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

Ovseiko PV, Melham K, Fowler J, Buchan AM - BMC Health Serv Res (2015)

Bottom Line: 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.Strategic partnership with a university served as an important ameliorating consideration in reaching trust merger.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.

View Article: PubMed Central - PubMed

Affiliation: Medical Sciences Division, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK. pavel.ovseiko@medsci.ox.ac.uk.

ABSTRACT

Background: 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. 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.

Methods: This 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.

Results: The 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.

Conclusions: There 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.

No MeSH data available.


Related in: MedlinePlus

Organisational culture profiles of the current (pre-merger) 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. The preferred future NHS Trust/University culture refers to the culture that should be developed across the clinical and academic enterprises in the next five years to more successfully pursue the shared mission of academic medicine.
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Fig2: Organisational culture profiles of the current (pre-merger) 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. The preferred future NHS Trust/University culture refers to the culture that should be developed across the clinical and academic enterprises in the next five years to more successfully pursue the shared mission of academic medicine.

Mentions: A total of 38 completed questionnaires (response rate = 53%) were received. Scores for each item were calculated by averaging individual responses, and scores for each culture subscale by averaging questions on the culture subscale (Additional file 2). The reliability of our results, as measured by Cronbach’s α, was highest for the entrepreneurial subscale, moderate for the team subscale, and lowest for the rational and hierarchical subscales (Additional file 2). 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 ORH on the CVF axes (Figure 2). It is interesting to note the key differences and similarities in the perception of organisational culture between the NOC and the ORH:Figure 2


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

Ovseiko PV, Melham K, Fowler J, Buchan AM - BMC Health Serv Res (2015)

Organisational culture profiles of the current (pre-merger) 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. The preferred future NHS Trust/University culture refers to the culture that should be developed across the clinical and academic enterprises in the next five years to more successfully pursue the shared mission of academic medicine.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4308851&req=5

Fig2: Organisational culture profiles of the current (pre-merger) 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. The preferred future NHS Trust/University culture refers to the culture that should be developed across the clinical and academic enterprises in the next five years to more successfully pursue the shared mission of academic medicine.
Mentions: A total of 38 completed questionnaires (response rate = 53%) were received. Scores for each item were calculated by averaging individual responses, and scores for each culture subscale by averaging questions on the culture subscale (Additional file 2). The reliability of our results, as measured by Cronbach’s α, was highest for the entrepreneurial subscale, moderate for the team subscale, and lowest for the rational and hierarchical subscales (Additional file 2). 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 ORH on the CVF axes (Figure 2). It is interesting to note the key differences and similarities in the perception of organisational culture between the NOC and the ORH:Figure 2

Bottom Line: 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.Strategic partnership with a university served as an important ameliorating consideration in reaching trust merger.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.

View Article: PubMed Central - PubMed

Affiliation: Medical Sciences Division, University of Oxford, John Radcliffe Hospital, OX3 9DU, Oxford, UK. pavel.ovseiko@medsci.ox.ac.uk.

ABSTRACT

Background: 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. 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.

Methods: This 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.

Results: The 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.

Conclusions: There 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.

No MeSH data available.


Related in: MedlinePlus