Five Harvard Medical School teaching hospitals released a joint statement Friday publicly confirming reports that they have been discussing ways to cooperate more closely.

The statement, signed by the chief executive officers and the chairs of the boards of Beth Israel, Brigham and Women's, Children's, Mass. General and New England Deaconess hospitals, said the board chairs "have agreed to oversee a six-month planning study to analyze and make recommendations." Medical School Dean Daniel C. Tosteson '44, who initiated the discussion of cooperation, also signed the letter.

Sources said the structure of the review is yet to be defined, but will likely include study groups that will study various aspects of proposed collaboration between the hospitals, which have traditionally been fiercely independent competitors.

"With our leadership responsibilities in patient care, research and education, our institutions have a special obligation to the community to maintain and improve the quality of what we do, while significantly reducing our costs. We believe that this will not be possible in the coming years without closer coordination," the statement said.

A Washington-based anti-trust lawyer has been attending the talks, which were convened by Harvard Medical School in what the statement said was a "response to the significant, far-reaching changes taking place in health care."

The statement said, "The possibility of closer coordination presents a challenge and an opportunity for all of us. While the outcome remains unknown, we firmly believe that new ways of thinking about how we carry out our mission will be required for us to flourish in the coming years."

Those familiar with the discussions said they are still at a "very preliminary" stage. But even with the outcome unknown, the news of the discussions between c.e.o.'s has ignit- ed considerable discussion--and some strong concerns--among hospital employees.

In two dozen interviews on Friday, employees at four of the five hospitals who had heard of the discussions seemed to conceive of the talks as a pathway to a merger into a "mega-hospital." In fact, while increased cooperation is a likely outcome of the talks, those familiar with the discussions between the hospitals and with the Boston health care scene say the creation of a 3000 bed hospital is unlikely.

"I don't think there'll ever be a complete merger," Stephen B. Kay '56, vice chair of the board of trustees of Beth Israel Hospital, said last week.

While employees may be misinformed about the exact nature of the talks, about three quarters of those interviewed had at least some idea that conversations were going on between the hospitals.

Many of those who had heard said they worry that the cost-cutting and new efficiencies billed as a benefit of cooperation might mean the loss of their jobs.

"I think it's bad," said Sergio Medrano, a biomedical technician at Brigham and Women's Hospital. "When these hospitals merge with the other hospitals, the one with more power ends up staying the same and the others have layoffs."

Rodrigo Lozano, also a biomedical technician at Brigham and Women's, said he expects layoffs.

"There's probably going to be some layoffs. I'm afraid they'll choose me," Lozano said.

Lozano said the biomedical technicians from all five hospitals could be consolidated into one operation, and that made him fearful. "That's probably one area they could centralize. There could definitely be less people if they consolidated," he said.

Janice Burnette, who coordinates research in the cardiology department of Children's Hospital, said, "I think it's going to be something that's very painful. That means a lot of jobs lost."

At Beth Israel Hospital, Andrienne Lapsley, senior coordinator of ambulatory services, said, "I think it's going to be a lot of layoffs. That's not good for the staffers here...It's not altogether unexpected, but it is very scary."

Some, like Dr. Sherwin V. Kery, director of the blood bank at Children's Hospital, said people need not be so worried about their jobs.

"It's not a matter of if you move six people and two labs together, people are going to lose their jobs. There may be new labs that are open or other places in the hospitals people can transfer to. Children's Hospital has always been very benevolent when it comes to employees."

Even among the employees who feared for their jobs, there were some who thought increased collaboration was necessary.

Chris H. Hitchcock, who does billing for surgery at Brigham and Women's, said she thinks increased collaboration is "a good idea. It's trimming the fat, so to speak."

"There's a growing mentality in favor of consolidating," Hitchcock said. "For everyone to have the kind of health care they want, we need to do it."

Hitchcock says she is worried about her job, nonetheless.

"My husband isn't working right now. It used to be you never worried about your job in this field--everyone gets sick, right?"

But with the onset of First Lady Hillary Rodham Clinton's health care reform proposals, the worrying has begun.

From the lowliest hospital employee to the loftiest hospital trustee, everyone is aware of what Kay calls "a whole new era" for the health care industry.

While some hospital employees fear for their jobs, others fear that the quality of care will be adversely affected by an increase in cooperation between or a consolidation of the five Harvard teaching hospitals.

Elizabeth Rabinowitz, administrator in the radiology department at Brigham and Women's, said she worries about the imperfections of central planning, and about the impersonal service offered by large hospitals.

"You can't apply standard guidelines to someone who is sick," Rabinowitz said.

"They're out of their minds," Rabinowitz said. "Ten years ago, they consolidated four hospitals to make this hospital, and it's too large."

Kery said there's one important test any plan must meet to get his support: "It must provide good if not better patient care than now exists. If that could be done in such a way as to save money, we need to look at it."

Amy Chang, a registered nurse in Brigham's renal transplant office, said she's unsure about what consolidation will really mean.

"I'm afraid it will be too big--very impersonal," Chang said. "I think you can lose a lot if that's what happens. If you want to satisfy the patients you're dealing with, you need to be catering to them. You're talking about care, not business."

Some skeptics said concerns about the effects of consolidation--whether they be layoffs or depersonalized patient care--are premature. They doubt increased cooperation will ever happen.

Said one clinical fellow at Brigham and Women's, who refused to give his name citing a hospital policy against speaking to the press without notifying the public affairs office: "I don't think they're going to eliminate competition. I don't think they'll change."

He said, "It seems to me if it happens it will probably be a pretty long process. They may in 20 years, but there's a lot of big egos."

Another clinical fellow was also skeptical of any plans that would centralize certain departments in certain hospitals. "The sub-specialties have a long tradition at all the Harvard hospitals," he said. "No one's going to give them up without a fight."

Still, some said the fight is already over, and that they are resigned to a new era of collaboration and, perhaps, downsizing.

"I think Tosteson's right. That's the way it'll have to go, and it's the way we've already gone," Rabinowitz said.

Kery said there's already a lot of cooperation between some of the Harvard teaching hospitals.

"In the blood bank area, the Brigham and Women's and the Children's Hospitals are already looking to consolidate these functions into one," he said, adding that the two hospitals also already have a joint program in neo-natology.

Children's Hospital and the Dana-Farber Cancer Institute already share patients, he said.

No one really knows yet what the five-hospital talks will mean in terms of layoffs, the structure of a new health care system or the quality of patient care.

Certainly, though, lots of people--from Hillary Rodham Clinton to Harvard Medical School Students, from hospital department chiefs to hospital cafeteria workers--will be following the talks closely during the next six months, and hoping for very different results.

Eleven men (plus an anti-trust lawyer) in a smoke-filled room will decide the future of elite medical care in the Boston area. Then again, they're hospital chiefs, so maybe there won't be any smoke. Nevertheless, at the urging of Medical School Dean Daniel C. Tosteson '44, the leaders of five Harvard-affiliated hospitals have begun to talk about, well, how to talk. Some of their employees are afraid of the consequences of...

I think it's going to be something that's very painful. That means a lot of jobs lost. Janice Burnette, research coordinator, Children's Hospital

It seems to me if it happens it will probably be a pretty long process...there's a lot of big egos. clinical fellow, Brigham and Women's HospitalCrimson File PhotoThe man behind the move: Dean of the Medical School DANIEL C. TOSTESON '44