Oncology Administrators Must Plan for Transition in Mergers

WASHINGTON--With regional hospital partnerships on the rise, cancerprogram administrators often find themselves charged with managing multi-institutionalprograms melded together within a system. Three middle managers who havebeen through such transformations offered their insider views at the Associationof Community Cancer Centers (ACCC) meeting.

Marija Bjegovich, RN, director of cancer services, St. Luke's MedicalCenter, Aurora Health Care, Milwaukee, said that among the challenges ofsuch a task are internal and external competition; entity, community, andsystem politics; pre-established referral patterns; staffing, payroll,budget, and other operational issues; and discrepancy in quality standardsamong units within the system.

To meet such challenges, the oncology administrator must pay specialattention to a number of areas, said Diane M. Otte, RN, operations director,Oncology Services, Alegent Health, Omaha. Ms. Otte is also co-editor ofthe PRR, Inc. publication Cancer Management.

Planning: While a general plan to merge institutions will havebeen worked out, such things as how to amicably unite the cancer unitsmay not be detailed in advance. Thus it falls to the oncology administratorsand staff to plan the transition and make it work, something that requiresdetailed thought and planning, not to mention some goodwill on the partof all participants.

Still, she warned: "No matter how well you and your team plan,things are going to happen that you weren't expecting."

Communications: This must be a constant concern. "You can'tcommunicate too much with your staff and your physicians. And the managementteam that you report to can't communicate too much with you," Ms.Otte said. She added that it is critical that communication with staffand physicians be done in a timely manner so that it does not appear thatinformation is being withheld.

Patient care: "We must be careful not to lose sight of thatvery important aspect of a strategy for success," Ms. Otte said. "Weall need to collectively look at how we can make patient care better. Thereis nothing wrong with asking the patient about how we can improve careor integrate services, rather than assuming we know the answers."

Keeping focused on the mission "that you're there for the patientsand that the services should revolve around them," is essential, addedNancy E. Haas, RN, corporate director of the Merida Cancer Institute inMayfield Heights, Ohio, part of a system of four community hospitals inthe Cleveland area.

Staff involvement: This is partly time management, partly a jugglingact, by Ms. Otte's description. It's important to get staff input, particularlyabout patient care, she said. The challenge is to create the time to getthe input, coordinate ideas, and make certain you have "adequate politicalrepresentation of staff involved from each side, all sides."

Flexibility: "You have to be prepared to have any giventhing happen on any given day and be able to deal with it," Ms. Ottesuggested.

Networking: "Don't ever think you can stop networking withyour peers," she noted. Networking's importance ranges from learningof future job opportunities to "figuring out how to publish a jointannual report or some of those other nitty-gritty details that we haveto deal with on a day-to-day basis."

Senior management commitment: Without it, needed change won'toccur. "No matter how much you and your team are committed, if thesenior management team is not in sync with you and supportive, it is notgoing to happen," Ms. Otte said.

A sense of humor: "I can't emphasize that enough,"Ms. Otte said. "You need to be able to relate to your staff, yourphysicians, and your patients with some degree of fun every day."

Ms. Haas concluded by noting that the benefits of such mergers are wellworth the effort. These include decreased duplication, standardized equipment,joint program development, promotion, and marketing plans, and improvementsin oncology services.