Mergers are complex undertakings even in the best circumstances.

On paper, larger enterprises with more scale and a mix of services look appealing—particularly in health care. But the evidence shows they consistently under-deliver on their stated objectives.

Do your partnerships keep failing? It's time to address these 3 risks.

In previous research, we've looked at the administrative function behind merging. In-depth case studies highlight that when one of the merging organizations feels under-valued or subservient to its partner organization, it can have a corrosive effect on the combined workforce and the merger itself.

The solution to this problem is building parity where both entities and their teams feel valued and critical to the new organization's success. This is challenging even with horizontal mergers where both organizations are "on the same footing." But what about mergers where the organizations are different? What about when it's a hospital and non-hospital provider?

Cheat sheet: Systemness in health care 101

The direction of travel for health is more integration between acute and non-acute services. One of the most vexing hurdles to getting that right is connecting physical and mental health. For years, mental health services have been under-funded and under-valued. If there were a textbook case for the risk of power asymmetry in a health care merger, it would be between an acute and mental health provider.

But one organization in England provides a successful case study to consider.

Mergers can (and should) prioritize mental health

Somerset NHS Foundation Trust (Somerset FT), in England, is the product of an April 2020 merger between a mental health and community care provider (Somerset Partnership NHS FT) and an acute hospital (Taunton and Somerset NHS FT). They mitigated many of the common risks of M&As and vertical integration while successfully integrating physical, mental, and community health services.

Taunton and Somerset NHS FT traditionally prioritized physical health, as many acute systems often do. But over two years before the official merger, the two organizations formed a single cross-organizational leadership team, with the goal of establishing balance in resource allocation and influence between the two centers.

Two strategies helped the new leadership team achieve this goal.

1. Bring historical imbalances to light

While it can be easy to overlook past disparities in resources and influence, it's impossible to correct for imbalances without first raising awareness that they exist. To expose any resource imbalance between the two organizations, the leadership team conducted a quantitative, objective evaluation of mental health gaps in the county. This helped get the leaders on the same page and provided a clear rationale for prioritizing mental health care across each stage of the integration process.

2. Never underestimate the signaling value of your actions

In every Somerset FT merger document, the mental health organization's name is always first, and the acute hospital's name is second. The executive team reinforced this in announcements and conversations to demonstrate to both workforces that they considered the mental health organization to be equally important to acute care.

Further, to challenge the notion of the mental health trust being the political "underdog," the leadership team opted to have the mental health organization buy the acute hospital, even though the latter was much larger. This sent a powerful message and strengthened staff support for the merger. While symbolic, these powerful gestures helped underscore that the new merger would be a partnership of equals.

Planning ahead is a must-do

These are just two of several tactics the Somerset FT leadership team employed to mitigate common risks and execute a successful merger. To learn more, review our case study on the merger.

It is still too early to tell if the merger has successfully improved social and clinical outcomes related to mental health, especially in light of Covid-19. But one thing is for certain: We need to continue talking about mental health and showing how important it is. This will become increasingly important as more systems undergo integration. Organizations that are planning mergers must think about what they want their organization to be and the culture they want to create, particularly when it comes to bringing equality across services. This includes building realistic goals and creating a collaborative structure to get them there.

The only system that can truly serve its population well is one that treats the physical disease burden while equally addressing complex mental and emotional health.