Abstract
A turbulent health care environment has prompted some hospitals to consider integrating services and in some cases merge entirely. Fundamental lessons may be learned by studying how an attempted merger between Women's College Hospital and The Toronto Hospital in Toronto failed--despite board and senior executive support. Clarity of purpose, involvement of essential external and internal stakeholders, rational analysis, ideological fit and political expediency are a few key elements to consider. Once initiated, changes of this magnitude may take on a life of their own with often unpredictable results.
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