Researchers urge newly merged health systems to address patient risks, share data on quality and safety, and clearly define care oversight responsibility for the joint patient population.
Healthcare mergers and acquisitions could adversely effect patient safety as clinicians deal with changes in their practice setting, patient mix, and infrastructure, a JAMA study has found.
Researchers at Harvard University analyzed the patient safety risks for Harvard-affiliated institutions by speaking with clinicians and health system leaders. Their interviews uncovered three oft-unrecognized areas of "significant safety risks" that are linked to changes in patient populations, infrastructure, or clinician practice settings.
"Teams with little expertise in patient safety are typically responsible for implementing health care mergers, acquisitions, and affiliations," the study said. "Their primary impetus is often financial rather than clinical, and when the impetus is clinical, the concerns usually involve patient access and services rather than the way care is practiced in the affected institutions."
Because of that emphasis, the responsibilities for quality and safety are often unclear.
"As a result, risks to patients arise at the 'sharp end' of care, where clinicians are asked to practice in new settings, with new populations, or with new infrastructure, without sufficient planning," the study said.
New patient populations
After a merger, acquisition or expansion, health systems may experience changes in volume and demographics with patient populations.
While hospitals do a good job anticipating the needs of these new patient demographics or clinical services at the unit level, they may lag in ensuring that staff throughout the hospital are able to interact with these new patients.
"An increase in referrals may bring an influx of non–English-speaking patients, for instance, who require more interpreters, institutional relationships with different community services, and increased awareness of economic and social challenges these patients face in following care guidelines," the report said.
That lack of wider institutional attention to specialized needs can result in serious deficiencies in provision of safe, timely care, the report said.
Unfamiliar infrastructure
The researchers note that health system expansions and mergers often come with significant changes in supplies, equipment, formularies, protocols and electronic information systems, all of which can create a significant learning curve for clinicians.
"The attention clinicians must now give to once 'automatic' tasks also distracts from other aspects of patient care or slows throughput," the study said. "Unless schedules and capacity are adjusted, such shifts in time and focus not only may result in dissatisfied patients but also in increased likelihood of major errors."
New clinical settings for physicians
A survey of 82 healthcare institutions that have undergone expansions found that 87% require physicians, especially specialists, to travel to new practice sites.
"When clinicians travel, they often receive little systematic orientation to their new setting, leaving them to practice with infrastructure, processes, teams, and a clinical culture that can vary in significant and unexpected ways from those at their home institutions," the study said.
“In the absence of guidance, physicians indicated that they have adapted to these new circumstances through trial and error, which can put patients at risk."
The study offers some risk mitigation strategies, such as: providing "hands-on orientation" for new physicians about institution-specific emergency resources; and identifying all hospital units that may care for new patient populations but are not in the direct care path.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.