”Vi läkare är inte utbytbara!”: - en studie om identitetsskapandevid fusioner i sjukvården

Sammanfattning: During the last 20 years, the Swedish health care system has faced major changes. One of them is the increasing pressure to generate economic profit due to private businesses entering the market. Health care units are forced to make some structural changes in order to become effective and efficient. As a result merger and acquisitions has become a part of the health care sector, and seems to be an increasing phenomenon. Mergers and acquisitions have mainly been studied in the industry. A frequent explanation to why the potential value of a merger is not realized is culture clashes between the merging organizations. From a social constructionist perspective cultures are not seen as definite structures. Instead social constructionists - having studied the industry - suggest the post merger integration activates a process where organizational identities are formed and defended. From this perspective a dialogue between the merging organizations is a prerequisite for a successful integration. Health care organizations have less distinct organization identities. Instead the professional identity and managers’ identities are categorizing for this type of organization. The purpose of this study is to get a deeper understanding for what happens within the health care organizations from an identity perspective when two units merge. Thus we have investigated: what identity formation is activated when two health care units are merged with purpose to win synergies for better use of resources. By using a qualitative abductive method we have studied a health care provider, run by an economic management team, which try to get two geographically different radiology units to integrate and cooperate in order to become more efficient. Twelve interviews have been conducted in order to get a picture of the situation the two different units are facing and what the reaction to the integrations is. The results show that two different processes of identity formation are activated, where the second process is unique for the heath care sector. The first one is the need for each unit to enforce their own organizational identity, accentuating the differences making it difficult to cooperate. The second process is the radiologists need to protect their own area of expertise towards the initiatives from the management team who wants to create economic profit. This study suggest that the identity formation around the profession is the essential and that the identity formation around the organization can be seen as an expression of radiologists’ need to protect their territory. Thus the study show more complex processes of identity formation appear in the health care sector than what has been reported from the industry. While – in the industry – researchers have found organization identities need to be confirmed for mergers to succeed, our result indicate a dialogue between management and physicians is central for the success of a merger within the health care sector.