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Merging hospitals - evidence underpinning success

25 August 2016

Clear communication and meaningful engagement are key to the success of hospital mergers.

In advance of merging three children’s hospitals into one National Children’s hospital, the HRB was asked by the Department of Health to look at existing international evidence* to help identify the barriers to, and facilitators of, the successful implementation of hospital mergers.

Clear communication and meaningful engagement in decision making were clearly the main ingredient of success. The main finding indicates that ‘the distance between senior management and hospital staff is a greater threat to implementing a hospital merger than the differences between cultures in merging hospitals’. This distance is characterised by senior management not affording hospital staff opportunities for active participation in how the merger is implemented; this is characterised by minimal dialogue between senior management and staff and little opportunity for staff to influence decisions pertaining to their role or their responsibility for patient care.

Our analysis of the literature suggests that hospital staff are not active participants during the implementation of a hospital merger. At best, they are afforded degrees of partial participation, which excludes them from influencing decisions pertaining to their role in the merger and decisions affecting patient care. This exclusion is perceived by hospital staff as a decision taken by senior management; a view that contributes to staff feeling disrespected and not trusted by management.

This in turn has implications for the way that staff perceives their role in the merger. For example, exclusion from decision-making and distance from senior management means that hospital staff are prone to experiencing anxiety and uncertainty about their role in the merger; in particular, they fear a threat to their professional autonomy which is linked to the absence of dialogue between management and themselves. They are also confronted with uncertainty about the goals of the merger and its impact on the quality of care for patients – uncertainty that is compounded by poor communication and unclear information.

On the other side of the coin, the analysis also reveals that implementing hospital mergers are facilitated when hospital staff and senior management actively engage in participatory dialogue; when senior management are less remote from staff and also when the primacy of patient care is emphasised and hospital staff can reclaim or maintain their professional caregiver status.

The full report can be downloaded at the link below.

www.hrb.ie/publications/hrb-publication/publications//711/

*This review used a mixed-methods integrative approach combining qualitative data through thematic synthesis from 18 studies with quantitative data through narrative synthesis of 32 studies. The studies were selected for synthesis following careful screening and quality appraisal.

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