Surviving merger requires adjustment to change
'Stay flexible and go with the flow'
By Kathleen W. VanDoren, RN, BSN, COHN,
Paralegal
Executive President, Association of Occupational
Health Professionals in Healthcare, Reston, VA
Coordinator, Employee Health Services, Good
Samaritan Hospital, Cincinnati
The often-repeated phrase "one thing that is constant is change" certainly applies to the health care industry over the past few years. Countless health care institutions are merging, with accompanying downsizing of personnel, re-examination of services, and consolidation of resources, all in the hopes of staying viable and fulfilling their community role. Employee health services have a vital role to play in these hospital mergers.
In October 1994, Good Samaritan Hospital, a Sisters of Charity Hospital, and Bethesda Oak and Bethesda North, Methodist hospitals, all in Cincinnati, developed a working relationship. Official papers were signed in January 1995, and the first board meeting of the new entity named TriHealth, Good Samaritan/Bethesda Hospitals was held in February 1995.
Management team chosen first
One major difference that set this organization apart from other health care systems was the order in which it approached planning the consolidation. A single combined management team was chosen first, followed by development of a strategic plan. Because the management structure was already in place, the same team that formed the strategic plan had the opportunity and responsibility to initiate it.
The strategic plan is founded on TriHealth being a consumer-driven, physician-led organization, with the assumption that managed care will be the dominant reimbursement model. A work design initiative was implemented as an orchestrated approach to organizational change, focusing on meeting customer needs, managing costs, and improving work quality. The management structure assures TriHealth will deliver outstanding services and quality and will carry it through the year 2000.
The change in management structure in January 1995 quickly affected the 7,800 employees. When senior management was chosen, 49 of the 80 directors were assigned new areas of responsibility, and some middle management positions were eliminated. Employee health services began to see evidence of job-related stress.
Trends in employee health
EHS practitioners noted that employee injury reports increased 20% over the previous year. Employees were preoccupied with changes, downsizing, and concern for their jobs, which caused decreased concentration on job safety. Workers' compensation claims also increased, not only because of increased accidents, but also because in lean times, some employees look to other possible sources of income in case their positions are eliminated.
Visits to the EHS for minor complaints also increased. Once in the department, employees often wanted to stay and talk a few minutes about their job concerns. Our staff spent time with employees to help them work through problems they were encountering. Many times, just having someone to listen to them was enough to encourage employees regarding the future. If someone appeared to have serious coping difficulties, we referred them to the employee assistance program (EAP).
Humor also played a big part in alleviating stress. Gallows humor often was heard, and comments
such as "the locks haven't been changed on my office door, so I still must be employed," and "my
badge still lets me in
the garage" were common. Our staff listened and encouraged employees to verbalize their concerns.
Upper management also was aware of the emotional climate and provided several ways to combat stress and encourage communication. Open meetings were held with EAP counselors, articles on coping with change were printed in hospital periodicals, and question-and-answer meetings were provided for employees.
Management also attempted to communicate with employees by visiting work areas, establishing a phone information line, and regularly printing consolidation updates in hospital newsletters. The goal of providing this information was to address rumors connected with the changes that were taking place.
One service that was well-received following department restructuring was "survivor" meetings. Those who are left after a company downsizing can feel guilt, and strategies for coping with that guilt were given in an employee seminar.
Each of the three facilities' EHS faced its own set of changes. The management position for the EHS at Good Samaritan was eliminated, and a manager over all three hospitals was appointed. The goal was to bring each EHS in line with the overall strategic plan, making each facility a mirror image of the other.
Our first department meeting consisted of the newly appointed manager and the three employee health nurses from the facilities. The meeting was organized using the continuous improvement team concept. Current services were categorized into several general components, and specific services were listed under those components.
In future meetings, determinations will be made regarding adding or deleting services, requiring additional education and/or certification, and consolidating forms, along with integrating policies and procedures. Meetings will be held at least twice a month until a department plan is formulated. By March 1996, we hope to have a formal consolidation plan to present to upper management.
Hints for dealing with consolidation reality
Consolidation with rapid change is charged with emotion and stress for all those affected by the process. Peter Holden, chief operating officer of TriHealth, offers "five Cs" to assist in dealing with these difficulties:
* Communicate often and actively. This includes active listening.
* Courtesy is needed. How we treat each other speaks volumes about our ability to succeed.
* Common sense should be used to make decisions. Don't be afraid to make mistakes. Indecision can be fatal in this competitive market.
* Challenge yourself to do the right thing for the community. As health care providers, we have a unique chance to impact health care significantly.
* Chill. Be patient. Frustration is to be expected. Talk to your peers; ask for help. Take one step at a time.
Management was encouraged to acknowledge business reality and employees' feelings. Employees were encouraged to increase communication with others, have realistic expectations of themselves, and maintain good support systems both inside and outside the work area.
The EHS tells employees to participate actively in the change process. Get involved in continuing education to learn new skills. Consider new types of jobs. Stay flexible, and go with the flow. Changes will occur regardless of what we think of them. In a merger, if you are unwilling to change and remain flexible, you may find you are the first to be eliminated.
Above all, keep a sense of humor. This will see you through almost any difficult situation, and provide the ability to think ahead and plan without being completely devastated by the emotional impact of job change. *
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