphasize factors internal to the organization such as structure, culture, and communications. While external causes, such as a poor economy or state/federal mandates, may be at least partially to blame for fiscal distress, fixating on these largely uncontrollable items saps confidence that a good solution can be found. Of course, presenting a diagnosis where the patient is partly to blame for his or her condition requires a delicate bedside manner.