His article, published in May in Academic Medicine, says leaders consolidated the two hospitals’ medical departments and divisions in a “stunning top-down decision” that cost some physician managers their jobs or caused them to leave and hurt morale. The corporate operations of MGH and Brigham had been combined for 30 years but not their clinical functions.

The merger resulted in MGH and Brigham, long the frenemies of Boston medicine, as a 2024 Boston Globe article put it, suddenly sharing a chief for each specialty, such as emergency medicine, radiology, and pathology, instead of each having its own. The new chiefs now divide their time between the two hospitals, making some rank-and-file doctors feel they have less access to leadership. Part of the rationale for the clinical merger, executives have said, was to prioritize patient care, enhance teamwork, and dampen the competitive rivalry between the two nationally renowned Harvard teaching hospitals.

But Jellinek wrote the merger didn’t account for the different cultures of MGH and Brigham and left physicians with “a sense of loss and alienation.” Leadership, he wrote, should have recognized the need to bridge the distinct hospital cultures.

Among the differences that he wrote affected the blending of the two institutions: MGH viewed itself as having an unrivaled reputation that didn’t require heavy marketing, while Brigham “actively promoted their reputation to be [on] a level with MGH.” Another difference: nurses at Brigham are unionized, while those at MGH aren’t.

Discontent about the merger likely fueled the defection of MGB primary care providers to rival Beth Israel Lahey Health — at least 18 at last count — and the recent formation of a union of primary care doctors, Jellinek contended.

“Such attrition and low morale almost certainly affect patient care,” he wrote.

A spokesperson for MGB said the health system respects Jellinek’s “long service to our organization and his personal perspective.” Nonetheless, MGB contended that merging clinical operations has improved patient care and enabled the system to create new institutes to treat cancer, cardiovascular disease, and other conditions. The spokesperson added that turnover among MGB’s nearly 8,000 physicians has been low.

Jellinek, who also works as a management consultant, recently sat down with the Globe in his office in Newton, which the golf enthusiast has decorated with a photograph of Arnold Palmer. The interview was edited and condensed from a longer conversation.

Question: Why do you say this was the hardest thing you have ever written?

Answer: I’ve been at MGH 50 years, and I love the place. It gave me tremendous opportunities.

Q: How many MGB employees did you interview for your article?

A: This was like an earthquake in the hallways. I’d been through one earthquake — when MGB and Brigham merged [corporate operations] under Partners 30 years ago, that was an earthquake.

This one was even bigger because in the announcement, they were going to combine clinical departments, and vice president positions, which meant many, many people would be impacted, either because they would lose their jobs or their administrative position, or the reporting relationships would all change.

So I knew this was going to be tremendously difficult, and I knew a lot of people. So if I had to pick a number, it would be 30 or 40.

Q: Was there a good rationale for merging clinical departments at MGB’s two flagship hospitals?

A: I think there was a good rationale. The way Partners was structured at the [1994] merger was a single [corporate entity with] two bottom lines. So the MGH had a budget and the Brigham had a budget, and therefore every patient that went to one place was a patient who didn’t go to the other.

All of those things made cooperation more difficult. So I think there was a good reason to try to merge the two institutions, to try to maximize cooperation and, I think, under the current likely financial strains, to have an opportunity at reducing costs.

My concern was: how do you do it in a way that takes the best of both cultures and creates a new culture, and I don’t believe enough attention was paid to that process.

Q: So how did that play out?

A: You’re asking a [department] chief who maybe had 100 faculty [physicians reporting to them] or 500 faculty might now have 200 faculty or 1,000 faculty, and they’re not in one building but they’re in two or three buildings.

The unit chiefs under them are not the unit chiefs that were part of that old hierarchy, because you could get a unit chief from the Brigham reporting to an MGH chief who’s now reporting to a Brigham vice president, because those are the ones who survived.

So all of those things broke down, and I think that added to a sense of loss at the institutions.

Q: How could it have been done better?

A: I think there were two options.

One option would have been to keep each [hospital’s] hierarchy to some extent, and maybe change out the top or change out people who were the most resistant [to greater cooperation with the other hospital]. But try to then do major cost-cutting within established relationships and established hierarchies. And then gradually, over five or 10 years, move to a more unified approach.

The other is: if you weren’t going to keep the hierarchies, and you really felt the only way to do this was to create a single hierarchy, I believe there should have been a very, very thoughtful effort at first explaining to the doctors why we’re doing this.

It wouldn’t have necessarily solved it, but it would have softened it and humanized it.

Q: You suggest in your commentary that the way MGB merged clinical operations starting in 2024 might have fueled a recent decision by unhappy primary care physicians at MGH and Brigham to vote to form a union.

A: I think it contributed to it a great deal. I don’t have the exact data, but my sense is the confidence in leadership is down, and that might result in other efforts at unionizing.

I don’t have any sense that the doctors at MGH that I know better want to unionize. They want to be heard. If I were involved now, I would try to strengthen the physicians’ organization and strengthen the voice of the doctors to kind of balance what’s been happening. That would be part of the cultural efforts I would make.

Q: Did you hear from Dr. Anne Klibanski, the CEO of MGB, about your article?

A: Yes, and quite honestly, I sent it to her. She and I are friends.

Q: Before publication?

A: Yes, out of courtesy. Anne Klibanski was the head of academic affairs when I was chief clinical officer, so we knew each other and we worked together, and I like her. I think she’s a wonderful person.

At the end of the conversation, she really felt that they were making those kinds of efforts [to improve morale about the merger].

I feel very strongly about how good these places are. My goal was to continue how good they are, and I just thought there was more attention [that] could have been paid to the human impact, the cultural impact on physician life and physician practice.

Jonathan Saltzman can be reached at jonathan.saltzman@globe.com.

Original source: us