HealthFebruary 02, 2016

Mergers 101 for nurse leaders

Referring to the surge of health care mergers occurring among hospitals, health systems, drug makers, insurers and even drug store chains as of late, a recent article in the New York Times dubbed the phenomenon “the urge to merge.”

The article explained that up until now the health care industry has been largely fragmented compared to other industries—say, telecommunications, for example. But increasingly, smaller players in health care are joining up to create more powerful entities in an effort to better deal with the fiscal challenges of modern practice.

“Hospitals are looking for the size and clout necessary to negotiate with insurance companies,” the newspaper reported, “but they are also preparing for changes in how they are paid in which they assume financial risk for how much it costs to care for patients.

“Hospitals are also supersizing so they can invest more in technology and computer systems that allow them to better track patients’ care.”

If you haven’t experienced a merger yourself, chances are you know other nurse leaders who have. And  since experts say the prevailing “urge to merge” shows no signs of slowing anytime soon, you may very well experience one firsthand in the future.

To help nurse executives through the process, the Journal of Nursing Administration recently published an article highlighting some of the major issues hospital mergers can present for nurse leaders. Here are a few takeaways you may find useful.

Consolidation vs. coordination, and the need for compromise

First, a step back. Hospital mergers bring together two or more previously independent organizations. As decisionmakers figure out how to blend their associated units, departments, nursing leaders and nursing staff, they have two main models to choose from: coordination and consolidation.

“Coordination permits a decentralized, collaborative management team to approach goals from the standpoint of the various organizations to achieve a new normal,” authors Letty Roth Piper, EdD, RN, and Maureen Schneider, PhD, RN, NEA-BC, CPHQ, FACHE, point out. “In coordination, dual nursing structures may be possible.”

Consolidation, on the other hand, involves centralizing activities and function, including leadership.

Whichever model the organization goes with, changes are inevitable and should be expected by nurse executives, the authors coach. Compromise is going to be required from all parties, they continue, even if the changes aren’t exactly thrilling to all involved.

Careful communication

Next, a reality check. What pours from the mouths of leaders will carry a lot of weight with how nursing staff will proceed through the merge. And how nursing staff react to changes can, in essence, make the process easy or arduous.

“The new vision articulated by nursing leaders will strongly influence the perception of the nursing staff and middle management,” the authors explain. “How employees react to a merger and move to achieve stated corporate goals is key to the success of the initiative.”

So choose your words carefully. But, by all means, don’t mistake controlled communication with clamming up, cloistering away and refusing to even mention the m-word within earshot of nursing staff.

“Nurse leaders report success in dealing with mergers starting with truthful information presented in a timely, reliable and carefully disseminated process,” the article explains. “Skilled communication and vision in a merger situation requires committed, visible and authentic leadership.”

Create connections

Third, keep the faith. Lags in the merger process—which can trudge on as long as a year or more—are likely. When they happen, don’t mistake distance for disinterest.

“Delays experienced in the operational process of the merger may also be considered sabotage and create distrust among the merger partners,” the authors write. “Therefore, there remains an acute need to create connections, trust relationships between the cultures, and leadership that visibly supports and enables effective integration.”

“The ultimate goal,” they continue, “is that values, group norms, and steps are agreed on; that units and employees know what is expected of them; and individuals feel united by these values, norms, and goals.”

Time considerations

Finally, stay organized. As a nurse leader, your organizational merger to-do list will be long. However, there’s no need to fret. The Journal of Nursing Administration article includes a checklist of more than 2 dozen activities for nurse leaders to consider in the 12 months leading up to the final day of transition.

From meeting to discuss the mission, vision and organizational structure for nursing under the new entity at the start of the merger process to welcoming staff to the new integrated system on the day of transition, the checklist provides a system for ensuring your bases are covered.

Mergers are not easy, but they are manageable with proper planning and preparation.

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