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7 tools for successfully integrating health systems

When considering a new partnership or transaction, it is imperative for health system leaders to get to know the community they will be moving into. However, many times negotiators are only concerned with getting the deal done and lose sight of the whole picture and the stakeholders involved.

While working out the legal and financial aspects of a transaction, engagement of the employees, physicians and community can be equally important, though it is rarely on the radar, Valerie Jackson, executive director of regional operations for UPMC Hamot Hospital in Erie, Pa., explained during the Becker's Hospital Review 6th Annual Meeting.

Here are seven tools to employ when embarking on a new relationship.

1. Set the foundation. The first step is to seek to understand the various characteristics of the organization you will be partnering with. Included in this step is communicating openly and honestly with stakeholders, including the board, staff and community.

"Building trust builds confidence," said Ms. Jackson. "What leads to confidence is having people know that you will tell the truth. This is more valuable than simply telling people what they want to hear."

2. Set the expectations. According to Gary M. Maras, CEO of UPMC Hamot Heart and Vascular Institute of UPMC, it is important to differentiate between needs and wants. New relationships shouldn't necessarily be about bailouts, but about finding the synergies that can be leveraged in the joining of systems to best serve communities.

3. Consider stakeholders. When approaching new deals, hospital leadership must assess and plan for risks or barriers to the deal with physicians, payers, the community and state government and federal officials. With proper assessment, hospitals can make informed decisions on important elements of the relationship. Will it be an affiliation or integration? What types of recruiting options and physicians services will be needed? Does the community have an affinity for a new partner hospital? What are the community's needs and wants?

4. A look across the seven C's. Discussion on the seven C's — clinical care, control, cash/compensation, culture, common vision, commitment and clarity — occurs on the board level, but should also be addressed with stakeholders and frontline workers, such as the clinical staff.

According to Ms. Jackson, another hospital's culture is one of the most important elements to be sensitive to when entering into a new arrangement.

"Culture will eat everything you do," she said. "You realize you have to give respect to local culture when you are joining with a hospital or system. You can't just say, 'You have to do it our way because now you're part of our system.'"

5. Negotiation techniques. There are various strategies hospital leaders can employ to reach favorable outcomes during negotiations. Mr. Maras provided the following strategies.

  • Understand the other person's personal needs.
  • Have a "person in the balcony," or a partner ready to take your place in the conversation if it hits a lull.
  • Sit on the same side of the table as the person you are negotiating with.
  • Avoid being the first person to speak after a long silence.
  • Know when to defer to a higher authority.
  • Leave your ego at the door.
  • Preserve the relationship by ending on pleasant terms, even if you don't come to a conclusion.

6. Keep in mind the four I's.

Imperative asks, what are the desired results of the relationship? Have the specific goals been defined? As leaders draft an agreement, it is important to create a timeline and process for joining together, and specify who is responsible for shepherding the process.

Insight, or really getting to know your potential partner, includes knowing how other entities perceive the organization, and how the other organization perceives yours.

Integration should be driven by alignment, according to Mr. Maras. However, integration should not necessarily aim to overrun regional differences. While there are advantages of standards, it is important to avoid strangling creativity, according to Mr. Maras.

Innovation. "Good partners seek methods of developing interfaces and findings new ways to handle existing problems," said Mr. Maras. "If you can't preserve entrepreneurship, or you're abandoning innovation to go back to an older model, you will lose value."

7. Engaging physicians. Physician alignment is a critical success factor in building new relationships. According to Ms. Jackson, physicians require respect, control and money — in that order — to stay engaged and aligned.

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