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The modern hospital has evolved through three phases since 1900. Between 1900 and 1950, hospitals were in a charitable era and from 1950 to 1990, they were in a technological era developing a comprehensive range of clinical services. From 1990 to well into the 21st century, hospitals will be in an economic era where decision making will shift from the boardroom to the administrative suite. Clinical and management viewpoints will be blended in order to successfully compete in the new environment.