Barber Cardiosystems, based in Melbourne, Australia, designs and manufactures therapeutic devices used for treatment of coronary conditions. Over four decades, it has grown to be among the top 200 medical device companies in the world. It competes against much larger companies through a continuous effort to control costs and increase productivity. It does so by aligning operational and human resource practices, particularly employee incentives, with its strategy. Concerns arise in the face of increased competition about whether the company can continue to reduce costs and maintain its margins while keeping both its generous bonus scheme and commitment to guaranteed employment. The company's executive team must decide how to respond. This case is suitable for use in undergraduate, MBA, and executive courses in organizational behavior, leadership, and strategic management. It is especially useful in a module on strategic alignment or organizational design.