Critical Steps Hospitals Need to Take Post Merger

The following is reprinted with permission from The Camden Quarterly.

What happens immediately after a hospital enters a merger or consolidation is as critical as the planning and execution of the transaction itself. There are a number of issues that need to be considered and steps that hospital executives should take to ensure that the new system will be able to realize the intended benefits of the transaction.  

Create the new reality
Possibly the most important first step is to avoid carrying on "business as usual." Rather, use transaction documents to guide planning and activities. Ensure that the strategic and operational plans follow the expectations for efficiencies that have been outlined. In order to maintain accountability and to stay on task with the plan of consolidation, consider convening two groups: one that has executive responsibility to manage the consolidation process and another group tasked to help all the departments and front-line staff (within the now-consolidated organization) to create a new, cohesive culture.

The executive level group should include senior staff from clinical, support, and administrative areas. This group should focus on the following objectives:

• Creating a common, accessible chain of command
• Clarifying roles in the newly consolidated administration
• Identifying enterprise-wide performance metrics and response systems
• Ensuring leadership accessibility and visibility
• Setting the motivational core around key issues of strategic and performance importance

The operations group should include front-line and mid-management staff from all of the sites, whenever possible. Ideally, a staff nurse and a non-clinical department manager should run the group. The group should focus on:

• Identifying internal shared governance
• Integrating support services
• Educating staff on data-driven decision-making
• Reducing factionalism from when the parties were  independent

The group should convene virtually if in-person meetings are not feasible; creating IT support to enable them to communicate easily will be critical. Empower the group to create systems for cultivating suggestions, incorporating changes, measuring performance in real time, and celebrating results. In developing a positive and forward-moving common culture, this group should feel that their activities are truly valued by the organization and that their successes will be recognized. Allocate a small budget for the operations group to help them develop committees, communication systems and other means of supporting and recognizing the new system. Ultimately, these two groups may meld into the existing or soon-to-be-developed shared management structure. For the first two years, however, these groups should focus only on creating the new reality.

Use the new brand in naming these groups and announce them to the entire organization with enthusiasm to show they have the support of management.

Communicate with constituents
After a merger, it is critical to reach out to key constituents, particularly the medical staff and patients. It is a mistake to assume that the medical staff will "get it" from their peers. Many providers rarely (if ever) come on campus, so it is important to hold regular meetings with the medical staff. In addition, communicate electronically; for example, post updates on physician-centric projects on their provider portal and send out email blasts to reach the medical staff. Perhaps most importantly — go to them. Rounding on physicians is one of the most critical things that the new administration can do to ensure open communications with and support from the medical staff.

Patients also need to understand the new system's resources and the value of the new system. Constantly communicate the new brand, mission, goals and the value that the new system will provide. Create service listings and maps of the new sites and make them available at all points of patient care. Develop provider profiles and add them to the website, the new system's advertising, other marketing channels and in community reports.

It is critical to emphasize the value the new system brings to its constituents; every member of the new health system will need to understand that the current flux will ultimately deliver clinical, quality, financial and social value to them as participants. Make this the hallmark of the new organization’s messaging during the first year.

Lead change management
A hospital consolidation can be an exciting opportunity but does require successful change management to ensure that the new organization will be as effective as possible. For those leading the process, being patient may be the most crucial advice to follow.  Change takes time and setbacks will occur. Keep focused on moving forward and stay positive about results. When in doubt, remember:

• Never assume that the status quo is the right way of doing things
• Involve more perspectives rather than fewer
• Create a culture of equanimity and opportunity from the top
• Reward collaboration and accountability

For more information on steps to take after a hospital merger or acquisition, please contact Steve Gelineau at (978) 317-7432 or sgelineau@thecamdengroup.com or Virginia Tyler at (585) 512-3902 or vtyler@thecamdengroup.com.

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Top 10 Lessons Learned from "Mature" Co-management Arrangements