The word 'merger' has now become a widely used term in healthcare and is referred to hospitals, departments, services, complex structures and also Local Health Units (LHUs). The term immediately evokes the ideas of rationalization of expenditure and efficient use of resources. The merging processes of healthcare companies, documented in the literature, started in the 1990s in the United States and the United Kingdom. Other countries, such as those in Northern Europe, Germany, the Netherlands and Canada, are proceeding in the same direction, what has been defined as a mania for unification or 'merger mania'. The Italian scenario is not dissimilar from the other countries. A reduction of 42% of LHU 33% of Local Districts and 30% of Hospitals have been reported from 2007 to 2017.
As part of these changes in the work environment, it becomes necessary to implement an assessment of the perceived organizational climate and of the job satisfaction of the workers. As well known, a suitable organizational climate leads to innovation and inspiration in the organization and has a positive role in reaching organizational objectives. However, evidence on the impact of mergers on staff satisfaction is surprisingly scarce.
The aim of this study is to assess the opinions regarding the work condition of the 'merged health professionals' in the new context. For this purpose, we will carry out a survey to analyze the opinions concerning the organizational climate through the administration of a validated anonymous questionnaire. The survey will take place in Sardinia Region, where the reconfiguration process created a single originated from the eight LHUs previously existing. The questionnaire will be administered to the entire staff of LHU Sardinia (16000 workers) twice: at the beginning of the study (soon after the closing of the merging process) and ten months after the first administration, to compare any changes in the perceived level of organizational climate.
There are limited models explaining factors contributing to job satisfaction. In Bedeian¿s and Armenakis' model [16], job satisfaction is positively correlated to role clarity but negatively correlated with job stress and propensity to leave. This causal model has been validated in acute [16] and mental health hospital settings [17]. No studies, to our knowledge, have assessed, so far, the effect of the process of unification of LHUs of the public service on the job satisfaction of workers. This study aims to investigate and evaluate the opinion regarding the organizational climate in the new institutional arrangements that took place in Sardinia Region. It is well known that organizational climate and health care workers well-being play a fundamental role for the quality of provided services. However, the only comparable studies evaluated the effect of the merging process on job satisfaction in hospital settings in the UK.
Hospital staff job satisfaction has been positively correlated with patients' experience [18-20] and quality indicators such as hospital-adjusted mortality ratios [21]. Any organizational restructuring would most likely affect job satisfaction levels and potentially compromise the quality of services provided, yet evidence on the impact of hospital mergers on staff satisfaction is surprisingly scarce. Existing literature comprises mainly qualitative case studies of selected mergers [1,7,22,23] and official 'how to' documents [24,25]. Nevertheless, they unambiguously and unanimously highlight the damaging effect of mergers on job satisfaction. Staff might perceive mergers as a breach of the psychological contract (implicit commitments and expectations between employers and employees) when they feel they are not listened to [22], when they have to 'suffer' from delays in service development and job uncertainties [7, 17], or when the anticipated benefits of mergers such as training fail to materialize [26]. Cultures of merging organizations might also clash when they have opposing attitudes towards risk [23, 27] or when the culture of one hospital dominates the other [7].
Jackson [28] further identified staff participation in the decision-making processes and perceived influence in job role as two other positive contributors to job satisfaction. Job satisfaction is also positively related to work environment including staff trust in the organization and satisfaction with employer obligations [29]. This study wants to add further knowledge on the effect of the merging process on job satisfaction taking into consideration a large Italian LHU that has been subjected to unification and evaluate the changes in the level of satisfaction soon as after and after a year from the merger.
References (from 1 to 12)
1. Fulop N, Protopsaltis G, Hutchings A, King A, Allen P, Normand C, Walters R. Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis. BMJ 2002 3;325:246.
2. Department of Health. Organisational Codes Service. Personal communication. London: Department of Health, 2001.
3. Ferguson B, Goddard M. The case for and against mergers. In: Ferguson B, Sheldon T, Posnett J (Eds.), Concentration and choice in healthcare. London: Royal Society of Medicine, 1997:67-82.
4. Dowie R, Gravelle H. Changes in medical training and sub-specialisation: Implications for service delivery. In: Ferguson B, Sheldon T, Posnett J (Eds.), Concentration and choice in healthcare. London: Royal Society of Medicine, 1997:51-66.
5. Garside P. Evidence based mergers? BMJ 1999;318:345-6.
6. Leroy F, Ramanantsoa B. The cognitive and behavioural dimensions of organisational learning in a merger: An empirical study. Journal of Management Studies 1997;34:871¿894.
7. Fulop N, Protopsaltis G, King A, Allen P, Hutchings A, Normand C. Changing organisations: a study of the context and processes of mergers of health care providers in England. Soc Sci Med 2005;60: 119¿130.
8. Tediosi F, Gabriele S, Longo F. Governing decentralization in health care under tough budget constraint: what can we learn from the Italian experience? Health Policy 2009;90:303¿312.
9. Bordignon M, Turati G. Bailing out expectations and public health expenditures. J Health Econ 2009;28:305¿321;
10. Mariani M, Acampora A, Damiani G. Merger mania. L¿ossessione degli accorpamenti delle ASL. Available at: www.saluteinternazionale.info/2017/01/lossessione-degli-accorpamenti-del....
11. Gigantesco A, Mirabella F, Bonaviri G, Morosini P. La valutazione della condizione lavorativa in popolazioni del settore sanitario. Istituto Superiore di Sanità, Centro di Epidemiologia, Sorveglianza e Promozione della salute, Roma. Med Lav 2004; 95,6:431-440.
12. Karasek R, Brisson C, Kawakami N, et al: The Job Content Questionnaire (JCQ}: an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 1998; 3:322- 355.