How is it possible for a hospital to finish one year safely in the hlack, then, suddenly have negative operating results in a matter of months? Is this really a surprise that hits with no warning? Or are there signs that simply get overlooked in the pressure to meet hottom-Iine expectations? Although the accountability for establishing a budgetary process that is steeped in reality belongs to the CEO. frankly, it is the CFO who has to work hand in hand with the CEO to hring hudget reality to the organization. Senior financial leaders often ask. "What can 1 do to bring hudget reality to my organization?" Here are some tips for you to consider.