Group 4, made up of 19 hospitals, is characterized by its correlation with the negative side of the first axis. These hospitals are the ones that can be said to engage in strategies relating to human resources management and marketing. They have performance assessment systems and stuff promotion schemes. the various groups of professionals within these hospitals undergo training in technical skills specific to their job category, health care management skills, and issues relating to quality and patient care. Also, the clinical and nursing divisions are deeply involved in the management of human resources.