If you live in a large metropolitan area, chances are you have been either a patient or a visitor in an academic medical center that has 500 to 1000 beds. If you live in a rural area, you are probably more familiar with a small local community hospital with less than 100 beds.

Because of healthcare mergers and acquisitions, these two different kinds of hospitals are likely to be part of one integrated health system. While different in size and scale, they both deliver healthcare to their community 24×7.

Small, independent hospitals are often very agile, extremely customer service oriented and supported by a loyal community. In IT, the staff are often generalists and less specialized. They may have a single integrated system from one vendor with basic functionality and limited integration points with other applications.

In contrast, large academic medical centers can be slow to make changes and appear more bureaucratic. They provide advanced medicine with subspecialists and clinical services not found elsewhere. They have to work harder to create a culture of customer service. Their community is broader and they attract patients from greater distances, including international patients. And their IT teams are larger with many specialized roles. In addition to their core electronic health record, they have many specialized departmental applications, many interfaces. Overall, it’s a far more complex environment.

So how do these different profiles mesh at merger time?

From my experience in several health systems around the country, culture is key. That means a shared mission and common values. It means showing respect for the uniqueness of each organization, being willing to learn best practices from one another, and appreciating all the staff.

There are many benefits of integrated health systems. The community gets access to a broader range of health services. Capital investment is usually a part of the deal as hospitals join larger systems. And there should be a rationalization of services so that the right care is provided in the right location at the right time. But there are also tradeoffs, including a perceived loss of control for small hospitals used to being independent.

Health systems employ different models as they grow and acquire hospitals. The degree of integration, centralization, and standardization varies. Health systems need to be more than just a common name and logo – they need to demonstrate the value of integration. IT plays an important role in that integration as eventually patients will have a single medical record regardless of where they receive care within the system.

And through all the negotiations and organizational changes involved in mergers, what’s best for patients and the community needs to be front and center.