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An entity that functions as a system of systems (SoS) is composed of multiple systems that individually provide various functions which collectively provide a holistic functional capability.  It is complex in design and function and tends to become even more complex over time as it evolves and responds to both internal and external changes. These changes might be in the composition or in the interoperability among its system members.  Since interoperability affects how well the members work as one system, managing it is critical to the performance of the SoS over its lifespan.             In support of this goal, this dissertation, through research and analysis of small-medium hospital systems, develops a descriptive approach to assist management in determining the impact that changes in membership and interoperability of member systems might have on SoS performance. A modeling approach was used to assess SoS performance before and  after changes. This model is part of an analysis framework called Tri-Ex that can be used by managers to evaluate proposed system changes. The procedures and techniques used are recommended for any future investigations into applicability for SoS performance in different domains; designing system structure with future capabilities in mind; and operational assessment during development.