| A critical gap in the literature is the lack of detailed knowledge about the experience of hospitals undergoing the process of collaboration. A primary purpose of this study is to close this gap by gaining a deeper understanding of a hospital's experience living through such a change---i.e., perceptions about key issues, concerns, and performance differences during implementation. Two primary research questions were explored: (1) How do health care organizations undergoing collaboration manage the change process? (2) What are the key success factors for collaboration?; Employing a linear-analytic case study methodology (Yin 1994), this research compared the processes of two very different collaborative efforts: the merger of the Beth Israel Hospital and the New England Deaconess Medical Centers into the Beth Israel Deaconess Medical Center (BIDMC) and the alliance of the Brigham and Women's Hospital and the Massachusetts General Hospital into Partners HealthCare System (PHCS). Although both collaborations became successful, the BIDMC collaboration was labeled "cumbersome and inefficient" (Garvin and Roberto 2003). In 2000, four years after the merger, despite a staff of 1200 physicians, annual revenues over one billion, and a very strong reputation for quality, the merged BIDMC hospital was losing up to {dollar}50 million a year and very close to disintegrating. In contrast, PHCS continually experienced positive financial results and maintained (or grew) the organizations' human capital.; The key explanatory factors associated with smoother implementation include: balance of power, stable leadership, and respect for cultural differences. An appropriate pace of development appears to have been allowed as the individuals at BWH and MGH were allowed to create new relationships in an evolutionary manner. At times the pace seemed too slow to some of them, but in hindsight they reported it was paced well to allow for the growth and the strengthening of relationships. According to the informants, PHCS appeared to have placed a strong focus on the people side (i.e., human capital) of the collaboration, establishing partnerships, informal relationships and stronger communication links. |
