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Health care providers are faced with two critical issues in today's evolving marketplace: lowering operational costs and achieving more efficient, cost-effective methods to delver high quality patient care. The rising costs of healthcare and decreasing budgets have placed additional strain on the United States Air Force Medical Service to aggressively lower its facilities' costs. With fewer funds and less personnel, the Air Force medical service is re-evaluating its current maintenance outsourcing implementation practices and reexamining how these strategies might be implemented and sustained more successfully. This research offers some of the foundational needs for designing, implementing and sustaining any type of outsourcing effort. Additionally this study highlighted some DoD specific issues to program management, focusing on some of the unique attributes associated with successfully managing and sustaining a DoD medical facility maintenance program. Content analysis was used to determine the ingredients for successful outsourcing implementation and sustainment.