Systematic attraction. Single hospitals faced with competitive pressures, demand for capital often look to join systems, but money may sour marriage.

Stand-alone hospitals often seek more security by joining a system. But those deals, like marriages, don't always work. Concerns over local control and squabbles over finances can break apart the alliances, sometimes leading to legal action. A dispute over local control led Benefis Healthcare to end its affiliation with a system. "The best thing for us to do was to part company and remain friends", says John Goodnow, left.