Improving organisational post-merger patient safety metrics

Summary

The trend towards health system mergers and acquisitions in the US is likely to continue in 2024. Mergers can be beneficial. However, post-merger integration can take years to complete and can have an adverse effect on patient safety, care culture and care quality. Some healthcare researchers have dubbed mergers as 'life events' for health systems.[1] Health system mergers and acquisition projects need to include a special task force to assess the risks to patient safety management practices. 

Content

Hospital systems in the US continue to face financial headwinds. The mergers and acquisitions trend in the US healthcare industry is likely to continue in 2024.  Mergers can be beneficial. A recent study of 204 US health system acquisitions found improvements in net income, charge to cost ratios and some quality measures, compared to a control group.[2] However, post-merger integration can take years to complete and can have an adverse effect on patient safety, care culture and care quality.

A study using Medicare Part A data from 51 hospital acquisition events revealed a 24.5% increase in hospital-acquired adverse events.[3] Another found a modest decline in patient experience post acquisition.[4] While these studies were focused on private equity transactions, mergers are complex projects regardless of how the financing is sourced. Unless special attention is given to the management and curation of daily care practices, a mergers and acquisitions transaction has the potential to cause deterioration in care quality because of changes in protocols, systems and culture imposed on staff.

Nurses and safety staff are vital in maintaining patient safety and care quality outcomes during a merger. Their clinical knowledge and experience are critical and engrained in the social fabric of the organisation’s care processes, care culture and practices. Mergers can destabilise this 'way of doing things' and increase the risk to patients. Not surprisingly, some researchers have dubbed mergers as 'life events' for health systems.[1]

Extra attention is required to maintain quality of care and patient safety when planning for and executing a merger between two health systems. Mergers and acquisition projects need to include a special task force to assess the risks to patient safety management practices. A data-driven assessment of safety data should be on the task force’s list of activities. An assessment and comparison of data can reveal the following:

1. The need to streamline the taxonomy of safety events leading to a simplification and consolidation of safety event management and care quality practices.
2. Identifying similar events recorded by each merging system leading to an improved prioritisation of post-merger safety and quality management practices.
3. An understanding of variation in patient safety event trends across both systems, based on an analysis of the coded event categories and similar event clusters in each system. These analyses, when compared, can inform priorities for the newly merged organisation as part of the post-merger activities.

References

1. de Kam D, van Bochove M, Bal R. Disruptive life event or reflexive instrument? On the regulation of hospital mergers from a quality of care perspective. Journal of Health Management and Organization, 2020; 34(4). doi: 10.1108/JHOM-03-2020-0067.
2. Bruch J D, Gondi S, Song Z. Changes in hospital income, use, and quality associated with private equity acquisition. JAMA Intern Med. 2020; 180(11):1428-1435. doi:10.1001/jamainternmed.2020.3552.
3. Kannan S, Bruch J D,  Song Z. Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition. JAMA, 2023; 330(24):2365-2375. doi: 10.1001/jama.2023.23147.
4. Beaulieu N D, Dafny L S, Landon B E, et al. Changes in Quality of Care after Hospital Mergers and Acquisitions. N Engl J Med, 2020; 382(1):51-59. doi: 10.1056/NEJMsa1901383.

Further reading from Kumar:

• A complex adaptive systems approach to patient safety
• Patient safety culture and quality: The missing link