Merger of Walter Reed and Navy National Medical Center provides blueprint for success

By David Ferguson

The merger of the nation's two leading military hospitals--Walter Reed Army Medical Center (WRAMC) and the Bethesda Navy National Medical Center (NNMC)--under the Base Realignment and Closure Act (BRAC) of 2005 was more than just a joining of two medical institutions, it was a melding of two historical rivals. 

But its success can ultimately serve as a blueprint for future challenging mergers and other institutional transformations, according to a blog post for Health Affairs.

The daunting task of combining two clashing and competing cultures successfully was accomplished by laying out a three-point plan authored years before the merger by Harvard professor John Kotter, writes blog post author Col. (Ret.) Chuck Callahan, who served as the chief medical officer at WRAMC. The plan, he says, called for three actions: 

1. Establish a sense of urgency.  All the parties involved must understand that the only choices are to change or to not survive. Stakeholders, according to Kotter's philosophy, must be "driven out of their comfort zones," which means shaking up the chain of command. 

At the outset, the WRAMC and NNMC merger's only sense of urgency came from a 2011 deadline, which in 2005, when the realignment began, was not sufficient. Finally, two years into the process, a senior military commander was appointed to run a "Joint Task Force" to move the project forward. 

2. Form a powerful guiding coalition. This aspect of the hospital integration proceeded in fits and starts. Frequent command turnover and staff rotations are a significant part of military culture, however this wreaked havoc on the effort to combine two historic institutions with distinct command philosophies and problem-solving techniques, Callahan writes. As a result, they hired civilian consultants to help the Army and Navy leadership communicate and smooth out the wrinkles in their clashing leadership styles. 

3. Establish the brand. The name of the new hospital was an early bone of contention. Both Walter Reed and Bethesda were known as the top hospitals in their fields throughout the military and civilian worlds. After much wrangling, the names of the two institutions were combined into the Walter Reed National Military Medical Center. 

Despite its early failures to align to Kotter's blueprint for successful transformation, Callahan writes that the two hospitals' personnel found their sense of urgency and worked together to integrate these institutions. Today, he says, the organization serves as the largest tertiary care referral center in the Department of Defense. 

To learn more:
-- read the Health Affairs blog post

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