This is where the actual Change Management change is happening. The Value is created at the level of the hospital, so one should make sure that this process is well-designed, documented, and all the Functional Leads are trained and are ready for change. Readiness for change should be assessed with assurance that there is ongoing process implementation by other departments. The processes that are deployed at the hospital level are called Decentralized Processes.

The change is usually implemented by the Regional Manager as the Program Manager, Functional Change Agent as a Subject Matter Expert and the Hospital Manager as the Project Manager with a Functional Lead as a Change Agent at the hospital Level (if different from the Hospital Manager). The Functional Change Agent should provide all the necessary training and metrics that measure the success of the implementation.


The unit of business where the Actual Value is created is the Hospital. Acquisition is a very stressful event for everybody at the hospital. There is a fear of losing a job, resistance to change, dissatisfaction with a new employment contract, and people are more likely not to trust the new management team. If the organization is not concentrated on the hospital level processes, the staff may easily become disengaged and seek a different employment opportunity.


There are multiple factors at risk. It is worth reviewing every role in the hospital and how they may be exposed to stress and what triggers are common post acquisition.

Owner Veterinarian: One of the reasons why the owners may decide to sell the hospital is due to burnout. This should be carefully assessed before the acquisition because the person may be seeking less stress and less work, but they are more likely to experience more stress while going through the due diligence, as well as post acquisition. A Professional Fulfilment Index test may be administered prior to engaging into a deep dive with the seller to understand their burnout status.

Owners are selling their business, which in most cases, they’ve been building for several decades. Passing their team to another organization is a significantly disempowering event. The core values are rarely defined at the level of the hospital so the process of culture integration is most of the time managed on a gut feeling.

Consolidators are not able to learn enough about the culture, so every bit of information should be carefully analyzed through a cultural assessment process.
There is a common practice to leave some portion of equity with the seller, which means they are incentivized financially, but are unable to grow their business themselves. The post-acquisition process can involve more work to fulfill any requirements of the new owner, who will reap the benefits.This can trigger work overload in light of feelings of unfairness. Lack of communication post acquisition can lead to breakdown of the community.

Veterinary Associates: Lack of cultural assessment can lead to various issues post acquisition. Turnover and sentiments the owner expresses about their team all can suggest what type of culture exists in the hospital. Contacts should be reviewed and assessed to determine whether there is going to be a significant change in the compensation, benefits, and expectations. The schedule is another resource that may suggest the current capacity of the team. When the sale of practice is announced, associates are likely to be concerned about the changes that may come. It is very important to assess burnout immediately post acquisition. After the integration process is complete, the additional burnout assessment should be conducted to assess readiness for change. Post acquisition, the associates are more likely to feel lack of control, value conflict, work overload, unfairness, and breakdown of the community.

Veterinary technicians/nurses: Technicians are the busiest staff members. They carry out most of the procedures at the clinical level, shape the culture of the organization, and are usually underpaid. According to recent research, technicians are more burned out than veterinarians and immediate post-acquisition assessment should be conducted. After the Definition of Done (DoD) of the integration process is completed, an additional burnout survey as well as a customer satisfaction survey should be conducted to understand the readiness for change. The most common concerns that should be resolved quickly are: fear of losing a job, loss of the leader as well as fear of remote management. Quite a few promises are informally made by the ex-owner and they all should be captured in the pre-acquisition assessment. One very important factor that motivates technicians to stay at the same place of employment is having a discount on veterinary services as well as pet food and over- the-counter medications. All of the classic triggers for technicians are common post acquisition: Lack of control, value conflict, work overload, unfairness, and breakdown of the community.

Connected Processes

  • Culture/People Integration
  • HR Process/Onboarding
  • Knowledge Accumulation
  • Core Processes Implementation
  • Strategic Filter
  • Prioritization (WSJF)
  • Talent Acquisition
  • Pre- and Post-Acquisition Assessments
  • Training
  • Quarterly Goals/Rock Planning
  • Recruiting at the Hospital Level
  • Implementation of VCP Processes
  • Capacity Reservation Process
  • Change Management
  • Data-Driven Change Management


One of the biggest advantages for these types of consolidation is ability to assess the culture upfront and hire people that fit it. Contract design, benefit packages and pet benefits – all could be designed well in advance. There is no post-acquisition stress and staff is very motivated to work in a brand new facility.
The only point of concern that should be addressed is the upcoming change and the Change Management Design should be considered before new processes are implemented at the hospital level.