One Doctor Tells His Experience With Hospital Mergers

PHILADELPHIA--During his tenure at Brigham and Women's Hospital,Lawrence Shulman, MD, has been involved in two hospital mergers.The first, with Massachusetts General Hospital, was done in secrecy,while the latest, with the Dana-Farber Cancer Institute, has beenan open process.

Each approach has its plusses and minuses, he said at the secondannual meeting of the Association of Cancer Executives (ACE).

The first merger led to questions and controversy. "Whenthe Mass General merger was first disclosed in the Boston Globe,it was viewed as a way to consolidate services and save money,"said Dr. Shulman, clinical director of hematology-oncology atBrigham and Women's Hospital. But later articles criticized thetwo hospitals for not consolidating and called the merger a "fraud"for its failure to combine the two facilities.

The reporters missed the point of the merger, Dr. Shulman said,which was not to downsize but rather to create a force powerfulenough to negotiate with managed care providers.

"We felt that by bringing the two rivals together, we wouldhave a powerful negotiating force," he said.

Working out a merger in the closet has advantages, he said. "Witha closet type merger, the physicians and other employees don'thave a period of anxiety beforehand, but they're pretty shockedin the morning."

In fact, Dr. Shulman said he only learned of the merger himselfwhen the news broke while he was attending a conference in California.

This contrasts with the current merger with Dana-Farber in whichthere have been 2 years of sometimes acrimonious negotiations,he said. Despite the discord, the institutions signed a memorandumof agreement in January of this year to move ahead with the merger.

Unlike the first merger, this one will attempt to meld the twosites of care into one operation, a process made difficult bya number of "cultural differences," he said. For example,the nursing groups, both unionized, have different contracts;the physician groups have different management styles; and thelaboratories use different technologies.

"This time , it's like nuclear fusion. You bring everythingtogether , wait for the explosion, and hope you have somethinguseful at the end, " he said.

Dr. Shulman cautions that with any merger those involved shouldbe prepared to deal not only with the technical details but alsowith the human fear factor. "People are anxious beyond belief,"he said.

"Change is hard, and you've got to allow people to suffera bit and tell them it's all right to be scared." Also, beprepared for hurt feelings, as many people who formerly had afair degree of autonomy suddenly lose their independent status.

In the end , overplanning will not pay off. "A merger isa product of 5,000 details," he said. "You paint anoverall mission, but you can't plan for everything."

Dr. Shulman also advised negotiators to "keep all the piecesin motion. Don't let people wait for another piece of the puzzleto be solved before dealing with their own issue. Keep all thoseballs in motion, lest the process freeze up."

Dr. Shulman added one final point: Mergers are about improvinghealth care for the patient , not protecting turf."It's easierto work through details if you just keep puting the patient first,"he said.