Summary Summary: Hospitals in Europe are under stress. They are exposed to complex influences and trends. The most prominent features of these are a growing impor-tance of professional specialization of the work force needed, a complex regulatory environment, high cost pressure, high customer or patient expectations, an aggressive competition in the market place and a distinctive professional culture of the medical and nursing staff. Their loyalty is more linked to their pro-fession rather than to the employing institution. An adequate response to the changes in the environment is needed. However such trends are not confined to hospitals. Other industries and companies are affected by these trends as well. Hospitals that act as learning organizations successfully will get a competitive advantage. Institutions that manage these complex challenges well may therefore assume a model charac-ter for company management in other sectors of the economy. Although the idea of hospitals as learning organizations is not well established yet.