In an article published in JAMA, investigators suggest that system expansions in the current healthcare environment are having clear effects on clinical care and patient safety. Specifically, these effects are most substantial when physicians experience changes in their practice setting, infrastructure, or patient population.

The rise of mergers and acquisitions in the healthcare space is resulting in drastic changes. A total of 3 significant safety risks associated with system expansions in professional medical organizations, including hospitals, pharmaceutical companies, medical device manufacturers, and large medical practices, have been identified and include changes in patient populations, infrastructure, and clinician practice settings.

After a system expansion, healthcare organizations may experience a shift in patient volume as well as patient demographics that are unfamiliar for the organization. If unaccounted for during expansion, new patients may be at risk for treatment inadequacies because of the lack of healthcare personnel available to take care of the new volume and/or the lack of healthcare providers with experience treating certain demographics. Attention should be made to improving the diversity of healthcare staff in addition to increasing the number of clinicians, nurses, and medical assistants available to reduce potential safety risks to patients.

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When a major system expansion occurs in a healthcare organization, there generally follows an increase in financial resources to purchase new supplies, equipment, and information systems. This change in infrastructure can be helpful for improving patient outcomes; however, clinicians unfamiliar with the new tools may encounter errors in performance, ultimately placing patients at risk. Training healthcare professionals on the new technology may be helpful after a system expansion, with the goal of overcoming the learning curve involved with any new systems in place.

In addition, healthcare expansions may result in the need for physicians to travel to new practice sites. At arrival, these physicians often do not have the time to become oriented to their new location, resulting in having to practice with unfamiliar infrastructure, processes, teams, and culture. This can result in miscommunication and errors in practice, ultimately affecting patient care. Proper planning and frequent “practice” visits to new locations may help improve comfort with the new practice sites and mitigate patient safety concerns.

The investigators suggest that institutions should “actively plan for, monitor, and manage the resulting risks as part of a comprehensive strategy, including sharing data on quality and safety, and sharing oversight of care for the joint patient population.”


Haas S, Gawande A, Reynolds ME. The risks to patient safety from health system expansions. JAMA. 2018;319(17):1765-1766.