Mission possible Greg L Carlson1,328 words1 March 1998 Healthcare Executive HEE 52 Vol. 13, No. 2EnglishCopyright (c) 1998 Bell & Howell Information and Learning Company. All rights reserved. You can create a strong post-merger culture. Merging two organizations, especially competitors, can be overwhelming. While financial, legal, and clinicalissues feed into its complexity, cultural issues make it even thornier. Unfortunately, these issues are noteasily resolved by the installation of software or the recruitment of new physicians. Still, they can be resolvedby recognizing that every organization has people who will make it successful. It is just a matter ofunleashing their talents. That is what we set out to do when Owensboro-Daviess County Hospital-where I had spent four years asboth COO and then CEO- officially merged with Mercy Hospital to form Owensboro Mercy Health System inOctober 1995. The parties involved had concurred: in a community of 60,000-and a service area of150,00-one consolidated organization could do a better job of improving access, enhancing quality, andcontrolling costs than two fragmented hospitals with overlapping services and competing interests. Pulling It Together At the time of the merger, our culture lacked clear vision and focus. A cultural assessment of the 80 directors and managers in the newly merged organization showed their satisfaction at 41 percent, commitment at 48 percent, and the strength of our overall culture at only 3 percent. Now, little more thantwo years later, satisfaction rates, commitment levels, and cultural strength are all above the 90th percentile. How did we do it? First, we pulled together a cultural design team that included eight managers from thenewly merged organization who were selected by the executive team for their leadership abilities. While theteam did not have the power to make decisions, it did act as an informal consultant to senior executives andmade recommendations for cultural transformation that best served the organization, both internally andexternally. Ultimately, the team helped us evaluate programs and policies and integrate systems and operations. During this process, we told the team what we hoped to achieve: a culture where employees were equallyinvested in both their own success and the success of OMHS. With the team's recommendations in mind, we accomplished the following objectives. We developed a new performance evaluation system that incorporated a 360-degree feedback process. We increased tuition reimbursement for all employees. In the past, our tuition reimbursement program wasdesigned to benefit LPNs interested in becoming RNs. We've since changed the program to encourage allemployees to take continuing education courses in vocational settings. We decreased turnover by increasing internal promotions. In fact, internal candidates have filled 75 percentof the management opportunities that have opened up since the merger. We implemented SuccessSharing a program that allows us to identify targets in terms of quality, service, and cost, and to reward employees for meeting them. We increased community outreach efforts. Over the past year, we have assessed the health status of 7,771grade school children and the physical fitness of 1,200 adults. We have provided an RN coordinator and 15volunteer physicians to treat 300 patients each month at a local clinic for the poor. We have alsoimplemented a school nurse program, sent a coordinator to a community custody center for non-violentoffenders, and instituted an internal employee wellness program. Community outreach is not only the right Page 1 of 3 2009 Factiva, Inc. All rights reserved. thing to do, but it gives both the community and our employees a real sense of pride in the organization. Laying the Foundation Before doing some of these things, we laid a cultural foundation for the newly merged health system bydeveloping a new mission statement that people could readily embrace. It says that OMHS now exists "toheal the sick and improve the health of the community." We also consolidated jobs and services because, at merger time, we had two of everything. Our selectionprocess was sequential: we started with vice presidents, then moved through directors, managers, and thenstaff. The two presidents of the hospital selected the vice presidents. Directors and managers were selectedby customized panels consisting of three peopleeach respective position's hiring vice president, a humanresources representative, and a second vice president. Representatives from both hospitals were involved inall cases. There were no formal interviews for staff positions. While managers had input into the selection process, people were ultimately chosen for their past performance at either hospital, growth potential, flexibility, skillsand, lastly, seniority These were the characteristics a random sample of 300 employees cited as the mostimportant in creating a successful enterprise. Once we decided which employees would do what, we moved quickly. That is because mergers create a lotof uncertainty and anxiety in an organization. The longer you hold people in suspense, the longer it will takethe organization as a whole to move forward. Therefore, it is important to consolidate services and placeemployees as soon as possible. We did both in a record-breaking six weeks. Fortunately, we made it through the re-employment process without any layoffs. Some people chose toleave while others were reallocated throughout the organization. It also helped that, six months earlier, wehad stopped hiring full-time employees and started hiring temporary workers in anticipation of the merger. So, when it finally came, jobs were available for our permanent workers. The Hard Facts After the merger, we spent the first six months fine-tuning the mechanics of the merger and the followingyearand-a-half developing the culture. We did so knowing it would ultimately determine our long-term success. Looking back, creating a cohesive, service- and mission-oriented culture was not easy. After all, we hadbrought together two dissimilar organizations and two somewhat divergent sets of philosophies. MercyHospital was a 130-bed religious organization with approximately 600 employees-and one-third the size ofODCH. It prided itself on a culture that was familial and a mission that highlighted the provision of basichealth services (i.e., obstetrics/gynecology, rehabilitation, inpatient/outpatient surgery, pediatrics, andemergency medicine). Conversely, ODCH was a 480-bed not-for-profit organization that was much like a complex medical center. With approximately 1,500 employees, it had a major trauma center, dialysis capabilities, open- heartservices, and a strong tertiary-care orientation. It adhered to a seven-pronged mission statement thatfocused on providing a full range of services, on access, quality, customer service, professionalenhancement, financial viability, and on facilitating the practice of medicine. Quality Improvement Given these differences, our employees had no sense of what OMHS stood for when we started. Today, however, there is a real sense of purpose throughout the organization, which has enabled us to realizesignificant improvements. In terms of patient satisfaction, adherence to our mission and core commitments has helped us score in the87th percentile on a national basis compared to other hospitals of our size. Also, our quality initiatives havebeen recognized by the Joint Commission on Accreditation of Healthcare Organizations and by VHA, Inc., which gave us a national quality award shortly after the merger. On top of that, we have increased our charity care by 30 percent, engaged in partnerships to bring newservices to our community, built new relationships with physicians, and developed a managed care plan withour medical staff that covers more than 22,000 peopleall of which has enhanced quality. Finally, because our culture is now built on a strong mission and shared values, our organization-and ourpeoplecan move forward and flourish. Page 2 of 3 2009 Factiva, Inc. All rights reserved. Bayer Quality Network Sharing Success in CQ This column in made possible in part through the support of Bayer Quality Network, a cooperative educational forum for healthcare professionals that serves as a resource for sharing methods in qualityimprovement. The Bayer Quality Network is sponsored by the Bayer Pharmaceutical Division. Greg L. Carlson, CHE, is president and chief executive officer of Owensboro Mercy Health System inOwensboro, Ky Owensboro Mercy Health System 811 E. Parrish Ave. Owensboro, KY 42302 (502) 628-2101 Document hee0000020010917du310000y Page 3 of 3 2009 Factiva, Inc. All rights reserved.