What forces lead to changes in governance among medical schools and their associated teaching hospitals? To what extent do such changes affect how well those schools and hospitals do their work? In this book, John A. Kastor, M.D., focuses on the academic medical centers of the University of Pennsylvania and the Johns Hopkins University, two institutions that underwent dramatic change in governance during the late 1990s. Drawing on extensive interviews with more than three hundred administrators, physicians, and other medical professionals at Penn, Hopkins, and elsewhere, Kastor identifies the factors that influenced changes in governance at these two institutions. Chief among these, he finds, are structure, personality conflicts, and current events. This book will be of interest to administrators of teaching hospitals as well as professionals in health policy and management.