Hospitals are among the most opaque institutions in American life. Few allow their doctors to talk to the press except in the hovering presence of “handlers.” Though they often employ cadres of “communications specialists” who pitch reporters with puff pieces, most are obsessed with keeping their finances and internal operations secret. 

The Hospital: Life, Death, and Dollars in a Small American Town
by Brian Alexander
St. Martin’s Press, 310 pp.

The first remarkable thing about Brian Alexander’s new book, The Hospital, is that he managed to pull off an exception to this seeming iron law of U.S. health care. He never explains exactly how, but in early 2018 he persuaded the CEO and board of a small, community hospital in rural Bryan, Ohio, to give him fly-on-the-wall access to their struggling institution—and complete freedom to write up what he witnessed. 

For the next year and a half, Alexander attended long rounds of anguished and divisive strategy sessions. Administrators and board members fought with consultants and each other over how to bring in enough revenue to avoid having to shut down or sell out to a big hospital chain. As Alexander became embedded in the hospital’s day-to-day […]