Thought Leadership Healthquake™: How to Ease the Human Cost of Consolidation by Michael N. Brown


Healthcare consolidation has been increasing for years, affecting doctors, hospitals, patients, and private practices. During the pandemic, the mergers got bigger, changing the balance of power, increasingly turning healthcare into a battle of the giants. There is no sign this will stop anytime soon.

It is an important part of what we call the Healthquake, seismic forces that are shaking healthcare at its foundations.

The two largest EHR companies are merging as Epic buys Cerner, forever changing the balance of power in the control of patient data and hospital workflows. Insurance companies are hiring more doctors to service patients. The lines between personalized clinical medicine and the assembly line are starting to blur. All this comes with a cost.

The cost of consolidation is borne by the people who work in healthcare. The costs are not just about money. In this tight labor market, which is experiencing record-setting staff shortages, consolidators are waving money at people, trying to get them to stay where they are or switch jobs.

But they may be waving the wrong thing because when businesses merge, money isn’t the primary thing on everyone’s mind. Most people are focused on change itself. When consolidators forget this, it can make for a rocky integration. To make things smoother, it’s worth looking at things from the employees’ point of view.

Let’s start with a basic truth.

Most people aren’t comfortable with change. There are over 500 million Google citations around “discomfort with change”, which isn’t a small number.

That’s why it’s no surprise there’s a lot of personal discomfort during a consolidation. It’s because there’s a lot of change.

Many consolidators focus their energy on operational, financial, and technical aspects of a merger, ignoring all that personal discomfort. The goal is to wring out profit and efficiencies, with the expectation that people will fall in line once they are assigned to “cross-functional teams” or trained on new systems.

Unfortunately, it doesn’t usually work out that way. Simply assigning people new roles in new teams, on top of everything else, doesn’t take care of discomfort. It often increases discomfort by introducing even more change. This can result in higher levels of stress, leading to sickness, burnout, and employee turnover.

The problem is amplified today because Covid-19 has magnified stresses, resulting in a growing shortage of healthcare workers, ranging from physicians and nurses to technicians and office personnel. Keeping your employees and keeping them happy has taken on a new urgency.

In our experience, management needs to first understand some of the basic stress triggers in a consolidation and, second, to alleviate these triggers through new management behaviors.

Change can be stressful. It’s common that these three factors can trigger it.

  • Uncertainty
  • Lack of information
  • The feeling of lack of control

During a consolidation, people are unsure about what’s going on. They are afraid for their jobs. They might be anxious that their department will be broken up and their “work family” will be scattered. They can scare themselves.

If they don’t have the information they need to reduce uncertainty, they might feel like they are out of control, that they are now a “victim” of the process of consolidation. With a victim mindset, they are likely to stress themselves more and be less likely to proactively embrace change. The psychology of this process can get complicated.

That’s why it’s critical during a consolidation to stay very close to the employees from the beginning and throughout every step. It’s so easy to leave it for “later” after the “big” operational items get done.

It’s easy to forget that there is no “bigger” thing than the people who interact with each other, with patients, with medical professionals, and everyone else in the organization, every day.

If people aren’t sure what’s happening – if they are uncertain – they can stress themselves. If they don’t feel they have all the information that need to get comfortable, they can stress themselves. Without certainty and information, they can feel like they are out of control – that things are being done “to” them rather than “for” them. Which can trigger more stress.

How can you help them reduce their stress and feel more comfortable about the merger?

When Fellow Health Partners is involved in client consolidations, it focuses on 4 guidelines to help companies through this difficult time. The intent is to help employees reduce stress and find reasons to motivate themselves to deal with the discomfort of change. They are:

1. Assume Nothing

2. Over Communicate

3. Assure and Reassure

4. Be Clear and Consistent

Here’s how this works…

1. Assume Nothing. This is important because in a consolidation, as the dust settles, everyone in both organizations goes back to square one.

In other words, no matter how well things were going for either organization before the merger, it’s now like a brand-new company starting from “scratch”.

Management cannot assume that anyone in their assigned task, at any level, is “fully” competent – unless they have seen that person do the task at least three times – from beginning to end, to their satisfaction, without supervision.

This is true even if the person was “competent” in the task before the merger. That’s because during a merger, employees might change the way they think a task should now be done to accommodate the new structure – without checking with anyone.

Over time, things will slowly return to normal as everyone learns how to migrate their existing skills from their current function (before the M&A) to become competent in the “new” job.
Until then, don’t assume anything.

2. Over Communicate.  Because stress increases with a lack of information, it is essential to triple or quadruple the frequency of communications (this includes meetings) at every level of the organization for the first 90 to 180 days.

This applies especially to meetings informing all staff about how things are working, integrating, not working, not integrating etc.

These meetings, at all levels, need to allow people to voice their concerns, fears, opinions, conclusions, and suggestions in an accepting, safe environment, without fear of judgment and/or punishment.

This feedback is critical because, in times of stress – when people are looking for feedback and they don’t get it – they usually create their own feedback and, human nature being what it is, the feedback is usually negative.

This is not good for the person or the company.

3. Assure and Reassure.  When you communicate, it is very important to help reassure people by creating context for everything that is happening around them.

It’s important to reassure them that even though the current time is stressful and appears unsure, things will work out well in the near future and going forward.

This is particularly important for leaders, managers, and the executive to communicate to the rest of the team.

It is essential that they constantly make these assurances to everyone they interact with – everyday. This means not only formally but informally as well: in the hallways, washrooms, kitchens, cafeterias, parking lots, in and around elevators etc.

These assurances must be made with sincerity and honesty and will go a long way to defuse and reduce everyone’s stress and uncertainty.

4. Clarity and Consistency.  Clarity and consistency are two of the most powerful things managers and leaders bring to any given situation and this remains true with consolidations.

It is critical that all leaders, managers, and the executive are aligned, clear and consistent in their messaging at this time. This helps reduce uncertainty among the rest of the employees.

Leadership must all be saying the same thing, the same way.

At all times, they must be aligned and in support of each other.  This includes never being heard or seen disagreeing with each other in public.

Leaders, managers, and executives can disagree all they want behind closed doors – but in public it must be one message: “We’ll get through this – and we’ll do it together!”
In summary:

When you focus on the people, helping to reduce their stress and discomfort by communicating appropriately, you significantly improve the long-term chances of success in a merger. This requires commitment and follow through.