Stories of failed mergers or service reconfigurations are pretty easy to come by in health care. One of the most dramatic ones we have seen comes from our research on network integration a few years ago. A system in New Zealand was looking to consolidate maternity services to one hospital to control costs and improve quality, but it overlooked engaging one crucial stakeholder—the midwives. Because they were against moving locations, the midwives went so far as to form an anti-consolidation effort in which they told mothers that their children wouldn't be part of the community if they were born in a different hospital.
6 key insights on systemness, distilled from a year of CEO roundtables
Sounds a bit absurd? Well, it was effective—in the end, the system abandoned the plan. Tales like this occur all the time, but as systems continue to scrutinise costs, integrate, and plan for the future, service reconfiguration is increasingly on most planners' and providers' minds. So how can systems avoid such a blowback?
Communication is the key
We spent some time root-causing why systems failed to rationalise successfully and found that communication was the key ingredient. Successful systems went light years beyond 'good enough' in their communication strategies to foster buy-in from every stakeholder.
One story in particular shows what a good communication strategy looks like. In 2011, Trillium Health Centre and Credit Valley Hospital were independent hospitals operating about 10 kilometers apart in Ontario, Canada. They had some overlap of services as well as some complementary ones. As such, area patients were often seen at both hospitals and complained about having to share their medical histories multiple times, wishing the two could be more connected.
So the two organisations decided to undergo a voluntary merger, becoming Trillium Health Partners, to achieve economies of scale, higher quality, and—above all—a more patient-friendly experience. Knowing how contentious mergers are, and that services would need to shift around, senior leaders spent significant time, money, and energy developing a targeted, comprehensive communication plan to enfranchise all key stakeholders.
Trillium's 3 pillars of thorough communication
Trillium segmented its stakeholders into three key groups and approached them each in a different way.
- Patients: Trillium titled the project "Partnering for Patients" in order to convey that the rationale behind the merger was to improve care for patients. One of the more innovative aspects of the organisation's strategy was then sending teams through the city with iPads to stop individuals on the street to survey them with questions related to their perceptions on the merger. They had regular town halls and electronic communication with the public as well.
- Clinicians and staff: Trillium used data to paint clinicians a picture of improved quality with higher volumes and better investments to improve care. The organisation then approached the top 100 clinical leaders in the two hospitals through more than 30 clinical engagement roundtables to discuss a variety of clinical topics related to the merger.
- Policymakers: As a final step, Trillium approached the city's 94-year-old mayor, who had political sway over town, to get her buy-in. When the organisation finally went to get approval from the Department of Health, the first question the Department asked was, "What does the mayor think?" Trillium could say she was sold on the idea, and soon the Department was too.
Why the strategy worked
Trillium's CEO credits this comprehensive communication strategy as the key to the successful merger. We found two key themes that made it such a success:
- Veto power: For each stakeholder, Trillium asked, "What are you concerned about?", and then targeted further communication to address those concerns. Notice how that's different than asking, "Do you think we should merge?" The Trillium team made the conscious choice not to give veto power to any group, but instead pushed to address all of their concerns.
- WIFM: The second key was that Trillium targeted each group specifically with the 'WIFM' principle—"What's in it for me?" By answering this question for all of the key stakeholders, Trillium gave each group a clear sense of how they benefited from the merger.
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How to achieve true systemness
Many health systems are only scratching the surface of the potential their scale offers. But today’s market leaders are leveraging purposeful integration and cohesive effort—what we call ‘systemness’—to streamline operations, deliver more reliable and coordinated care, rationalise fixed costs, and even transform entire delivery models.
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