A major hospital lacked an integrated risk management framework. Internal Audit reviews linked this deficiency to poor budget management and substantial losses sustained by the organization. Additionally, prior efforts to implement a risk management framework were deeply segregated and focused primarily on “clinical” risks. To achieve the objectives of risk integration and visibility into a holistic risk universe, priorities and interests around risk management were aligned between the business administration and Chief Medical Officer, as well as his staff. As this process revealed the disparate needs of the organization, the consultant facilitated agreement and common ground was found. A comprehensive and integrated risk management framework was defined and implemented to serve the needs of all the stakeholders involved.