Russ ... I wonder if it is a result of maturity of processes. Leesburg has been around a long time and has mature procedures and processes for doing business. TVRH has grown very quickly .... perhaps its facilities have grown faster than the human ability to manage and hone an operation of this size. And then there is the challenge of dealing with seasonal fluctuations in population.
I have no direct experience with the hospital so this is just speculation.
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Maryland (DC Suburbs) - first 51 years 
The Villages - next 51 years 
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