All ETDs from UAB

Advisory Committee Chair

Larry Hearld

Advisory Committee Members

Jeff Szychowski

Robert Weech-Maldonado

Nate Carroll

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


Since 2009, the United States has experienced another wave of hospital mergers. Consequently, health systems are getting larger and increasing their market concentration. How patients benefit from hospital consolidation remains an open issue for policy-makers, economists, health care executives, community leaders, politicians, government agencies, and others. One measure of healthcare consolidation’s impact, and its potential benefit/detriment, is how mergers affect patient experience, which, since 2007, has been measured by the standardized HCAHPS instrument. Hundreds of studies conducted over the past 50 years have found mergers trigger an internal, socially-disruptive effect in the first 12 to 24 months following the event as the two merging organizations attempt to blend cultures, restructure job assignments, implement merger-related efficiencies, and achieve the overall strategic goals that brought about the merger. Consequently, organizational performance may decline in the short-term as the merger-related changes and accompanying upheaval move through the organization and get resolved. Many researchers have evaluated the impact of hospital mergers on quality, safety, access, costs, pricing, and profits. However, no research study has examined the relationship between hospital mergers and patient satisfaction or patient experience. This research attempted to fill that gap with a quasi-experimental design using an interrupted time-series study. Cross-sectional, aggregate mean values of four different HCAHPS ratings (overall, physician communication, nurse communication, and staff responsiveness) of 99 merged/acquired hospitals were compared to that of 99 matched hospitals over a six-year time period (three year prior to the merger and three years post-merger). Fixed effects difference-in-differences testing was applied to evaluate and compare the post-merger rate of change in HCAHPS ratings between the two hospital groups. This study revealed a negative relationship between some elements of a hospital’s HCAHPS performance and merger status (i.e., completed a merger in the last 12 to 24 months or not). Specifically, a negative relationship was found between the merger group and two of the four HCAHPS domains (overall and nurse communications). Furthermore, a significant difference was found among the merged/acquired hospitals with respect to merger type. Hospitals that were acquired performed worse than hospitals that were part of a merger-of-equals. With the exception of the nurse domain, negative differences were resolved three years after the event. Findings from this study will guide and inform hospital administrators, health system boards, state and federal government regulations and policies, and others across a wide spectrum of healthcare industry stakeholders.



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