By Ann Burke, RN, CPHRM, Director, Risk Management

For the 10th quarter in a row, more than 200 mergers or acquisitions occurred in the U.S. health services industry according to When entities come together, flux is inevitable. There's a mix of cultures, processes, and systems, and as they stir and settle, issues are bound to arise. How can organizations protect patients from unnecessary risk during complex transitions? Let's take a look.

Three gaps that can impact patient safety
  1. Technology. Integrating technology between organizations is significant, costly, and complicated. There are major concerns when moving electronic health records from one system to another or when working out of two systems. Not only do cyber risks grow, but there may also be gaps in communicating critical patient information that could lead to patient harm.
  2. Policies & Procedures. Patient care may be impacted if policies and procedures are not tailored to apply to a newly acquired organization’s setting and practice. One-size-fits-all is not the right philosophy. If policies aren’t appropriate, there will be deviations causing variations in practices and processes that will impact safe and effective care.
  3. Culture. Culture clashes or failure of different cultures to adapt and move toward sharing the same mission and values will create a bumpy road. It’s essential that leadership consistently communicates the importance of a culture of safety.
How to mitigate risk and support a smooth transition
Guide the process using an enterprise risk management (ERM) framework to help capture all eight domains of risk: strategic, financial, operational, clinical, technological, human capital-related, hazard-related, and legal/regulatory. The American Society for Healthcare Risk Management provides an ERM Tool that outlines the process. Building on that platform, here are seven steps you can take to identify patient safety and quality issues.

Involve risk managers during every phase
  • Issue: During the acquisition process, risk managers may be involved too late. 
  • Recommendation: Involve risk managers from start to finish – plan a formal gap analysis after the acquisition is complete and continue post-merger analysis for patient safety concerns. Involve key staff from all settings and departments.
Find the bugs
  • Issue: Tech integration is costly and complicated. Patient information, confidentiality, and security exposures during transitions are serious concerns.
  • Recommendation: Make tech integration a high priority. Consult with IT security experts, and be hyper-vigilant about data breach prevention. Involve super-users for every system, and invite their feedback. Create a post-merger testing protocol to ensure all technology performs as intended.
Go big-picture on policy
  • Issue: The acquired facility may offer different services and/or come from a different practice setting. Lack of focus on aligning or creating relevant policy and procedures can greatly impact patient care and jeopardize regulatory compliance.
  • Recommendation: Ensure there is an effective assessment of the acquired organization that includes regulatory and/or accreditation obligations. Develop a strategy to address the acquired exposures early on.
Take care of the team
  • Issue: The people who are most affected by institutional change often have the smallest voice – leading to low morale, grumbling to patients, and a PR ripple effect.
  • Recommendation: Don't overlook an acquisition’s impact on employee culture, mission, and morale. Never tell employees that nothing will change. Encourage leaders on both sides to tell their teams the knowns and the unknowns. Give team members a voice. Many processes are new and still being defined, and the staff must feel empowered to speak up and “stop the line” or question direction when they feel there is a concern for patient safety. Leadership must support this practice.
Talk to everyone
  • Issue: The acquiring company may be unfamiliar with the physician practice world and may overlook processes unique to the acquired organization.
  • Recommendation: Seek input from stakeholders in the acquired organizations. If there are multiple locations or different settings, get input from each one. If there are inpatient and outpatient settings, involve staff from both. Benefit from multiple points of view. 
Stay on it
  • Issue: Just when you think the integration is complete, new issues can arise. Some processes and regulatory requirements occur with quarterly, semi-annual, or annual frequency and therefore, don’t come up every day. 
  • Recommendation: Measure progress on achieving goals and create a list of future exposure points. Keep key stakeholders in the know, such as the board of directors, staff, and community as appropriate. Develop a feedback mechanism that the entire organization can use to report successes as well as ineffective processes, policy and compliance breaches, and quality issues for at least one year post acquisition.
Don't forget your community
  • Issue: Patients and community members may get nervous or angry about the acquisition, especially if it affects their care in any way – from office locations, services, and hours, to billing procedures and provider networks.
  • Recommendation: Communicate and control the spin. Update your patient community on any changes that may affect them, and be sure they understand how the new combined organization will benefit them. Educate your team on key talking points to communicate with patients.
It’s also recommended that you discuss the seven issues covered in this article with your legal counsel during the merger or acquisition process.

Mergers and acquisitions are never easy, but they can be handled effectively with sensitivity and foresight. Of course, this involves more effort, but ultimately, it pays off in a stronger team, greater efficiency, and higher quality of care.

No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.