Once the hard work of finalizing a merger is complete, the even harder work of integration begins. During integration, it’s not uncommon for an “us vs. them" mentality to emerge between members of the previously separate organizations. Tensions may even be exacerbated if these organizations were previously competitors. This poses challenges for cultural integration and often results in silos that impede integration progress altogether.

Ballad Health was formed by the merger of two competing regional health systems. It has 21 hospitals, a large multispecialty physician practice network, behavioral health services, and post-acute care offerings. The organization serves communities across the Appalachian Highlands and has locations in North Carolina, Tennessee, and Virginia.  

Early in the merger, Ballad Health’s leaders recognized that the administrative leadership council alone could not effectively roll out an integration plan and address physician concerns at the same time. A year and a half after the merger closed, Ballad created a new physician governance model with 1) a physician board, and 2) service line councils. The goal of this model was to increase transparency with physicians around decision-making and improve physician wellbeing.

This dual governance model amplified physicians’ voices in the integration process by providing them with a dedicated outlet to raise issues or concerns, while also providing more transparency into how decisions are made. Leaders measured the success of the governance model via physician surveys and realized noticeable cultural benefits.