"There are lots of ways to bring in capital—even private equity capital," he says.
In his work with county and city-owned hospitals, he says he's seen too many local politicians be marginalized in discussions about the facility's future.
"A lot of times, what happens is you have somebody saying [that]these politicians are not experts in healthcare," he says. "That may be true, but they have sat through meetings talking about resolving disputes among developers and working with neighbors. They are experts in democracy, and they have been elected and this is a fundamental issue that requires the people's voice."
For some, he concedes, selling may be the right choice, but it should be the last one.
"Don't focus on surviving, focus on thriving. Keep reaching for excellence in quality and look for creative ways to accomplish that instead of using the blunt instrument of the merger," he says. "Not everything takes money. Some things take brains."