1. “Overcoming the Obstacles to a Successful Practice Merger”
A. Desirable results of merging medical practices?
Not specific to the formation of a single specialty or multi-specialty group:
• Enhanced control of personal and professional destiny,
• Opportunity for future income stabilization and growth,
• Cost advantage of using technology for improved patient care and
management,
• Establishment of viable exit strategy for retirement,
• Survival of practice over the long term,
• Continuity of patient care upon departure of physicians,
• Stronger presence in the marketplace for patients,
• Protection of referral sources,
• Opportunity to develop young physicians for future leadership roles,
• Ability to create operational efficiencies from improved facilities,
• Stronger capacity for engaging talented support staff,
• Improved ability to compete in an environment of cost sensitivity, and
• Improved practice financial performance.
B. Key Obstacles to overcome if a Successful Merger is to be completed.
A) Strategic Imperative
B) Operational Economies
C) Financial Viability
D) Governance Guidance
E) Culture Integration
C. Five Key Strategies for Strengthening the Merger Result
1. Early and significant commitment of practice leadership.
2. Adopt early integration due diligence and planning activities.
3. Select integration leaders, manager and teams early in the process.
4. Develop successful cultural alignment and integration strategies.
5. Attend to human dimensions.
D. Ten Merger “Best Practices” for Completing a Successful Practice
Merger
1. Develop Overall Strategy and Goals.

2. The idea here is to create an environment that allows the potential
partners to develop, often through “difficult dialogue”, a mutually generated
imperative for completing a practice merger. In essence, the rational for the
merger is determined resulting in mutual agreement that the merger alignment
and integration should move forward.
2. Mutually appoint an Accountable Integration Manager.
►Many process obstacles may occur and need to be overcome,
including:
• Participants are not sure how to work their way through multiple
issues and options,
• Professional advisers (attorney and accountant) for the
respective groups may be too busy or conflicted to help the
parties reach the level of compromise needed to form a new
group,
• Limited ability to resolve sensitive issues that both parties feel
strongly about, and
• Neither party has someone with the time and knowledge to
coordinate and facilitate the merger process.
►Answer is to jointly appoint a Merger Facilitator mutually acceptable to
each group with responsibility to function in the following roles:
• Serve as an objective and impartial third party who can
represent the interests and concerns of the newly merger group
and can assist the merging parties reach reasonable solutions
to conflicting interests.
• Serve as a merger process, communication and coordination
guide,
• Serve as a technical adviser relative to possible solutions to key
issues that need to be resolved,
• Act as a facilitator to keep the merger process on track
3. Conduct thorough Strategic, Operational, Financial & Governance
Due Diligence analysis of both practices.
Opportunity for the interested merging practices to see if each party is a
potential partner via identifying possible areas of compatibility, incompatibility,
and synergy.
►Strategic
►Operational
►Financial
►Governance
4. Conduct a Cultural Due Diligence Analysis of both practices.
Examples of seven characteristics of organizational culture that may be changed:

3. • Individual autonomy – degree of responsibility, independence and
opportunity for exercising institutive.
• Structure – rules, bureaucracy and direct supervision used to oversee and
control employee behavior.
• Support – degree of assistance provided by managers to their
subordinates.
• Identification – degree to which members identify with the organization as
a whole rather than with their particular work group or field of professional
expertise.
• Performance reward – degree to which reward allocations are based on
employee performance criteria.
• Conflict tolerance - degree of conflict present in relationships between
peers and work groups as well as the willingness to be honest and open
about differences.
• Risk tolerance - degree to which employees are encouraged to be
aggressive, innovative and risk seeking.
5. Agree to organizational design, structure, and governance early
on.
The new leadership team and key organizational issues of practice
design, structure and governance should be agreed to as early in the merger
process as possible.
6. Create a Cultural Alignment and Integration Plan
The Cultural Alignment and Integration Plan is intended to bring the
culture of the merging practices together to define “how we do things” in the new
practice. The key objective is to develop and gain support and commitment to
the new practices vision, mission and values. Alignment of the physicians,
physician leaders, administrators and support staff with the practice business
plan produces the maximum impact and permanence.
7. Create a One-Year Post-Close Position Statement complete with
Success Metrics.
• Establish 100-day bottom-line goals and focus new practice
attention on achieving these desired results,
• Develop a one-year post-merge vision,
• Develop a comprehensive “key performance indicator” roadmap,
• Establish specific success goals (strategic and financial) and track
progress against goals
8. Use integration teams with members from both practices.
Use integration teams with members from both practices as a bridge to
get from the planning stage to actually going operational. Conduct a launch

4. meeting to clarify team charter. Consider the integration team as a lever to
share cultural intelligence between the two practices.
9. Develop integration work plan complete with time lines, tasks and
responsible person(s) for tracking progress toward completion.
Success mergers require detailed action plans, financial measures,
financial tracking and reporting, clear decision-making, and coordination across
practice functional areas continuing on after the new merged practice goes
operational.
Once the merger has been completed, the focus should then shift to
tracking the strategic, operational, human resource, and practice value creation
objectives.
Celebrate successes throughout the alignment and integration process.
10. Develop a strategic employee and marketplace
communication strategy.
1. Increase the clarity
2. Diminish the uncertainty
3. Enhance the benefit
4. Diminish the effort.