Hospitals and other health care organizations across the United States are engaging in collaborative ventures—including alliances, joint ventures, and mergers and acquisitions—at an increasing rate. Modern Healthcare’s (2012) annual mergers-and-acquisitions reports show, for example, a 3.5 and 3.4 percent increase in the number of mergers-and-acquisitions deals in 2010 and 2011, respectively, and a 73 percent increase in the number of hospitals involved in these deals from 2009 to 2010, the greatest increase in the past decade. Health care providers may be increasing their efforts to collaborate in response to the new risks and opportunities they face, stemming primarily from the Patient Protection and Affordable Care Act (ACA) and the service delivery models it promotes, as well as related pay-for-performance reforms that aim to improve quality of care.

Unfortunately, the majority of collaborative ventures among health care organizations fail to significantly improve the overall performance of participants; there is a great deal of variation in outcomes (Bazzoli et al., 2004; Cartwright and Schoenberg, 2006; King et al., 2004). However, several study results indicate that key practices, including effective leadership before, during, and after these ventures are implemented, may promote their effectiveness (Hansen, 2009; Marks et al., 2001).

The purpose of this paper is to identify these best practices for policy makers and managers concerned with improving the outcomes of collaboration among health care organizations. I organize the paper as follows. First, I briefly define and distinguish major forms of collaboration, focusing on relationships among hospitals and physicians as the key organized providers of health care; this section also presents the conceptual framework that guided my work. Second, I review evidence on the context and outcomes of collaboration among health care provider organizations. Next, I examine results concerning the processes of change and implementation practices involved in efforts to collaborate—To what extent, and how, do these factors affect the outcomes of collaboration? I present a checklist of best practices for improving the outcomes of collaboration and discuss leadership approaches that can help put these practices into effect. I conclude with a discussion of observations about best practices for effective collaboration (Hansen, 2009).


This paper examines key forms of collaboration among health care providers who aim to coproduce services. I focus primarily on three major forms of collaboration among health care organizations: mergers and

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