The role of path dependency in a hospital merger

Purpose – The purpose of this paper is to explore how change processes are dependent on historical events, geographical conditions, strong stakeholders and social norms developed over long‐time periods. The paper poses the question: what is the role of path dependencies in mergers between hospitals when motives of the mergers are ambiguous and the context of the change initiatives is characterized by conflicting goals? Design/methodology/approach – The primary objective of this study is to describe the experience of three hospitals that were merged into a hospital enterprise, with the focus on a change in activity from 2003 to 2006. This fieldwork allowed a longitudinal study. The empirical data were generated from observations, interviews, document studies and newspaper clippings. Findings – The investigations showed that the merger forced the hospitals to change, but the new organization – the different components of the merged hospital – followed different pathways to handle the externally imposed changes. Parallel processes evolved, and these processes were rooted in the historical and geographical conditions. Further, the paper illuminates the unique strengths of qualitative research methods that allowed a deeper understanding of these change processes. Originality/value – The paper's findings add to our knowledge on the complex relations between externally imposed organizational change and the nature of internal organizational behaviour when intertwined with strong stakeholders. The paper particularly highlights the possible consequences when there is little interaction between the changes of systems and the practices of the professionals in hospitals when the processes are heavily influenced by path dependencies rooted in historical and geographical traditions.