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Hospital Merger Downton Style

In the final season of the acclaimed PBS series Downton Abbey, Lady Grantham and the Dowager Countess waged a heated struggle for control of Downton’s only hospital. Like many small community hospitals of our day, the Village of Downton’s sole hospital faced a difficult choice — maintain its independence or become part of a larger hospital system. High stakes. High drama. Great subplot.

Watching the plot line play out, I found myself thinking about the real-life plot line playing out all across America as constriction takes place. Will bigger be better? Will patients really get better care, or will the affiliations/mergers merely make for more efficient ways to maximize reimbursements? Will we actually make people healthier? Will we save money? Will we end up reversing this trend 10 or 20 years from now? Will Mr. Mosley and Miss O’Brien end up together and will Mr. Barrow ever find happiness? (Sorry — couldn’t resist.)

The process of a smaller hospital becoming part of a larger organization can mean great things for patients and for both healthcare organizations involved, but the nuts and bolts of a merger can be mind-numbing.  Dollars and cents are tangible. Reputation and sustainable market share less so. Communicating change to patients, staff, supporters, regulators, and communities at large is a colossal challenge for any institution involved in merger or affiliation.

Change creates disruption and uncertainty. It also creates opportunity — opportunity to rebrand, to build and rebuild market share, and to solidify reputation.

But I digress. Let’s go back to Downton. Lady Cora and the Dowager both have noble intentions (well, for the most part). Both care passionately for the hospital and what it means for the village. But they have different visions of what healthcare for the people of the village should be. Tradition or efficiency.

In a most compelling scene during the final episode of the series, Lady Grantham addresses the staff of the hospital to assure them that all would be well. Their jobs were safe, healthcare for the people of the village would be better, and Dr. Clarkson would be staying in place to continue to lead them. And they’ll all live happier ever after. The 1920s were, after all, a period of great advances in medicine. Blood types were discovered, as were vitamins and insulin. And the electrocardiogram was invented.

What will the 2020s bring?