The administrative residency in a multi-institutional system.

JVlANY GRADUATE PROGRAMS in hospital administration do not have courses in multi-institutional structure, but refer only tangentially to this expanding segment of our healthcare delivery system. The administrative residency offers an excellent opportunity to study multi-institutional systems from within. This article shall define a prototype for the residency experience within a particular type of multi-institutional arrangement, the holding company or umbrella organization. Is the nonprofit hospital sector in danger of extinction and to be replaced by a system comprised only of public and private hospitals? If there is to be a savior of the nonprofits, it may well be the emergence of the multi-institutional arrangements. The investorowned chains have used their economies of scale and strategy to create a competitive advantage.' The economic, manpower, and organizational benefits of the multi-institutional systems at both the institutional and community level have been documented. The importance of multi-institutional systems is reflected in the