Merger, Consolidation and Transition for CNOs: Pearls of Wisdom and Learned Hard Knocks"

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1 Merger, Consolidation and Transition for CNOs: Pearls of Wisdom and Learned Hard Knocks" Maureen Schneider PhD, MBA, RN, NEA, BC, CPHQ, FACHE ID Presentation: 303 April 16, 2015

2 Disclosure Today s presenters do not have any relevant financial interests presenting a conflict of interest to disclose. Participants must attend the entire session(s) in order to earn contact hour credit. Continuing Nursing Education credit can be earned by completing the online session evaluation. The American Organization of Nurse Executives is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. AONE is authorized to award 0.5 hour of pre-approved ACHE Qualified Education credit (non-ache) for this program toward advancement, or recertification in the American College of Healthcare Executives. 4/8/2015 2

3 Presentation Objectives Demonstrate an understanding of how to use a merger algorithm and transition checklist for clinical departments which can be utilized during a merger transaction. Identify clinical and administrative policies and procedures critical to the success of the nursing department post-merger. Demonstrate an understanding of how to utilize a post-merger assessment tool in order to evaluate the operational success of merger readiness of leadership and clinical staff. 4/8/2015 3

4 Mergers and Acquisitions In 2014, the health care industry saw $438 billion in mergers and acquisitions worldwide, the most active year for health care deals in the past two decades. The trend to merge and combine health care systems is expected to continue and is creating new challenges for systems to coordinate care, provide better health at a lower cost and create a value-based transformation as a result of the Affordable Care Act. 4/8/2015 4

5 Hospital Mergers and Acquisitions Strategic Direction: Organizational Culture: Governance: Capital Due Diligence: Facilities Due Diligence 4/8/2015 5

6 Schneider s Nursing Merger Transition Checklist The following checklist is designed with the (ideal) timetable of twelve months. Use the boxes to the left of the items to check off tasks as you complete them. 12 MONTHS PRIOR TO MERGER TRANSITION: CNO s meet to discuss transition plans, discuss mission, vision, and organizational structure of both hospitals. Discuss new organizational nursing leadership model (system CNO, decentralized CNO) and structure: reporting process, meetings, and nursing philosophy and shared governance program. Arrange tour of each hospital inclusive of meeting key nursing leadership from each hospital. Discuss and evaluate patient safety processes and practices: ITS and documentation systems, Bar Code-Medication Administration, etc. Each CNO to choose a team of nurse leaders from each hospital to create a system wide policy and practice council. Each CNO to discuss the culture of the nursing organization and discuss the cultural transition with the new system. Each CNO to hold staff and leadership meetings frequently throughout and after the merger with both organizations. Each CNO to be represented on a newly created system wide integration steering committee. Each CNO to review contracts (dialysis, pumps, educational) programs for consideration after merged entity. 4/8/2015 6

7 Schneider s Nursing Merger Transition Checklist 6-9 MONTHS PRIOR: Review nursing systems and divisions for redundancy and explore opportunities for efficiencies. Review and consider opportunities to systematize (centralize) functions: Practice, Patient Satisfaction, Quality, Education, and Informatics). Decide local versus system structures in order to maximize the work of patient care. Review quality metrics, NDNQI, patient satisfaction and begin to set mutual goals. Create a steering committee of key nurse leaders of both organizations for operationalizing transition. Establish every other week meetings with targeted goals to accomplish and to report back to the CNO s. Each CNO to participate in organizational steering committee process. Meet with CMO s to discuss nursephysician processes and programs. Each CNO to review service line structures and nurse involvement along with nurse orientation review. Each CNO to sit on newly established HR system committee and review HR nursing, and staff policies. 4/8/2015 7

8 Schneider s Nursing Merger Transition Checklist 3 Months Prior: Each CNO of hospital to ensure that merger transition goals are on target. Each CNO continues to ensure that hospital work is ongoing. Each CNO educates nursing staff and nurse leaders on the transition process. Each CNO continues the operation and the management of the hospital and the integration. 1 Month Prior to Transition: Each CNO communicates with the nursing staff and nurse leaders the dates and goals of the transition. The established nursing steering council continues work toward integration and meeting target goals for transition. Work with system steering committee to ensure readiness for integration. Communicate to all vendors, schools of nursing, and partnerships about merger transition. 4/8/2015 8

9 Schneider s Nursing Merger Transition Checklist DAY OF TRANSITION: Meet and greet staff and welcome them to new integrated system. Establish frequent meeting with nursing staff and nursing leadership for visibility and communication opportunities. Work after Transition: Establish new structure and begin the journey of a newly established nursing organization! 4/8/2015 9

10 Strategic Direction The time of significant change for health care is NOW and as a result a new vision of acute, post-acute, and the community-based organization needs to develop a vision that expands the scope of service while at the same time finds innovative strategies to innovate, operate and evolve the health care business model. 4/8/

11 Organizational Culture Forward-thinking hospital leaders willing to make changes now face the task of getting buy-in from their organization and are perhaps asking themselves, "How do I carry out this change management!! Evolving hospital organizations into new state of changes involves several phases using a multipronged approach and using strong innovative change management principles. Follow the 4 R s: Reason, Result, Route and Role 4/8/

12 4 R s: Reason, Result, Route and Role Reason: Result: Route: Role: Why do the merger? What will the entity look like in the future? An effective change management guide. How does the change impact the employee? Change management: cannot breed defensiveness or condescending overtones. Hospital leaders must create trust, with Board, physicians and hospital staff. 4/8/

13 Mergers and Acquisitions Healthcare reform deals with overwhelming and complex issues of a new reimbursement structure, population health initiatives, expansion of access, health care quality, and continuity of care that patients with more complicated diseases receive through treatment by network providers. Health care institutions propelled by economic pressure join with larger networks, while others have closed. 4/8/

14 What s Happening in New Jersey Hospital partnerships, great consolidation in industry. 4-5 major healthcare systems Hospital closures and high number of mergers. 10 hospital merged and more in play. Two major healthcare systems to merge For profit mergers occurring- New in NJ 4/8/

15 Merger: Two Magnet Hospitals in New Jersey Community hospital 15 mile distance of Tertiary Medical Center in NJ Definitive Agreement signed 1 Year of strategic and operational planning Utilized Lean and Six Sigma Framework Created committees: committed to consolidation from 2 to 1 campus 3 nursing committees: Magnet-Quality, Education/Research, Staffing 4/8/

16 Outcomes of Merged Hospitals Established upfront that there would be 2 campus but 1 hospital One Leadership team at 2 campuses 2 Magnet Nursing Departments with independent accreditations Nursing Committees completed: policies, procedures, staffing models, nursing framework, educational and research structures, shared resources under 1 System CNO. Change in various Nursing Leadership roles at Community Hospital Operational Efficiencies and Shared Resources for both campuses 4/8/

17 Tools Developed and Utilized for Merger Schneider s Nursing Merger Transition Checklist What activities can be accomplished when in Definitive Agreement Process Planned and coordinated timeframes for Nursing Department Merger Schneider s Post-Merger Assessment Survey Opportunities to evaluate and assess the merger transition 4/8/

18 Schneider s Post-Merger Nursing Assessment Survey Human Resources: Retention of Nurse Leaders Turnover Rates of Nurses Complaints Roles and Responsibilities Leadership interviews Salary and benefit review Rating: Score: Score: Number and type Yes or No Yes or No Yes or No 4/8/

19 Schneider s Post-Merger Nursing Assessment Survey Nursing Leadership: Rating: Yes / No Integration of Policies and Procedures Integration of Mission, Vision, Nursing Philosophy Integration of Nursing Culture Establish Nursing Department Table of Organization Integration of Nursing Council Structure Establish Nursing Administrative Processes (meetings, reports, etc.) 4/8/

20 Schneider s Post-Merger Nursing Assessment Survey Nursing Education: Rating: Yes / No Establish education roles and responsibilities Integration of vendor and school contracts and establish new contracts Establish system-wide educational and orientation programs System-wide Integration: Rating: YES / No Nursing participation in hospital and enterprise operations 4/8/

21 Summary Do it right the first time. Over Communicate to everyone!!! Be involved at all levels!!! Take Risks- You will learn a great deal through the process There will be resistance Work with it!! Keep an Open Mind- Change is Difficult for all involved 4/8/

22 Summary Provide Guidance to Your Leadership and staff Find professional peers who have done mergers before for advice Be helpful with Integration and Merger Support Culture Change Monitor Timelines Accept the Change 4/8/

23 Summary Accept Fear of the Unknown- Major Culture Change Plan the 12 months prior to Integration Utilize Transition Checklist Utilize Post-Transition Assessment Survey: evaluate the change/merger process. Look Ahead to the Future!! 4/8/

24 References Galpin, T., Herndon, M. (2007). The Complete guide to mergers and acquisitions. Ca: Josey Bass. Kotter, J. (1996). Leading change. Boston, Ma: Harvard Business School Press. Suter, E., Oelke, N., Adair, C., & Armitage, G. (2009) Ten key principles for successful health systems integration. Healthcare Quarterly, 13, /8/

25 Speakers Contact Information Thank you Maureen Schneider PhD, MBA, RN, NEA, BC, CPHQ, FACHE 4/8/

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