I wouldn’t like to say we’re a nation of pessimists, but for me the single biggest myth surrounding mergers in healthcare is the idea they are all failures. The British media has a tendency to dwell on the negative. In part, this has led to headlines screaming about millions of taxpayers’ pounds being wasted or columnists calling for heads to roll. This overshadows success stories and limits people’s understanding of the difficulties that NHS mergers have to overcome.
There are some fantastic examples of successful hospital mergers. Guys and St Thomas Foundation Trust is now seen as a single entity by both NHS staff and the public. Equally, the UCLH NHS Foundation Trust is actually the result of a series of successful hospital mergers. These don’t get written about because success doesn’t make for much of a story.
While there have been failures in the past, I don’t think these failures were because of the merger itself, but due to a fault in the design of the process of merging the organisations.
NHS mergers tend to be more challenging than their private sector equivalent. They are often enforced acquisitions caused by a failure in some area, whether it’s clinical or financial, resulting in a series of issues. Any problems that led to the merger, such as its operating model or a lack of investment in infrastructure and modern equipment will take a considerable investment of time and money to put right.
There is also a lack of understanding around the terminology used. The term merger is largely applied to both mergers and acquisitions in the NHS. That is probably because acquisition sounds more aggressive and managers use merger in a mistaken attempt to mitigate the sensation of being taken over.
The result of calling an acquisition a “merger” is that staff are left bewildered as to why they are not involved in developing the strategy for the future of their new organisation. People on the ground often don’t get the opportunity to actively contribute to the planning of service delivery, and they feel new ways of working are simply imposed from the top.
Another problem is the lack of planning. Mergers are often seen as a panacea and the end of a process rather than the beginning. The pressure on management to deliver immediate savings often leads to a lack of vision around what they ultimately want to create in terms of organisation and service delivery. They work on step one, but don’t move onto steps two and three to work out their destination.
During the process a lot of staff will be focussed on their own jobs and circumstances. Although this is entirely understandable, there needs to be an understanding about the reasons for the merger and what managers are aiming to achieve. That will help with the organisational integration in whatever form that might take.
Truly integrating and embedding different cultures can take years. I think people vastly underestimate the timeframe involved. NHS mergers take years to root: they are never an overnight success and what may, at times, look like a failure, in reality is a process that hasn’t yet finished.
Both parties in the merger need to help define the final destination and actively work together to create a new identity, whether they are the acquired, or acquiring, party.
Success should be measured in terms of the quality of service being delivered as well as the merged trust’s long-term financial and operational sustainability. That is far more important than its short-term profitability.
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