The researcher is the president and chief executive officer of Medical City Dallas Hospital, a 705-bed acute care hospital located in the Dallas/Fort Worth metroplex. The transformation of this organization from mediocrity to excellence is the subject of this research. The hypothesis is that hospital performance improves when transformational leadership is utilized in strategic planning. The research chronicles the organization's transformational journey over the past eight years, including the creation of the Medical City Dallas Leadership System (MCDLS) placed within a strategic planning framework. In defining transformational leadership, the researcher categorized the results into seven attributes which were identified by an internal HCA study on high performing facilities. These attributes are defined as visionary leadership, consistent and effective communication, selection for fit and on-going staff development, agile and open culture, service is job one, constant recognition and community outreach, and hospital-physician leadership. The strategic planning was categorized into seven phases which included: plan, input, analyze, prioritize, establish, deploy, and review. The comprehensive multi-year strategic planning process incorporated the elements of transformational leadership. The creation of mission, vision, and value statements was foundational to this work and provided clarity of organizational purpose and direction. Medical City Dallas Hospital developed five key indicators of success or the Five Keys to measure organizational performance against strategic planning structures and efforts. The creation and establishment of these elements is explained. The five key indicators are as follows: employee pride, physician engagement, patient loyalty, fiscal performance, and community involvement. The research confirmed a progressive improvement in results from 2000 through 2008 and demonstrated superior performance in comparison to other HCA facilities, HCA high performing facilities, and HCA North Texas hospitals. The research described and confirmed the presence of leadership behaviors as defined by transformational leadership theory. The incorporation of these behaviors in the strategic planning process was documented and the resulting achievements demonstrated superior organizational performance. This case study of Medical City Dallas Hospital confirmed the hypothesis that hospital performance does improve when transformational leadership behaviors are utilized in strategic planning.