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Health Progress, May/Jun 2001 by Levin, Ira M, Proctor, Deborah, Thibault, Thomas

The Bringing Together of Two Catholic Health Care Cultures Was a Complex Effort

In late 1998 the sponsors and executive leaders of the Sisters of St. Joseph Health System (SSJHS), Ann Arbor, MI, and the Daughters of Charity National Health System (DCNHS), St. Louis, decided to form a single organization, which they would cosponsor. To do this successfully, they realized, they would have to bring together two well-established cultures.

They knew this would not be easy. The 1990s had seen an increasing number of mergers, joint operating agreements, and other forms of strategic affiliation among U.S. organizations, including a number involved in the Catholic health ministry. Many of these efforts had failed, however, and even the survivors had tended to produce results that disappointed their managers and stockholders.1 The culprit most often identified was a clash between "organizational cultures."2

An organization's culture is usually understood to be the shared assumptions, beliefs, and values that guide its members' perceptions, judgments, and actions. Culture is formed over time as the result of the embedding of its founders' personal beliefs and values and of successful actions taken in response to various challenges.3 In fact, successful actions tend to confirm and strengthen the founders' beliefs and values. That is why culture is so difficult to change-it is the product of success, not failure.

SSJHS and DCNHS both had long histories of success. Their leaders therefore faced the cosponsorship project with great care and guarded optimism.

THE COSPONSORSHIP APPROACH

Once the leaders had decided to explore cosponsorship as an affiliation model, they appointed a Steering Committee to guide and manage the process. The committee was composed of four members of SSJHS's sponsoring congregation, one member from each of the four provinces of DCNHS's sponsoring congregation, and the two system CEOs. The committee hired a facilitator to help manage its working process.

The committee broke down the cosponsorship planning approach into three phases:

* Phase I: Exploring the concept of cosponsorship and establishing the shared sponsorship foundations

* Phase IT.- Carrying out the due diligence by identifying successful practices from both health systems

* Phase Ill. Facilitating the transition and integration process associated with bringing the two organizations together

From the start, the committee's members paid particular attention to culture-related issues. They understood that in everything they did-the early choices they made, their style of deliberations, the way they conducted their work, and the way they communicated the results of that work to their respective organizations-they would be modeling the kind of culture they hoped to create in the new health system. They therefore designed the sequence of the three phases to ensure that foundational sponsorship concepts and elements would be agreed to first, thus serving as the basis for subsequent organizational decisions, design, and integration work.

As they began their work, the committee members expected to confront a variety of sensitive and difficult issues commonly associated with mergers: a general sense of loss, fear about how influence and control were to be exercised, and unease concerning which aspects of the former organizations were to be preserved in-or abandoned by-the new system. The committee agreed to work through such issues, no matter how emotional, as they emerged.

The committee also agreed to follow three key principles in its work. These principles, which formed early norms for working together and helped establish some of the formative beliefs of the new culture, were:

* Coming together as partners to create a new organization, rather than allowing one organization to subsume or dominate the other

* Deliberately exploring differences in perspective or opinion as they emerged, in order to work toward mutual understanding and building of common goals

* Building support and commitment across both organizations, through broad and balanced participation in the design and integration processes

PHASE I

VALUES TASK FORCE

In this phase, the Steering Committee focused on building a shared sense of their foundational thinking and developed mission and vision statements for the new system. Once that was done, it formed a Values Task Force, composed of executives and managers from both SSJHS and DCNHS, whose job was to articulate the values of the new organization.

Task force members solicited input from a broad cross-section of executives, managers, physicians, and staff regarding what they believed should be the new system's core values. Once a particular core value was identified, respondents were asked to describe work-related behaviors that modeled it. The task force then wrote up a description of these values, which was refined further through additional dialogue sessions conducted with associates from each system. The task force then submitted this final statement of values to the Steering Committee for its approval.