Alana gets to work immediately implementing changes to streamline the hospital's processes and increase efficiency. Most of what she does is to make things more uniform, like standardizing the supplies in all of the ORs, but some of the things are a little more out there -- like installing cameras in all of the CCU rooms so that a remote doctor can presumably help with cases. Cristina winds up with a doctor named Bob "helping" her and Leah, and she butts heads with him and refuses to listen to his suggestions about preferred medications. They then wind up with a teenage patient who was in a horrible accident, but he's a Jehovah's Witness which means they can't give him any blood whatsoever. Leah had no idea that there was an actual law in place that forces doctors to obey these wishes, but Cristina knows and does all she can to try and help the kid sans blood even though he lost about half of his own in the accident. She does make a plea to the family to allow the blood but they stick to their guns, and Leah gets up in arms about their decision to the point where she goes into the kid's room and tries to sneak him some through his IV drip. Unfortunately for her, she forgot about Bob, who catches her in time and busts her with Cristina. Unfortunately for the patient, he winds up dying and Leah is left struggling with her inability to understand or respect the family's choices, and her confusion that Cristina was so calmly able to handle it.

Another streamlining measure is to start standardizing certain surgeries; today the lesson for the general surgeons is regarding hernia repair and Alana brings in a guy to teach his method which has been deemed the best. Bailey is still all for playing along with these changes since the alternative is watching the hospital close, but Richard is adamant that his personal method is better and he's going to just go ahead and stick with it, thankyouverymuch. He finally gets in a fight with the guy about it and Richard accuses him of trying to turn the hospital into an assembly line. Unfortunately, as the guy is yelling back, trying to defend himself, he slips and actually yells that the patients don't matter -- this gives all of the surgeons who witnessed the outburst some pause.

Alana doesn't hear this because she wound up helping Owen with a surgery on account of she was standing next to a patient when his carotid artery blew and was the one to patch it up with her own hand. As she's a trained surgeon she knows the best chance of the guy surviving is to not try and switch her out for another person so she winds up helping out with the whole surgery. While they work she admits to Owen that she's used to being the villain because everyone needs someone to blame when faced with all of this change, but that she's saved a bunch of hospitals already and while no one thanks her, she at least knows she helped them. After the surgery she goes with Owen to talk to the patient's family and is profusely thanked and hugged for saving his life, and seems to have a moment where she turns back into a person and remembers that some of being a surgeon can be awesome and actually getting thanked for your job is kind of a wonderful feeling.

Callie, Arizona and Alex are working together on a 13-year-old who had to have a double hip replacement and whose elite gymnastics career is over as a result. The girl is a monster to all of them; she thinks her life is over now and refuses to get out of bed. Alex is the first one to try and talk her out, but she manages to chase him off and leave him depressed about life in general. Callie and Arizona have been fighting all day about how Callie always winds up playing Bad Cop to Arizona's Good Cop when they have to deal with an issue with Sofia. This of course comes into play with their patient, and Callie tries her Bad Cop routine on the girl only to have the girl basically send her into a black hole of depression about the futility of life. Arizona mocks them both and finally goes in to play Good Cop. When that doesn't work, she pulls up her pant leg, shows the girl her prosthetic, and points out that she actually does know what she's going through. But even that doesn't work, so she finally goes full-on Livid Scary Cop and orders the girl out of bed in a raging fury. The girl is so stunned -- almost like someone threw her into a shower fully clothed -- that she finally gets up and actually looks happy when she can start taking baby steps.

April and Derek come up with a plan to ask all of the different departments to cut their budgets a little bit and if it all works, they should have enough money to keep the ER open. When Derek gets called into surgery, April has to do the pitches herself and ends up with everyone hating her and no one agreeing to the plan but Derek goes back to everyone afterward and she gets a lesson in how to finesse people; they are able to get everyone to agree to the cuts and triumphantly find Owen and Alana and declare that now the ER can stay open. Alana's surgical high is quickly wiped out as she tells them that they have misunderstood and no amount of budget cuts will reopen the ER because they are going to be selling the hospital and she's basically there to spruce things up and make it attractive for potential buyers. Apparently buyers don't want ERs in their hospitals these days.