When Groups Merge But Their Cultures Don’t

Episode 125: When Groups Merge But Their Cultures Don’t

Welcome back to Medical Money Matters, where we dig into the business realities of healthcare—from strategy to staffing to leadership and beyond. If you’re part of a medical group that’s ever been through a merger—or even just considered one—today’s episode is going to hit close to home.

We’re diving into a topic that doesn’t always make the due diligence checklist, but it absolutely determines the long-term success or failure of any group merger: culture.

You’ve probably heard the old Harvard Business Review quote: Culture eats strategy for lunch. That line’s been floating around boardrooms for decades now. And it’s never been more relevant than in healthcare—especially when two or more medical groups merge.

Because here’s the truth: You can have the best financials, a perfect legal structure, a slick shared EHR, and a promising growth strategy. But if the cultures of the merging groups don’t align—or worse, actively clash—none of that matters. Your strategy won’t survive the day-to-day behavior of people who don’t trust each other, don’t communicate well, and don’t feel seen in the new reality.

So in this episode, we’re unpacking:

• What “culture” really means in medical groups
• The massive cost of not addressing culture in mergers
• Real-world examples of what can go wrong
• And how to lead through a culture integration intentionally and successfully

Let’s start by defining what we mean when we talk about “culture.”

In a medical group, culture isn’t just what’s written in your values statement or your mission. It’s how people actually behave. It’s what gets rewarded and what gets quietly ignored. It’s how decisions are made, how conflict is handled, how communication flows—or doesn’t.

It’s the subtle cues that tell people what’s safe, what’s respected, and what’s expected. It’s how your team responds when someone speaks up in a meeting. It’s whether physicians are empowered or micromanaged. It’s whether administrators are seen as partners—or as obstacles.

Culture is the rhythm of the organization. And when two different rhythms are forced to play in unison without preparation, the result is discord.

Think about this: One group is collaborative, patient-centered, and maybe even consensus-driven. The other is more top-down, focused on metrics and margin. On paper, they’re both successful. Together, they could be even stronger. But unless someone names and navigates the cultural gap, friction is inevitable.

And here’s the kicker: most medical group leaders don’t talk openly about culture during merger discussions. The focus tends to be on billing systems, EMRs, compensation models, maybe governance structures. And that makes sense—it’s the measurable stuff. But culture? That’s where the silent failures begin.

Let’s talk about the costs.

It starts quietly. A physician who used to love their work is now disengaged. A staff member who used to go the extra mile starts doing the bare minimum. An administrator finds themselves constantly mediating interpersonal conflict. Patients start feeling the ripple effects through reduced morale and longer wait times. And leadership meetings become more about damage control than forward momentum.

Culture clashes can lead to significant staff and physician turnover. They slow down decision-making, derail strategic priorities, and create toxic pockets of resentment.

I consulted with one group that had just completed what looked like a perfect merger on paper. The financials aligned. The geographic expansion made sense. The combined specialties offered great synergies. But within six months, morale was tanking. One group had a deeply physician-led culture—flat structure, lots of peer input. The other had a corporate-style governance, with strict admin oversight and clear lines of authority.

Neither was inherently wrong. But no one had the conversation about how those philosophies would be reconciled. And what emerged was confusion, resentment, and ultimately, a complete breakdown in trust. It took them nearly two years to stabilize, and they lost several top physicians in the process.

That’s the power of culture. And that’s why the old saying is true: culture eats strategy for lunch.

Let’s talk more about that quote, because it’s not just a catchy phrase—it’s a strategic warning.

Strategy is about plans, projections, and positioning. But execution? That lives in the hands of people. And people don’t follow strategy—they follow culture. If the culture doesn’t support the behaviors your strategy requires, the strategy dies.

You can have a beautifully crafted integration plan with clear timelines and KPIs. But if your newly merged teams don’t feel aligned, don’t trust each other, or don’t understand the “why” behind changes, they’ll resist—actively or passively.

We see this a lot with technology integration. I worked with a group that tried to roll out a shared EHR after a merger. On the surface, it was a smart move. Operationally sound. But culturally? Disaster. One group was used to customizing everything. The other followed strict protocols. The clash over charting norms, autonomy, and workflow became so intense that they paused the rollout halfway through—costing hundreds of thousands of dollars and months of productivity.

And it wasn’t a tech failure. It was a culture failure.

So how do you avoid that?

It starts with diagnosis—before the merger if possible, but definitely right after.

You need to assess each group’s culture not just in terms of “values,” but in terms of behaviors and systems. How do people communicate? How are conflicts resolved? What does leadership look like? What kind of behavior gets rewarded?

This is where structured cultural assessments come in. At Health e Practices, we often use a combination of leadership interviews, staff surveys, focus groups, and even observational tools to map out the real-world culture—not just what’s stated, but what’s lived.

Once you’ve identified the differences, you can’t just hope they’ll resolve on their own. They won’t.

You have to lead through them—intentionally.

Here’s what effective cultural integration looks like in a medical group:

First, you’ve got to name it to tame it. Be explicit about the cultural differences. Put them on the table. Acknowledge what each group brings to the table, and where the friction might lie. Transparency is the antidote to resentment.

Then, create a shared language. Establish the values and behaviors you want in the new organization—not just a patchwork of the old. Maybe you blend aspects from both cultures, or maybe you decide to create a completely new standard. But it has to be intentional.

Next, build trust through early wins. Pick a few cross-group projects that are likely to succeed, and use them to build positive momentum. People need to feel the benefits of the merger, not just hear about them.

Then, reset norms. You’re not just merging policies—you’re merging identities. That requires symbolic actions and clear expectations. Rethink how meetings are run. How decisions are made. Who gets a voice and when. These are the places where old habits linger.

Also, don’t underestimate the power of rituals and recognition. Celebrate joint accomplishments. Publicly highlight examples of the new culture in action. Culture shifts when people see their new identity reflected in day-to-day experiences.

One of the best integrations I’ve seen happened when a group created what they called a “culture compact”—a simple document that outlined how they agreed to behave with each other post-merger. It wasn’t legalese. It was behavioral. Things like: “We don’t talk about each other—we talk to each other.” Or “We assume good intentions, even in disagreement.” It sounds simple, but that compact became a guiding light for decision-making, conflict resolution, and team development.

All of this takes leadership.

And not just positional leadership—real, cultural leadership.

That means modeling vulnerability. If you’re part of the legacy leadership team, you’ve got to be willing to let go of some “how we’ve always done it” mindsets. You have to be open to learning from the other group. And you have to demonstrate that change starts with you.

Consistency matters too. Don’t say one thing and do another. If you claim to value collaboration, but all decisions are made behind closed doors, the message is clear—and the culture reverts.

You also need fairness. Culture wars often flare up when one group feels like the “acquirer” and the other feels like the “acquired.” Even in technically equal mergers, one group’s systems, language, or leaders can dominate. Be intentional about creating equity—not just in pay or governance, but in voice and influence.

And if this all sounds overwhelming, that’s okay. Culture integration is hard work. That’s why many medical groups bring in outside support to help guide the process. You’ll benefit from some help in navigating the messy middle of merger integration—not just the business side, but the human side. We’ve seen firsthand how intentional culture work can transform not just the merger—but the future of the group.

So let’s wrap this up.

If your group is considering a merger, or if you’re already living in the aftermath of one, here’s the big takeaway:

Culture isn’t the soft stuff. It’s the hard stuff that shapes everything else.

You can’t execute strategy in a culture that doesn’t support it. And you can’t build trust in a culture that hasn’t been intentionally shaped.

But you can lead through it—with clarity, humility, and commitment.

Diagnose the differences. Align on a shared vision. Lead with consistency. And remember—culture is happening whether you shape it or not. So you might as well shape it well.

Thanks for tuning in to Medical Money Matters. If this episode sparked something for you—or if your group is navigating a merger right now—reach out to us at Health e Practices. We’d love to support you with a cultural diagnostic or help you build your integration roadmap.

Until next time, lead well.