According to Modern Healthcare, “Hospital megamergers continue to drive near-historic M&A activity,” the actual number of hospital mergers and acquisitions have been similar to 2018 and the numbers seem to be pretty consistent from when the merger and acquisitions “trend” hit in 2010. What is different according to the article is the amount of revenue that is part of the process. The money involved was “nearly four times higher in the second quarter of 2019 compared with the prior-year period.” No longer content with serving a specific locale (city, county, etc.) hospital systems are expanding to larger regions and into different states to diversify and expand market share.
What this article doesn’t talk about is everything that happens once these hospitals are acquired and merge. Everything from HR, GME, billing, etc. gets assimilated to the buying entity’s system. As librarians we see this every time our hospitals merge, doctors, nurses, and some administrators assume that they automatically have access to the library resources “now that we are part of your hospital.” That is not the case. Like many other librarians, I am forever explaining that our license agreements only extend to the current facilities and do not automatically allow for newly acquired institutions to be added. If the newly acquired institution wants to be added to the licenses, they must agree to pay the costs of the library resources. This blows their minds. I don’t know why, because that is same deal with EMR systems. You just don’t get EPIC for free now that your hospital was bought by a hospital using EPIC.
Nursing, Pharmacy, IT have programs and resources that they license for the institution to be used by their people. Why is it that they seem to get those added to the new institutions faster than library resources when some of resources are drug databases and nursing information tools and are often sold by the same companies that sell to libraries? It was only a few weeks ago when I was once again reciting my license speech when it hit me. Every hospital (buyer and acquired) has a CNO, Chief Pharmacy Officer, CTO, etc. Yet, due to an increase in layoffs and “retires but no rehires” (see Hospital Library Association benchmarking survey) there are very few “Chief Librarians” or any librarians at many of the hospitals. So while the two CNO’s work together to discuss address issues, costs, etc. of their two hospitals merging, the librarian rarely has a peer at the other hospital to do the same thing. Not only that, but there is no hierarchy for the librarian of the buying hospital to consult at the acquired hospital to address the issues, costs etc. of merging. Because there is no librarian, there is nobody supervising the librarian, buying/budgeting library resources, licensing them, etc. It is basically a black hole.
Can you think of this happening within any other hospital department? I’m trying… help me out.
Without my counter part at the other hospital to discuss the merger and to discuss the costs, logistics, onboarding, etc. with their boss, I am left to talk to the wall. Nobody in the newly acquired hospital knows how to handle it and plays hot potato passing along the “library stuff” to the next administrator who also doesn’t know…. all before I drop the cost bomb. So, I am left giving my license speech to doctors and nurses explaining why I can’t give them access. I become the big bad librarian, alienating potential customers.
If a tree falls in the woods and nobody is there, did it make a sound? If a hospital librarian asks about resources and services and nobody is there, do we even exist? How can hospital librarians navigate this situation? Where do you find the support for resources in a hospital system that never supported it and doesn’t have the infrastructure to create it?