That's an operating expense, and we always treat it as an operating expense no matter how it is reported.

Management will need to carefully monitor operating results and capital spending over the next two years in order to maintain the rating. Failure to meet projections could result in a rating or outlook change.

It's not unusual for two audits of two organizations to be completed at different times.

Upward rating potential exists, but will need to be accompanied by some combination of a reduction in the debt load, continued growth in liquidity, and consistent growth in cash flow leading to higher coverage levels.

We believe that Temple University Health System will emerge with a clear improvement plan in the next few months. The related operational turnaround, however, could take one to two years, given the size of the operating gap so far this year.

A good leader should focus on making sure everyone is being given the tools to do their job, not just expecting - poof! - that they're going to produce great work.