The trend line for multi-institutional systems can only go up.
D006739:Hospital Administration / Q000639:trends*; D006777:Hospitals, Proprietary / Q000639:trends; D006788:Hospitals, Voluntary / Q000639:trends; D009096:Multi-Institutional Systems / Q000639:trends*; D009935:Organizational Affiliation / Q000639:trends; D014481:United States