Abstract
PurposeDespite the continuation of hospital mergers in many western countries, it is uncertain if and how hospital mergers impact the quality of care. This poses challenges for the regulation of mergers. The purpose of this paper is to understand: how regulators and hospitals frame the impact of merging on the quality and safety of care and how hospital mergers might be regulated, given their uncertain impact on quality and safety of care.Design/methodology/approachThis paper studies the regulation of hospital mergers in The Netherlands. In a qualitative study design, it draws on 30 semi-structured interviews with inspectors from the Dutch Health and Youth Care Inspectorate (Inspectorate) and respondents from three hospitals that merged between 2013 and 2015. This paper draws from literature on process-based regulation to understand how regulators can monitor hospital mergers.FindingsThis paper finds that inspectors and hospital respondents frame the process of merging as potentially disruptive to daily care practices. While inspectors emphasise the dangers of merging, hospital respondents report how merging stimulated them to reflect on their care practices and how it afforded learning between hospitals. Although the Inspectorate considers mergers a risk to quality of care, their regulatory practices are hesitant.Originality/valueThis qualitative study sheds light on how merging might affect key hospital processes and daily care practices. It offers opportunities for the regulation of hospital mergers that acknowledges rather than aims to dispel the uncertain and potentially ambiguous impact of mergers on quality and safety of care.
Highlights
Like many western countries (Angeli and Maarse, 2012; Bazzoli et al, 2004), The Netherlands has seen its share of hospital mergers the past decades, bringing back the number of hospitals from 243 in 1978 to 79 in 2016 (den Hartog et al, 2013; Dutch Ministry of Health, n.d.; Roos, 2018)
We focus on three hospital mergers in The Netherlands to answer the following questions (1) How do regulators and hospitals frame the impact of hospital mergers on the quality and safety of care? and (2) How can hospital mergers be regulated given, their uncertain impact on quality and safety of care?
We address a gap in the current literature, as outcome-oriented studies do not demonstrate how mergers impact the quality of care, while the process-oriented studies insufficiently trace the impact of a merger on organisational processes to the quality of care
Summary
Like many western countries (Angeli and Maarse, 2012; Bazzoli et al, 2004), The Netherlands has seen its share of hospital mergers the past decades, bringing back the number of hospitals from 243 in 1978 to 79 in 2016 (den Hartog et al, 2013; Dutch Ministry of Health, n.d.; Roos, 2018). The continued consolidation of the Dutch hospital market played out against the backdrop of sustained public and political debate on the desirability of mergers (Postma and Roos, 2016) and throughout the restructuring of the Dutch healthcare market from 2005 onwards, to make the sector more competitive (Helderman et al, 2005; Schut and Varkevisser, 2017). We know, are challenging organisational processes that can have “multilayered and complex” effects on the services provided by organisations The full terms of this licence may be seen at: http://creativecommons.org/licences/by/4.0/legalcode
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