A Health System Built in Reverse: Inside Merrimack Health's Rapid Integration

CEO Diana Richardson shares how the organization is integrating systems, infrastructure, and culture on the fly while stabilizing community hospitals long overdue for investment.

When the collapse of Steward Health Care threatened the future of two Massachusetts-based community hospitals in need of a lifeline, Merrimack Health didn’t have the luxury of years-long planning typical of health system integrations. Instead, the organization formed in crisis.

Now, president and CEO Diana Richardson is leading one of the most accelerated health system integrations imaginable, folding disparate electronic medical records, medical staffs, payroll systems, leadership structures, and even crumbling physical infrastructure into one cohesive organization.

The work is fast, high-stakes, and unusually backward, but Richardson says the urgency is the point.

“We stepped into the situation in the midst of a crisis to really make sure that [the hospitals] didn’t collapse,” she told HealthLeaders.

After Steward filed for Chapter 11 bankruptcy in May 2024, the futures of Holy Family Hospital-Methuen and Holy Family Hospital-Haverhill were thrown in flux. Lawrence General Hospital stepped forward and, with the state’s help, took control of the two hospitals in October 2024.

Richardson, who had previously helped lead the state’s incident response to the Steward fallout as a senior transition liaison with the Massachusetts Department of Public Health, already understood the fragility of the situation when she was appointed interim CEO of Lawrence General this past April. But familiarity didn’t make the task any less daunting. The health system was born before the components were aligned, resulting in what Richardson calls an integration process done in reverse.

The transition also came with a new identity. In September, the organization rebranded as Merrimack Health to reflect its roots in the Merrimack Valley, and in October, Richardson shifted from interim to permanent CEO to continue guiding the health system in its next phase.

Integrating After Go-Live

What makes Merrimack Health’s story uncommon is not just the scale of the integration, but the order in which it had to happen.

“Approaching integration for the last year has been thinking quickly and efficiently, and then implementing that work after the integration or after the system had actually formed,” Richardson said. “A little bit unusual to what most [organizations] go through.”

When the system launched, every major operational and clinical platform still existed independently.

“All the systems were still separate, ranging from a payroll system to an electronic medical record, to names on the buildings, to our medical staff,” Richardson said.

What followed was an expedited push to knit those functions together in real time.

One of the biggest milestones came just months into the system’s existence: “We integrated our electronic medical record, which was aggressive and scary,” Richardson said. “But now we actually have a consolidated record for patients.”

Unifying the medical staff was equally critical to ensuring consistent care across the system.

The next major step is modernizing and consolidating on the administrative front, with payroll and HR systems set to go live in January, Richardson noted.

Pictured: Diana Richardson, president and CEO, Merrimack Health.

To integrate this quickly, across multiple hospitals and legacy systems, required what Richardson describes as both discipline and improvisation. The goal, she stated, was always to serve the community by stabilizing the hospitals and building reliable long-term structures.

“We have taken a very systematic approach to thinking through integration, always starting with, 'What do the patients in the community need? What does our team need to do that work? And how do we do that in a fiscally responsible way to make sure that this source to the community is here for a long time,'” Richardson said.

While integration alone is a massive undertaking, Richardson said the organization has simultaneously faced a second challenge of repairing the physical state of the former Steward facilities.

“We’ve had to do a lot of work like placing roofs and placing HVAC systems and fixing old piping and wiring, making sure that we have an electrical backbone for equipment,” she said.

Ordinarily, a newly formed health system would spend years unifying strategy before tackling capital projects. Merrimack did everything at once.

A Fast Path Toward Unity

Despite the complexity, Richardson said the organization has moved faster than anyone expected. Much of that momentum stems from the shared culture she found across the hospitals, which helped integration at the human level.

“Whether you are from the former Lawrence General Hospital or from the legacy Holy Family hospitals, the culture is completely focused on providing care for the community,” Richardson said. “People are neighbors. People often worked together before.”

Many staff who left Holy Family during Steward’s instability later took jobs at Lawrence General, creating bridges across the new system. “There’s just much more awareness, knowledge of each other, and comfort with the teams than you might think,” Richardson said.

That social cohesion made it easier to implement rapid operational changes.

Though internal alignment has progressed quickly, Richardson admitted that a major part of integration has been external as Merrimack Health works to restore trust in the quality and stability of the former Steward hospitals.

“The trust that we have to work on is the trust in the community, that in fact the care that they're receiving at Holy Family now is the highest quality, the safest care, the facilities are up to par, that there aren't equipment shortages and supply shortages and some of the things people heard about in the news,” Richardson said.

The rebrand has been integral to recapturing that trust, with Richardson highlighting that the health system is conveying to its community that it has one medical record, one medical staff, one set of bylaws, necessary equipment, and fixed infrastructure.

Richardon’s work is far from finished, but with the foundational pieces now in place, Merrimack Health can begin to shift its focus from standing up a system to shaping one that will support its community for years to come.