NHS staff need to understand clearly defined reasons for going into the merger process if they are to be engaged and help drive forward the new organisation. They are, in general, highly committed to providing the best outcomes for patients. However, staff frequently don’t see how their daily work fits into a bigger picture.
This disconnect is often exacerbated during a merger process, just when it’s essential to get everyone onside. A lack of pre-integration planning means that often trusts do not think about what the real vision is for the new organisation. Putting two trusts together and expecting them to be more successful as a result is not an effective strategy.
Staff are unable to buy into short-term thinking and a focus on solving immediate financial issues. They need to be clear about the benefit to patients of any reorganisation.
There’s often a lack of two-way communication between boards and frontline staff. Typically in a merger process boards are focussed on financial and operational planning, with staff engagement trailing in a poor third.
The planning and effort put into staff integration is an add-on, when it happens at all. Staff are left unclear about both the reasons behind merging and their own individual roles in making it a success. Many staff feel that their job is threatened and a lack of communication exacerbates this.
Acquiring trusts can create additional tension by going into the failing trust as though they are somehow superior. This attitude is frequently reinforced by all the stakeholders, including the regulators.
Staff from the failing trust who are shut out from the decision making process will immediately be disengaged. While the acquirers may well be in a stronger financial position, they’re not necessarily better in every aspect. There is another way, involving more effective communication between the two trusts supported by a proper cultural integration plan.
The attitude of ‘We’re all the NHS, we’ll just bolt together’ is naïve. Unless these differences are integrated, you get an ‘us and them’ mentality where staff continue to work in silos doing things the way they’ve always done.
There are massive cultural differences both within and between NHS organisations - everything from management styles, working practices and how staff interact with patients. The benefits of a merger will only be achieved by understanding these differences followed by full cultural integration of the merging organisations.
Even in cases where staff have been carried forward to the point of merger, management attention soon shifts back to the daily business of managing the hospital post-merger. This is unsurprising given the demanding nature of managing hospitals, but it does mean that the planned benefits fail to materialise.
Keeping newly merged organisations on track in terms of delivering integration and change management is going to require an element of compulsion. There is a role for the regulator here in supporting organisations post-merger.
The Trust Development Authority and Monitor already undertake regular performance management checks. Adding the delivery of planned benefits to these checks would help ensure continued management attention to staff engagement, integration and, as a result, more successful mergers.
This article represents the views of the author only, and does not necessarily represent the views or professional advice of KPMG in the UK.