As the chief executive officers and chairs of the boards of five Harvard Medical School teaching hospitals meet over the next six months to study ways to further cooperation, almost everything will be on the table.

Power, money and national health care reform plans will influence decisions. Future power and earning potential will be carefully considered and allotted. Personnel questions will likely arise.

But one of the most important factors in the talks is also one that is difficult to quantify--the character of each of the five hospitals involved.

Harvard Medical School now boasts of the separate personalities of these institutions, comparing itself favorably to other medical schools with only one main teaching hospital.

It is the separate personalities, however, that could be lost, or eroded, if the five hospitals formed a single, centrally-governed system, or even if they simply decide to become more reliant on each other.

And it is these same personalities that could prove difficult in the early days of such a system. Resistance and personality clashes could result in the same sort of messy disputes that went on when Time executives dueled with Warner executives in the months following the Time-Warner merger.

Some of the hospitals in question have built and fostered their own characters for more than 100 years.

In a way, this has been necessary. Many cities have one "city" hospital, then perhaps a Catholic hospital and an academic hospital. But in Boston, academic hospitals are so plentiful that each needs a way to differentiate itself in order to attract patients and donors.

As a result, Mass. General, Brigham and Women's New England Deaconess, Beth Israel and Children's Hospital each have their own image, their own personality, their own character, their own corporate culture.

These distinguishing characteristics help each hospital develop its own specialties and provide a wide range of services to the Boston community. But they most likely will make greater cooperation between the hospitals, each of which approaches matters from its own individual perspective, somewhat difficult.

Surely one of the knottiest challenges Medical School Dean Daniel C. Tosteson '44 must face is deciding how much of the individual characters of the hospitals can or should be saved, and to what extent they can or should be replaced with a new common culture.

Consider what the dean and the chairs and chief executive officers of the five hospitals have to start with:

A Giant General

Massachusetts General Hospital is the Big-foot of this bunch. Founded in 1811, the hospital has more than 1000 beds and, with more than 10,000 employees, is the largest private employer in the city of Boston.

Clinically, the hospital tries to be the best in all the major specialties of medicine. Mass. General officials say such comprehensive breadth of excellence can be an advantage to patients who want their body treated as a whole.