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The major universities offering health sciences education in New Jersey were restructured in a 2012 legislative act. The plan evolved from a limited transfer of one medical school to a complete integration of two large entities. We describe how this evolution occurred and how leaders of the combined organization implemented the plan, especially considering an unexpected deficit in one of the largest operating units. This case study is a companion to an article analyzing the integration, and illustrates common means to achieve performance improvements in any merger.

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