It may have been the great health-services paradox of the '90s - at the same time that demands for evidence-based medicine were growing across Canada and around the world, merging hospitals was almost universally seen as crucial to the survival of the health care system.

And yet, as a 1999 paper by three Quebec researchers makes clear, there is little concrete evidence that mergers do what they're supposed to, either by saving money or improving care.

The paper, "The Struggle to Implement Teaching Hospital Mergers," by Jean-Louis Denis, Lise Lamothe and Ann Langley, appeared in Vol. 42, No. 3 of Canadian Public Administration. It compares two teaching hospital mergers, each involving three large institutions.

In it, the authors conclude that despite the dominance of the "urge to merge" among teaching hospitals, it is far from clear that mergers achieve their ends. The recurrent mistake hospital administrators organizing mergers make, Professor Langley said, is underestimating the complexity of getting people to work together. Unless programs are amalgamated at one site, economies of scale and other efficiencies are unlikely to be recognized, but getting strangers to work together is tremendously hard, she said. "You're basically destroying something that worked to create something new, and it takes so much time and so much suffering and misery that when you finally calculate whether it was all worth it, you can't be sure," she said.

An abstract of the mergers paper is available on the Canadian Public Administration journal website at: https://www.ipaciapc.ca/english/publications/forthcoming.htm or in French at https://www.ipaciapc.ca/french/publications/forthcoming.htm

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