Hospital mergers and acquisitions continue to reshape the healthcare landscape. In the second quarter of 2023, 20 hospital M&A deals, generating $13.3 billion, were announced, according to a report by Kaufman Hall. 

Most often, hospital mergers are intended to optimize organizational capabilities, expand access to value-based care, and improve financial stability through consolidation. While these transactions can offer numerous benefits to the health systems and communities involved, research has found that patient experience and quality of care can decline during the integration process. 

To achieve the best outcomes, hospital leaders must intentionally focus attention on patient experience and quality care indicators while navigating integration.

Patient Experience Scores Tend to Drop After M&As

Although hospitals undergoing mergers often tout the prospect of improved clinical care to patients, providers, and concerned community members, an analysis by Deloitte's Center for Health Solutions and the Healthcare Financial Management Association (HFMA) found that patient satisfaction scores at previously high-achieving hospitals declined after acquisition and did not rebound until two years post-transaction. 

A 2020 New England Journal of Medicine article that examined changes in care quality after hospital mergers and acquisitions also found that acquisition by another hospital or health system was associated with “modestly worse patient experiences.”

That’s problematic because patient satisfaction has been linked to better clinical outcomes, patient loyalty, and fewer medical malpractice suits. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores also factor into reimbursement rates. 

It’s easy to see why patient experience ratings may decline when two (or more) hospitals merge. Patients may meet new providers. Providers may struggle to navigate new spaces, processes, and technology. Policies and practices may change as leaders figure out how to best combine cultures and meet the needs of diverse patient populations. 

Risks to Patient Safety During M&A

Research has found that hospital consolidation can also pose risks to patient safety and quality of care, particularly in the short-term. A 2022 JAMA Network Open article notes that evidence to date “suggests an overall negative effect of mergers on quality,” with most studies showing increased overall mortality. 

Patient safety experts have identified a few common risks to patient safety from health system expansion:

• New patient populations. Clinicians who are unfamiliar with the needs of new populations may miss clinical signs of patient deterioration. Hospitals admitting new patient populations also may not yet have the appropriate equipment and medications to effectively (and safely) manage certain patient populations.

• Unfamiliar infrastructure. When discharge processes or medication order systems change, mistakes can be made. Similarly, it’s also more difficult for staff to safely use unfamiliar equipment and technology. (Think IV pumps, external defibrillators, and electronic medical records systems.)

• New, unfamiliar settings for healthcare providers. When hospitals combine, physicians and other clinicians may not know the quickest way to the emergency room, intensive care unit, or operating theater. Delays increase risk to patients.

We’ve also noticed another risk to patient safety during mergers and acquisitions: A decreased emphasis on patient safety and quality care as hospital leaders focus on the logistics of hospital integration. 

Mergers typically involve rebranding or changing products, and as part of that process, we’ve seen hospitals turn off their electronic hand hygiene systems as they change hand sanitizer dispensers. That’s a risky move, as research has shown that clinicians’ hand hygiene performance tends to decline when it is no longer monitored. Decreased hand hygiene increases patients’ risk of healthcare-acquired infections. 

Successful M&As Require Focus on Quality Care

Declines in care quality and patient satisfaction scores are not inevitable after mergers and acquisitions. Intentionally prioritizing patient experience and quality care before, during, and after integration can lead to improved clinical outcomes.

When NYU Langone Health, an urban academic medical system, merged with Lutheran Medical Center, a 450-bed teaching hospital that served many low-income individuals, hospital leaders agreed to full clinical and operational integration, with an emphasis on quality care. 

By the end of the three-year integration period, unadjusted mortality declined from a mean of 2.5% to 1.9%. Unadjusted readmission rates declined from an average of 9.5% to 7.2%, and there were significantly fewer central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (UTIs). Patient satisfaction also increased. 

To protect patient safety and satisfaction during a merger or acquisition, prioritize quality care, including hand hygiene and clinician-patient relationships. The SwipeSense platform can help you achieve organizational efficiency and safeguard patient health.