Continuum racked up $56 million in losses that year. NS-LIJ was able to bring Lenox Hill Hospital into profitability after buying the hospital in 2010. This year's results are not yet in, but the Manhattan facility has dipped back into red ink. In the six months ended June 30, it posted an operating loss of $12.8 million. Mergers take a long time to look good, said Mr. Dowling. "It's a lot slower than you think. My general rule of thumb is five years." That's because the newly merged organization often needs a complete culture shift. "If I move the boxes around and don't change the attitude, I don't get rid of people, everything's just going to be made more difficult." In previous mergers, Dowling has cut middle managers and front-line workers, as he did at Lenox Hill. "Some of those changes were made very fast. Some were made in a couple days," he said. "All my clinical leaders, the heads of my clinical departments, have been completely, totally changed in the last seven years."