Healthcare mergers and acquisitions (M&A) have garnered significant attention as many in the industry anticipate increased consolidation. Health services M&As have faced various levels of success and are usually tied to broader economic trends facing these institutions.
While deal value increased slightly in 2024 to reach $69 billion—up from $63 billion in 2023—this is down significantly from 2021's high of $197 billion. This fluctuation likely reflects the impact of some key issues facing hospitals and health systems, such as regulatory challenges, cost pressures and shifts in care practices and patient preferences.
For hospital systems, these transactions offer the promise of expanded service offerings, greater efficiency and financial sustainability. But beneath the surface, there’s an often-unseen challenge that threatens success: cultural misalignment. Between 70% and 90% of mergers fail, often due to poor cultural integration. In an industry where nurses make up nearly 30% of the workforce and are at the front lines of patient care, overlooking their role in M&A can lead to low morale, increased turnover, and disruptions to care delivery. All of these things combined will erode any financial gains an acquisition was meant to achieve.
For health systems to ensure M&A success, they must redefine their approach and place nurse engagement and cultural due diligence at the heart of integration efforts.
The true costs of cultural misalignment
The consequences of neglecting cultural integration are far-reaching and directly impact patient care and financial stability. Nursing turnover costs the U.S. healthcare system $9 billion annually. Post-merger instability can act as a catalyst for burnout and exacerbate already high attrition rates, and the sometimes-ambiguous future that can be brought through M&A activity often intensifies job dissatisfaction. Imagine the uncertainty, the shifting workflows and the leadership changes that frontline nurses face while already dealing with high acuity and patient volumes. Additionally, large, complex mergers can take up to 18 months to stabilize, but a lack of communication and leadership alignment can extend that process indefinitely.
Despite these clear risks, too often the marker of a successful merger remains laser-focused on financials and leaves frontline workers as an afterthought. This creates a critical gap between strategic planning and the reality experienced by those delivering patient care.
Nurses as the linchpin of successful integration
To bridge that gap, healthcare organizations should look at nurses as strategic partners. It’s like trying to merge two families without understanding their unique traditions and habits. That's essentially what happens when healthcare organizations minimize the integration of different workplace cultures and workflows.
During the due diligence phase, health systems should evaluate the workforce and organizational functionality of the nursing practices in both institutions. Identifying any major differences in patient care practices, decision-making structures, workflow technology synergies and team dynamics allows leadership to anticipate and address potential friction points before they escalate.
Leadership realignment is inevitable in mergers, but it doesn't have to destabilize nursing teams to the point of interrupting patient care. Equip leaders with training on change management and cross-team collaboration, and they'll become the steady hands guiding the organization through uncertainty. But it’s important to remember that even the most well-prepared leaders cannot succeed without effective communication.
We know that up to 90% of change initiatives fail and much of that can likely be tied back to poor communication. Organizations must create two-way channels where nurses can voice concerns and actively contribute to integration decisions. Hearing from a third of your workforce is not only a savvy business move, but it allows leadership to understand how a merger may impact every shift, every unit and every patient. To counteract the anxiety that may arrive from such changes, healthcare organizations should prioritize retention by offering financial incentives and development opportunities to show nurses they are valued and secure within the new organization.
And finally, let's empower nurses as cultural ambassadors. They are the vital link between administration and patient care. Identifying and training internal nurse champions to act as liaisons between merging entities helps maintain continuity and best practices. It is important to have ambassadors who are located across the different system sites while forming a central governing body. They can relay information to and from leadership and can help unify the workforce into a collective “we.” These nurse champions can help ensure that the best aspects of each organization's culture are preserved and celebrated in the new, unified entity.
The real measure of M&A success
While M&A deals are often judged by financial metrics, true success lies in the lasting impact on patient outcomes, staff engagement and organizational stability. Mergers that strategically focus on cultural integration—particularly by empowering nursing teams—are more likely to achieve sustained success.
Bethany Robertson is a clinical executive at Wolters Kluwer Health, Learning, Research and Practice, as well as a professor at Emory University's Nell Hodgson Woodruff School of Nursing.