Published: 23 June 2016
The barriers and facilitators to successful hospital mergers
The review presents a set of barriers to, and facilitators of, the successful implementation of hospital mergers. Our overall qualitative finding in answer to our main research question is 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 findings from the literature suggests that hospital staff are not usually 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 seen by hospital staff as a decision taken by senior management; a view that contributes to staff feeling disrespected and not trusted by management. This 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.