• Elizabeth A Rider and H Esterbrook Longmaid.
• Department of Pediatrics and Office of Educational Development, Harvard Medical School, Children's Hospital and the Division of General Pediatrics, MassGeneral Hospital for Children, Boston, Massachussetts, USA. Elizabeth_Rider@hms.harvard.edu
• Med Educ. 2003 Sep 1; 37 (9): 794-801.

IntroductionAs health care delivery systems experience economic and competitive challenges, institutional mergers have become a means for economic survival. Academic hospital mergers are well chronicled, yet little has been written about postgraduate, or residency, training programme mergers and their human and programmatic consequences. Mergers present opportunities to strengthen and redesign residency programmes, but risks include programme disruption, resident and faculty morale, and housestaff and faculty recruitment and retention. Mergers can cause a sense of disequilibrium, influencing resident and staff perceptions of job security, commitment to teaching, and even the viability of the residency programme.ObjectiveWe describe a process for the survival and successful merging of existing residency training programmes in the context of larger health care mergers. People, management, and communication skills are critical for leaders of the change process. We offer approaches and guidelines for leaders and others who are involved health care and residency training programme mergers. Awareness and understanding of systems issues and human factors improve the likelihood of success. Although our guidelines are intended primarily for residency programme mergers, they are equally applicable to mergers of health care institutions.ConclusionSuccessful residency training programme mergers require a carefully planned and executed series of actions that minimise disruptions. Effective communication on all levels is key. Success is associated with effective leadership, good communication skills, an open process with physician input, attention to institutional cultures, and a relatively short timetable. Most important is the continuous involvement, input, and creation of the programme by those most affected.

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