What’s New in the Patient Safety World

September 2018

Mergers and Patient Safety



In multiple presentations on healthcare policy (outside of our patient safety activities) we have discussed the impact of mergers and acquisitions in healthcare. Having participated directly or indirectly in several mergers, we’ve focused primarily on the financial implications.


The American Hospital Association (AHA 2017) released a report in 2017 (Noether 2017) touting that:


Call us skeptics. While every merger promises the community incredible financial benefit, few deliver on those promises. Theoretically, mergers should produce much savings by eliminating duplication. But, in reality, such mergers usually result in putting negotiating clout in one system and eventually rising healthcare costs for the community.


A number of years ago we participated in a panel discussion with Alan Sager, Ph.D., from Boston University School of Public Health, who had done extensive research on the community impact of hospital closures. His research showed that hospital closings have repeatedly failed to cut costs, and can even result in increased costs. Moreover, hospital closings have harmed access to care—particularly in underserved areas and communities of color (Sager 2006).


But until now there has been little attention to the patient safety repercussions of hospital mergers. Haas and colleagues (Haas 2018) recently published a Viewpoint in JAMA, highlighting several key challenges and barriers that may interfere with clinical care following mergers.


The authors identified 3 key risks to patient care resulting from mergers:


Post-merger, patients may be cared for by clinicians and staff who have little existing knowledge about them. Changes in supplies, equipment, formularies, protocols, and information systems also lead to unfamiliarity that may adversely impact patient care. And physicians, especially specialists, may now be required to travel to new settings where they may be unfamiliar with infrastructure, processes, teams, and clinical cultures that may differ significantly from one organization to the other(s).


Importantly, in collaboration with their Ariadne Labs, they make available for free a guide and patient safety toolkit to help with clinical planning between institutions prior to mergers. It also includes a checklist for developing a joint clinical integration council.


Mergers are not easy on clinicians and healthcare staff and ultimately may jeopardize patient safety. These resources are extremely valuable for any organizations considering merger and need to be tapped very early in any discussions about merger.







AHA (American Hospital Association). New Research Finds Hospital Mergers Drive High-Value, High-Performing Health Care. AHA Press Release 2017; January 25, 2017




Noether M, May S. Hospital Merger Benefits: Views from Hospital Leaders and Econometric Analysis. Charles River Associates 2017; January 2017




Sager A, Socolar D. Closing Hospitals in New York State Won’t Save Money But Will Harm Access to Health Care. A Short Report Prepared for The Committee of Interns and Residents New York City. 20 November 2006




Haas S, Gawande A, Reynolds ME. The Risks to Patient Safety From Health System Expansions. JAMA 2018; 319(17): 1765-1766




Ariadne Labs. Patient safety toolkit for system expansion.






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