Liaisons lend sanity to merger madness
Liaisons lend sanity to merger madness
Tension, distrust are obstacles to overcome
After purchasing an HMO in 1996, the board of directors at Shands Hospital in Gainesville, FL, decided to reorganize the five community acute care hospitals, two specialty hospitals, and an extensive home health care network into a single integrated enterprise.
More often than not, however, mergers bring rumors, political strife, and perhaps financial failure, says Rose Rivers, RN, PhD, director of nursing. (See story on surviving mergers, p. 34.)
Complicating this particular merger was the fact that one of the acquisitions, Alachua General Hospital (AGH) was a former rival of Shands. "It was 30 years older than we were and regarded as a center of excellence for cardiac, cancer, women’s, and emergency care as well as neuroscience and neonatology. Barging in and dictating change was not an option," she says.
Instead, six Shands managers, selected by the chief executive officer, were designated as temporary "transition liaisons" to the newly acquired facilities. Five of the six liaisons were nurses; one was a respiratory therapist.
"Our purpose was twofold," Rivers explains. "First, we were interpreters of Shands philosophy, mission, and values. Secondly, we were there to discover and understand the operations and culture of the other hospitals."
Their three-month charge included assessing objectively the following:
• status of patient care;
• opportunities for consolidating resources;
• strengths and weaknesses of the leadership group;
• priorities of the medical staff;
• community support.
"We were also looking for best practices that could be adopted elsewhere in the system or maintained in that area," she says.
Because the role was so vital, the liaisons reported directly to the CEO and did not perform regular job duties during the three-month assignment. "We did not have to worry about competing priorities and could immerse ourselves in organizational culture," Rivers says.
Liaisons set up an office at AGH with their portable computers from Shands. "We were on site at least three days a week at the assigned hospitals for a minimum of two, but not more than three months."
They immersed themselves as quickly as possible into the culture by attending meetings of AGH executive committee, nursing leadership, and physicians. They also maintained a voice-mail line at AGH so nurses could leave messages and requests for support. "For example, we facilitated floating some of Shands nursing staff over to AGH during a staffing crisis," Rivers says.
Most of all, they talked — and listened.
"As liaisons, we had free range of the hospital and were able to talk with employees as we desired." In addition to participating in key meetings, the liaison reviewed budget, minutes, patient satisfaction, and accreditation reports. "We also focused on listening to understand their point of view. Of course we validated our observations through discussion, questions, and comparison of responses."
The two liaisons, together with AGH’s leadership group, also adopted a the following definition from the American Nurses Association as a guiding principle of collaboration:
A true partnership is one in which the power on both sides is valued by both, with recognition and acceptance of separate and combined spheres of activity and responsibility, mutual safeguarding of the legitimate interests of each party, and a commonality of goals that is recognized by both parties. This is a relationship based upon recognition that each is richer and more truly real because of the strength and uniqueness of the other.
Then they started discussions with administrators, physicians, unit managers, and staff by asking two questions: What do you want us to know about you? What do you want to know about us?
Rumor control was an important — and inevitable — aspect of the liaison’s task. For example, stories circulated that Shand’s vice president of nursing would replace AGH’s chief nursing officer and that Shands’ physicians would convert AGH to a children’s hospital or outpatient center.
"We kept reiterating that, while there were budget targets in mind, there was no preconceived plan," she stresses. "We assured them that we were dedicated to developing a collaborative plan for the best use of all the system’s resources."
To further foster open communications, the liaisons shared written reports with the AGH leadership team before submitting them to Shands’ CEO. "Open discussion was encouraged on any aspect of the report," Rivers says.
Because of their candid approach to addressing issues and concerns, the AGH leadership rapidly gained a sense of trust in the liaisons’ ability to serve as advocates. "We focused on relationship-building as we believed that rules and regulation minus relationships equals resentment and rebellion," she says. "They didn’t feel threatened because we made it a point to serve as facilitators, not as dictators."
They worked to foster this concept throughout the newly acquired hospital. For example, as the liaisons visited each unit, they encouraged managers to voice their opinions as well. "They told us unequivocally that they didn’t want their units to become a mini-teaching hospital,’" she says. "While they admired many aspects of Shands, they didn’t want the complexity of a teaching environment."
Liaisons also facilitated site "exchange" visits that enhanced opportunities for collaboration between unit managers in the soon-to-be-one system. "They compared patient types, acuity, staffing, and protocols. It was a valuable learning experience for both groups."
Nurses also were given the opportunity to get to know one another in a nonthreatening environment. The vice president of nursing and patient services at Shands chaired a chief nursing officer council in which each facility took turns hosting a monthly luncheon.
The liaisons became advocates for AGH staff at Shands’ leadership meetings. "We didn’t claim to be experts, but we knew enough to question practices that might impact them and make sure their voices were heard," she says.
After the information-gathering phase was complete, liaisons worked with AGH leadership group to develop a specific action plan that included goals, team leaders, and deadlines for these areas: clinical care, fiscal management, quality improvement, training, accreditation, and personnel.
In addition to providing a guide to operationalize the integration, the plan shifted AGH’s outlook from being a single community hospital to being part of a system, Rivers says. Here are some lessons learned through the process:
• Don’t mess with the best. A critical part of the liaison’s job was to identify and report on the best practices of the newly acquired hospital. Shands adopted AGH’s system of managing incident reports and its clinical coordinator’s job description.
"More important than adopting their ideas was the learning that occurred because it helped us to view things differently," she says. "The challenge for all of us was to get past the idea of individual success and to learn to function as a system."
• Select excellent communicators as liaisons. "They need to have outstanding interpersonal and leadership skills, as well as clinical and administrative expertise," Rivers says.
• Seek first to understand. "Because liaisons understood and communicated the perspective of the newly acquired hospitals, they were able to decrease anxiety," she says.
• Pre-empt return to the real-world problems. When the liaisons resumed regular job duties, they found it difficult because other staff, who viewed the temporary assignment as a "vacation," seemed angry. But some of the liaisons headed off resentment by keeping their co-workers informed — and in some cases, amused.
"One liaison gave each co-worker a stuffed animal to keep until her return as well as sending them weekly updates," Rivers says.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.