Joint leadership: the key to successful hospital mergers

[PRESS RELEASE 2011-03-02] The merger of Karolinska Hospital in Solna with Huddinge University Hospital is examined in detail in a doctoral thesis that has recently been presented at Karolinska Institutet´s Medical Management Centre. This in-depth international study into the formation of Karolinska University Hospital reveals many different challenges and success factors that had not previously been identified. Despite hospital mergers being a high-risk strategy that is prone to failure, joint leadership proved to be the key to success in creating a single, merged clinic.

"The clinic manager and the deputy manager agreed to work in tandem as an operational team," says Soki Choi, a newly qualified medicine doctor with a Masters degree from Stockholm School of Economics. "They came from two different hospitals; one had built up contacts and confidence in Huddinge, the other in Solna. Once the two clinics had been integrated, the deputy manager was able to withdraw."

However, Dr Choi discovered that it was not simply this shared responsibility for official management that facilitated the difficult process of merging two knowledge-intensive organisations. It turned out that the relatively successful clinic also had an unofficial strategic leader who, working in association with the operational managers, succeeded in avoiding the common pitfalls of a hospital merger. Working together, the management team acted as a critical link between the management logic of the hospital management on the one hand and the professional logic of the clinical staff on the other, as represented by the academic manager.

"The results show that it was not the anticipated tension between the contrasting cultures and traditions of the two hospitals that caused the biggest problems," explains Dr Choi. "Instead, it was the conflict and the distance between the hospital management and the healthcare staff that proved to be most problematic."

The thesis points out that the horizontal culture clash at the heart of traditional merger research did not turn out to be the main stumbling block in the process. In actual fact, it was the vertical logic clash between managerialism and professionalism that emerged as the principal driving force behind merger processes within the healthcare system.

"I would advise those responsible for creating Skåne University Hospital not to apply conventional management models uncritically: they should adapt these models to the special context of publicly financed healthcare," she continues. "Different rules apply here, and there are intense conflicts of interest between those involved."

Dr Choi believes that joint leadership is one possible solution for dealing more effectively with competing logics, and that it is time to stop putting our faith in a single leader who must continuously negotiate his/her role and identity as either someone who seeks cost-effectiveness for the hospital or a defender of care ethics and patient safety. Research has also shown that this kind of negotiation can involve high emotional and professional costs for a single manager - costs that can be devastating in the long run.

"Creating mutual respect and a healthy interaction between the logics of managerialism and professionalism, which currently compete within healthcare institutions, is essential if we are to heal the healthcare system," she concludes.

Doctoral thesis:

Competing logics in hospital mergers - the case of the Karolinska University Hospital, Soki Choi, Department of Learning, Informatics, Management and Ethics, Medical Management Centre. The supervisor was Professor Mats Brommels, and financial backing was partly provided by Stockholm County Council. The thesis was successfully defended on 18 February 2011.

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