All for one and one for all: Creating culture alignment after a merger

At a time when many healthcare organizations are in flux, physicians are becoming rapidly and increasingly employed by corporate entities.

Mergers and acquisitions have become commonplace; leadership needs a clear guide to welcome and help physicians transition. It's important to remember that employment does not equal alignment. Having a strategy to help new team members acclimate to your company's culture will make the transition smoother and the new entity stronger. The best model is situation and culture-dependent, but there are common aspects that all alignment plans should include:

1. Embrace physician leadership. Time and time again, we've seen that healthcare organizations that include physicians are more cohesive and do better when led by physicians. While it makes sense that physicians would know how best to manage other physicians and the services they provide, data confirms that clinicians who work for physician-led organizations are happier, suffer less burnout and are less likely to leave the practice of medicine. This is not a small consideration at a time when there are serious shortages of healthcare providers nationwide. 

2. Make sure your leadership team is prepared. Chiefs in this era need different skills than they needed 20 years ago. Leadership training, financial training and sometimes management coaching are part of the repertoire to help bridge gaps that chiefs may have as they take on new leadership responsibilities. 

3. Design programs to advance relationships and foster mutual respect. One thing we did early in our merger was to get the leaders and physicians together — physically, in the same room. It was amazing to see how many people already knew each other and had worked together. This changed the atmosphere from a potential "us" and "them" to one in which we were a team joined by existing relationships and a common purpose. We also ran programs to help all physicians get to know each other better. As with the leaders, we found they often knew each other, and giving them the opportunity to socialize, learn and earn CME credit at group gatherings worked incredibly well.  

4. Avoid creating a community vs. academic health dichotomy. One common tendency is to try to delineate the faculty practice plan as different from the community practice plan. It's not surprising that this occurs given that they are sometimes governed and organized differently — and may have different financial accountability. That said, culture can help bridge this gap. In reality, there is a lot of potential overlap between working at the academic medical center and the community medical center. For example, we have found that many of our physicians like doing some of both. And we don't describe them as different types of physicians — they are just different jobs with different emphases on scholarship, clinical care, and education — and we are flexible about combining all of those activities. That approach makes for a much richer workforce experience and makes us more appealing as an employer. 

5. Take the time to listen and learn. In the case of a merger, it's important that managers take the time to understand the type of organization that has been acquired so that they can recognize where there are synergies and where there is likely to be friction. For example, in a situation where a hospital has acquired a private practice, the physicians will likely be trading autonomy for centralization — where they used to suffer the benefits and the burdens of making their schedules, they may now have less control over their schedules, staffing and performance expectations. Physicians are now likely to be told when they need to see patients and when they will be operating. With any type of organization, acquiring a smaller entity likely means trading customization for standardization. Helping new employees understand why your organization "does it this way" will ease the transition. 

6. Create a communication plan. Having a clear communication plan in place will make transitions and acclimation easier. Communication will look different for different sized organizations, but in a smaller organization, one possibility is to create teams that welcome new employees with paired mentors to answer questions, introduce the new employee(s) to people at your organization, and explain systems and procedures. At a larger organization, mentors or "guides" can also help, especially if your company is still working remotely. Email and online communications are essential for any organization, and weekly town hall-style meetings are a good way to build consensus and community. Ideally, communication will start before the merger or acquisition so that new employees are already familiar with your company and know what to expect.

8. Strive for some early wins. While you may have a more structured plan to bring together service lines or groups, encourage those that crop up organically, where people want to bring their groups together in some way. Those early successes send a message to everyone that the enterprisewide approach can be successful. That sets up an eventual tipping point when people will feel that they are one entity working together toward common goals. 

9. Buy in early and stay the course. Mergers are hard and take a lot of patience, management of setbacks, and strong, consistent leadership. Buckle up and be prepared for the ride. In today's world, some organizations won't survive without larger partnerships, and those that get in the game earlier from a position of strength are more likely to succeed. 

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