Organisational culture and post-merger integration in an academic health centre: a mixed-methods study.

Jan Fowler,Karen Melham,Alastair M Buchan,Pavel V Ovseiko

doi:10.1186/s12913-014-0673-3

Abstract

BackgroundAround the world, the last two decades have been characterised by an increase in the numbers of mergers between healthcare providers, including some of the most prestigious university hospitals and academic health centres. However, many mergers fail to bring the anticipated benefits, and successful post-merger integration in university hospitals and academic health centres is even harder to achieve. An increasing body of literature suggests that organisational culture affects the success of post-merger integration and academic-clinical collaboration.MethodsThis paper reports findings from a mixed-methods single-site study to examine 1) the perceptions of organisational culture in academic and clinical enterprises at one National Health Service (NHS) trust, and 2) the major cultural issues for its post-merger integration with another NHS trust and strategic partnership with a university. From the entire population of 72 clinician-scientists at one of the legacy NHS trusts, 38 (53%) completed a quantitative Competing Values Framework survey and 24 (33%) also provided qualitative responses. The survey was followed up by semi-structured interviews with six clinician-scientists and a group discussion including five senior managers.ResultsThe cultures of two legacy NHS trusts differed and were primarily distinct from the culture of the academic enterprise. Major cultural issues were related to the relative size, influence, and history of the legacy NHS trusts, and the implications of these for respective identities, clinical services, and finances. Strategic partnership with a university served as an important ameliorating consideration in reaching trust merger. However, some aspects of university entrepreneurial culture are difficult to reconcile with the NHS service delivery model and may create tension.ConclusionsThere are challenges in preserving a more desirable culture at one of the legacy NHS trusts, enhancing cultures in both legacy NHS trusts during their post-merger integration, and in aligning academic and clinical cultures following strategic partnership with a university. The seeds of success may be found in current best practice, good will, and a near identical ideal of the future preferred culture. Strong, fair leadership will be required both nationally and locally for the success of mergers and post-merger integration in university hospitals and academic health centres.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0673-3) contains supplementary material, which is available to authorized users.

Highlights

Around the world, the last two decades have been characterised by an increase in the numbers of mergers between healthcare providers, including some of the most prestigious university hospitals and academic health centres
To demonstrate the current organisational culture of the NOC NHS Trust and the University, as well as the future preferred organisational culture across the two organisations, we plotted the results from the NOC against the results from the Oxford Radcliffe Hospitals NHS Trust (ORH) on the Competing Values Framework (CVF) axes (Figure 2)
Respondents at both the NOC and the ORH perceived that the academic enterprise had a less hierarchical and more team-oriented, entrepreneurial, and rational culture than the clinical enterprise; Figure 2 Organisational culture profiles of the current cultures at the two merging NHS Trusts, University clinical departments, and the preferred future NHS Trust/University culture, according to 2010 (ORH) and 2011 (NOC) organisational culture surveys

Summary

Introduction

The last two decades have been characterised by an increase in the numbers of mergers between healthcare providers, including some of the most prestigious university hospitals and academic health centres (AHCs) [1,2,3,4]. An AHC is not a single institution, but “a constellation of functions and organizations committed to improving the health of patients and populations through the integration of their roles in research, education, and patient care” [5] Because of their unique tripartite roles, AHCs have been at the forefront of innovation and high-quality care in North America and have spread internationally [6].

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Conclusion