Once you merge, the countdown starts: 1 year until your policies should match

Joint Commission expects alignment in same-day surgery programs

Beware: Once you merge with another facility, the clock starts ticking. After one year, surveyors from the Joint Commission on Accreditation of Healthcare Organizations are likely to examine whether you have uniform policies and procedures in your same-day surgery programs.

"The Joint Commission sees you as one entity," explains Cheryl Sangermano, RN, BSN, CNOR, director of Grant Eye and Ear Hospital’s operating room, post-anesthesia care unit, ambulatory surgery center, and laser center at Grant Medical Center in Columbus, OH. Grant Medical Center and Riverside Methodist Hospital, which previously were separate entities within the Ohio Health system, merged in the summer of 1996. Grant underwent a mock Joint Commission survey in June 1997.

"Their comment to us was that, ‘You have a one-year honeymoon. Then we see you as one, and your policies and procedures have to be the same across the board,’" Sangermano says.

On the record, while Joint Commission staff say there isn’t a hard-and-fast timetable regarding merged policies and procedures, there are expectations. "It would depend on the policy and depend on where they are in the process" of merging, says Paul VanOstenberg, DDS, MS, director of the Department of Standards. "Were they just acquired in the previous months? Our expec-tations are lower. If it was a year ago, our expectation would be that everything would be aligned. It depends on what’s reasonable for the organizations."

To obtain lucrative managed care contracts, health care mergers and acquisitions are increasing in significant numbers. According to Irving Levin Associates in New Canaan, CT, 175 hospitals underwent mergers or acquisitions during the first two quarters of 1997.

For same-day surgery managers, merging policies is one of the biggest headaches they face. One of the primary reasons: staff resistance.

"It’s a challenge getting people to see that this policy isn’t better than that policy. It’s a mindset change," Sangermano says. "Staff say, ‘Why are we doing it this way, just because this hospital does it that way?’ Or they say, ‘We’re just changing everything to be like them.’ They’ve been separate entities for so long. The biggest challenge is having staff be able to see we are now one. It’s not we and they — it’s us."

To assist our readers who may be caught up in "merger mania," here are suggestions from your peers who have been through the process:

Put communication at the top of your priority list.

To address potential staff resistance to change in policies and procedures, "continue to communicate more than you think people would ever want to know," suggests Cheryl Vogel, CRNA, MA, director of perioperative services at Fairview-University Medical Center Minneapolis. On Jan. 1, the University of Minnesota Hospital and Clinic merged with Fairview Riverside Medical Center.

"People need support and need to feel confidence in the process," Vogel says.

Give your front-line managers and staff whatever information you have, Sangermano suggests. "If there are things going on up here [in top administration], and they don’t hear about it — that’s where rumors get started," she says. "Even a little information is better than none at all."

Involving your staff in the merger process helps dispel rumors, Sangermano advises. She used monthly staff meetings to keep employees informed of the status of the merger and to solicit their feedback about how the process was going.

"They need to feel like they’re a part of this merger, this change, and their ideas are important," she says. "It’s not that we’ll always use their ideas, but if they have the opportunity to participate in some of this, it makes it a much easier road to travel. But if you leave them out of it, it’s difficult. That’s where resentment, frustration, and the ‘we/they’ idea comes in."

Lay a foundation

When the Fairview-University Medical Center Minneapolis merger was beginning, all disciplines were represented in discussions and action plans, Vogel says. "We also had an OR task force that cut across all disciplines." This group included representatives of each clinical specialty.

"The OR task force developed vision and values and ground rules and prioritized what needed to be dealt with first," which cleared the way for understanding and trust through relationship building, Vogel says. That task force evolved into a permanent OR committee that still meets.

Inservices are an ideal place to address the merger, Vogel suggests. Her hospital used human resources staff and external consultants to lead three sessions on the processes of change, grief, and anger. "It’s a way of trying to get through to a more positive environment." she says.

Divide the policies and procedures.

Distribute the policies and procedures that need to be merged among perioperative managers at all the merging facilities, Sangermano suggests. "You need to get various inputs from staff or management to make sure everything is covered in the policy," she says. "You have to make sure you’re all doing the same thing. If you put it in the policy and procedure, you’d better be doing it."

Involve ancillary departments.

Obtain participation from those ancillary departments, such as infection control, that are involved in the same-day surgery process, Sangermano advises. Involving other departments makes the task of merging policies seem less monumental.

Find common ground.

Look at your policies to see what items are the same, Sangermano says. Work first with the policies that have significant common areas.

This advice is seconded by Vogel, who had a Joint Commission accreditation survey six months after her merger. "We tried to consolidate the ones that made sense, but we have a lot left to do," she says.

Acquisitions lead to concerns about benefits

Address benefits changes immediately.

In the case of acquisitions, employees are most concerned about benefits, so deal with this area immediately, suggests Catherine Nichol, RN, regional administrator of northern California for ASC Network Corp. in Walnut Creek, CA.

"Everyone is concerned about what will affect them immediately: Will my paycheck be the same? Will my benefits be the same? Will they be worse or better? What holidays will I get? Will my time off be affected by this change?" Nichol says. Discuss these areas soon after the merger is announced and focus on the pluses of the merger, she advises.

Remain open-minded and flexible.

Whether going through a merger or acquisition, approach the process with a positive frame of mind. "I know friends that have been through this and approached it in a negative way by saying, ‘We’ve always done it this way. Why do we have to change?’" Sangermano recounts. "Be positive. You’ll hit bumps in the road, but you’ll get through it."

Not that everything falls into place when you’re merging policies, even when you develop a first draft, she emphasizes. "You may have to step back, look, and say, ‘Maybe this isn’t the thing to do.’"

Be willing to adapt to the culture that is in control and learn how that culture operates, same-day surgery managers advise.

"The faster people can accommodate themselves to realizing that things are changing, the smoother it’s going to be, and the more job security they’ll have," Nichol says. "I’m not suggesting people just roll over, but you can’t criticize or change something until you fully understand it. And you can’t be a contributor to an organization before you fully understand it."

When a hospital acquires a surgery center, consider filling open spots at the surgery center with hospital surgery staff, suggests Norma Shaw, RN, BSN, MS, director of surgical services at Union Hospital in Terre Haute, IN. Three years ago, Shaw’s hospital signed a lease agreement with a clinic and freestanding surgery center. She faced the difficult situation that almost all of the surgery center staff had worked for a competitive hospital. Many resisted the lease agreement, Shaw says.

What has she learned? "Take it one step at a time, very slowly," she says. "You can’t expect miracles overnight — there are none. Mergers are tough to deal with. That’s all there is to it. You make people unhappy. It’s not an easy thing to deal with, but it’s the name of the game today."