Last fall, Dallas-based Baylor Health Care System and Temple, Texas-based Scott & White Healthcare completed their merger, forming the largest nonprofit health system in the state. The new Dallas-based Baylor Scott & White Health is comprised of 43 hospitals, more than 6,000 physicians, 34,000 employees and the Scott & White Health Plan.
Merging and aligning the two systems' technology and informatics functions is no easy task, says Joseph Schneider, MD, vice president and now CMIO and medical director of clinical informatics for the North Division of Baylor Scott & White Health. "I think we have done as well as or better than what could have been expected, though it certainly is difficult when two big organizations merge like this," he says.
To help ease the process for others, he offers the following advice based on his experiences and observations during the Baylor Scott & White merger.
1. Have a plan. "I strongly encourage anyone doing a merger to dig as deep as possible into what needs to be done and have a good, thorough discussion about it before merging," says Dr. Schneider. He recognizes this is not always possible as there are often more pressing issues right before a merger and not all the important variables may be known. However, planning as much as possible and making any important decisions that can be made beforehand will allow leadership to focus on other issues after the merger. "Getting really good discussions going about how everything will work beforehand is important so you're not trying to solve these problems as other people are starting to come to you with outside demands and problems," says Dr. Schneider.
In retrospect, more in-depth conversations earlier might have made the merger go even smoother, says Dr. Schneider. "There can be cultural differences or differences in reporting relationships between the two organizations that can make it difficult to talk about issues," he says. "When you're not sure where your reporting relationship will be, it's sometimes difficult to have some of the most crucial conversations in advance."
2. Get governance structured and settled. "I don't want to downplay the difficulty of the technical side of things, but the human side is often more challenging," says Dr. Schneider. He says having a strong leadership structure established is crucial to effectively manage projects, and therefore it should be a top priority.
Establishing internal information management governance structures at Baylor Scott & White has been one of the largest challenges, says Dr. Schneider. "We're several months post-merger and are just now beginning to implement our new governance," he says. "It will take months more for it to grow and mature to where we need it to be."
It is also important to clarify governance structures at the executive level as soon as possible, he says. “Information management is a function of business strategy and if it takes a long time to develop the governance groups that develop this strategy, it can hold things back. Luckily we are tackling these issues as quickly as possible.”
3. Hold off on staff shake-ups. Looking back, Dr. Schneider believes one of the best decisions made during the merger was not making any changes in the IT staff for the first six months. "The new CIO [Matt Chambers] came in and said, 'We're not going to do anything major, now's the time we want to get in and learn more about each other,'" he says. Postponing significant personnel changes has allowed Baylor Scott & White time to evaluate current talent resources and make the best decisions about any future changes.
4. Learn about the other organization. Dr. Schneider stresses the importance of knowing as much as possible, as early as possible, about the other hospital or health system. "You can't learn too much about the other organization," he says. This will help identify places for "synergies," or ways in which the two organizations can work well together. Potential stumbling blocks or opportunities to standardize processes between the two organizations can often be found through a thorough examination of the other organization as well.
It is also important to identify the other organization's strengths and weaknesses to help ensure the new entity has the best of both. For example, the former Baylor Health Care System had strong data warehouse capabilities and a larger staff. "We're planning on using that data warehouse capability to meet the merged organization’s needs," says Dr. Schneider.
In recognizing that one partner has greater strengths in a particular area, it’s also extremely important to continually recognize the hard work and accomplishments of the other partner. “No one wants to hear that their efforts haven’t been worthwhile,” says Dr Schneider. “Make sure that people feel like they are equal partners.”
5. Be ready. Often, mergers are shrouded in uncertainty up until the end of negotiations, leaving executives with little time to prepare for the transition. So if a merger is uncertain or far in the future, the best thing to do is ensure the departments are running as smoothly as possible. "Do the things you've been putting off in terms of business planning or reorganizations," says Dr. Schneider. "It's like getting married — before you have the new spouse move in, make sure you clean things up."
Part of cleaning up operations in information management is ensuring a strong relationship between the CMIO and CIO. IT and informatics are not the same, but they rely heavily on each other and the organization as a whole relies on their collaboration, says Dr. Schneider.
"So, if you don't have a strong relationship with your CIO, or vice versa, go make it happen. Set up your office next to theirs if you have to," he says. "If you get that solved before the merger, it won't cause problems afterward."
Dr. Schneider summed up the merger to date by saying, “This has been a very positive experience for the two organizations. It’s incredibly challenging, but it’s also a time of great opportunity to make things better. We are building the health system of the future and it’s an honor to be a part of this.”
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