Many governmental hospitals might benefit from ownership change; in certain instances it is acutely needed. They face the same pressures to improve quality and lower costs that challenge most hospitals and health systems. In addition, they are confronted with complicated governance structures and disclosure requirements along with restrictions on capital.

Leaders of governmental hospitals that wish to consider ownership change should focus heavily on governance issues. Most resistance-to-change and transaction difficulties have resulted from leadership of the governmental entity and the hospital failing to act in a unified manner. Juniper aims to help create cohesion among hospital and government leaders as early as possible in a partnership process.

The initial efforts should encourage both governmental and hospital leaders to reach early agreement regarding the need for the process and what would be an optimal outcome.
• Gain consensus among the two groups on several fundamental objectives for the health system.
• Proceed in a collaborative manner with consistent governmental and hospital representation.
• Work with legal and financial professionals to overcome legal and structural complexities.
• Follow state sunshine laws assiduously and provide the public with regular updates on the process.
• Utilize communications professionals.
• Understand and confront the challenges of group decision-making; foster
frequent interaction between leadership groups.

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