While healthcare mergers within the NHS are a very challenging prospect for a number of reasons, I think that one of the largest contributing factors to their failure is individual organisations.
In many cases, the merger is actually an acquisition with a larger or more successful Trust taking over a smaller or a failing one. This instantly gives rise to the perception that the acquiring organisation feels that they are better in some way, and that the smaller or failing Trust’s identity will be lost within the bigger one. So the relationship is broken before it has even begun.
Sadly, I think there’s very little emphasis on the integration of organisational cultures when it comes to healthcare mergers. It’s seen as a soft issue and not of real importance. It is typically much better managed in the private sector, which I believe is one of the reasons why those mergers are often more successful.
Within the NHS, bringing people together barely features at the right time within the acquisition process. It’s either done as a token gesture at the end or the focus will be on job security, rather than what life will be like working together. The net result of this is that people feel insecure and they leave, which exacerbates the problems of the failing Trust, as in the Stafford merger, where they were forced to rely heavily on agency workers.
This communication about the identity of the newly merged organisation and engaging staff in how working together will benefit patients is fundamental in order to move towards a fully integrated system. When the merger or acquisition is simply imposed from the top, staff don’t have the means to understand why merger or acquisition is the best option going forward.
This is easier to achieve in a more strategic merger, for example a move to integrate units offering complementary services, such as combining women’s and children’s services. The resulting merger would clearly have a different shared identity as it would be offering different services.
In a situation where a larger hospital or Trust merges with a smaller one, particularly in the case of acquisitions, the post-merger culture, identity and operating model is too often based on an enhanced version of the acquiring organisation’s model. So organisation A adds organisation B and together they become organisation A+, rather than truly merging to become organisation C.
For the staff who are part of the acquiring organisation, the impact on their working life can be minimal, because they experience little more than a name change while going about their business in the same way on the same site. Some might hold this up as an example of success, but I’d argue that this is merely a façade of the previous organisation and very little real integration has actually taken place.
When Trusts which are still based in geographically different locations merge, integration is much more difficult to achieve. In these cases, simply changing the name or the make-up of the Board isn’t going to bring them together. True integration, and acceptance that it is a single entity, will probably only take place if you mix the staff over the two sites; a measure which is likely to meet with some resistance.
I think it’s essential that both the merging organisations acknowledge that the outcome of the merger creates a combined identity and culture which is new for both of them. Some of its values may be the same as one or both of the pre-merger organisations, but it is not enough to simply change the name or board members and carry on as before. Real communication, sharing of resources, and mixing of staff between sites are necessary to move towards a shared vision and allow for complete cultural integration.
This article represents the views of the author only, and does not necessarily represent the views or professional advice of KPMG in the UK.
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