Why Does Operating Model Design Struggle After Organisational Mergers

Healthcare organisations are under constant pressure to do more with less. Mergers promise scale, better care, and stronger systems.

At first, that sounds right. You bring teams together, and you expect things to improve. However, reality often feels messy. Services stay split, roles overlap, and decisions take too long. 

People work hard, but progress feels slow. That frustration builds over time. So, a clear question shows up. Why does this happen even when the intent is right? This is where Operating Model Design matters. It shapes how work actually gets done each day.

Andy Heeps offers a clear and practical view on this challenge. He is the Chief Executive Officer of University Hospitals Sussex NHS Foundation Trust and a Generation Q Fellow at The Health Foundation. He stepped into this role after serving as Deputy Chief Executive.

This came after the trust formed in 2021 during the COVID-19 period. He helped stabilise the organisation during that time. 

He also guided its direction after the merger. He has a clinical background as an obstetrician, and strong NHS leadership experience.

He joined as Managing Director, then became Chief Operating Officer. There, he led service delivery across several hospital sites. Now, he focuses on building one integrated organisation that works as a whole.

In this article, we will learn why post-merger models start to break down over time. We will explain how silo thinking creates delays, confusion, and uneven results.

We will also show how clear ownership improves speed, alignment, and performance. Finally, we will look at what leaders must do to make the model work in real life.

Why Operating Model Design Changes After a Merger

After a merger, most organisations focus on one thing. Keep services running and avoid disruption. That makes sense. But the structure they build in that moment often has limits.

At first, a mixed model feels like a safe choice. It combines site leadership with divisional control, so both local and system needs get attention. On paper, it works. However, things start to feel off.

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Where Problems Begin

As time passes, roles start to blur. Site leaders push local priorities, while divisional leaders focus on wider goals. Both sides act with purpose, but they don’t always align.

That creates friction. Decisions slow down, and teams begin to feel stuck. A simple issue shows up. No one feels full ownership.

When Pressure Builds

Now add real pressure. Recovery targets slip, and service delivery becomes uneven. Teams try to fix things, but the structure keeps getting in the way. You can feel the frustration. People work hard, yet progress stays slow.

Common signs become clear:

• Decisions take too long
• Priorities clash across teams
• Accountability feels unclear

These are not effort problems. They are structure problems.

Why a Review Becomes Necessary

Once things stabilise, leaders step back and look again. They ask a direct question. Can we act as one organisation? If the answer is no, then change is needed.

Moreover, internal feedback often confirms this. Teams highlight confusion, overlap, and lack of clarity. So the organisation makes a shift. It moves away from a complex matrix and towards a simpler, unified model.

The goal is clear. Remove friction, create ownership, and help teams move faster together.

How Operating Model Design Works in Practice

A clear strategy points the way. But the operating model decides if you can actually move. After a merger, services often stay split.

Teams run similar work in different places, but they don’t work as one. That slows everything down. You end up with one demand, but a scattered response. It feels inefficient, and it is.

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The Real Problem: Silo Thinking

When teams sit in separate structures, they focus on their own area. That’s natural, but it creates gaps. You start to see:

• Work handled differently across locations
• Resources not shared properly
• Pressure building in one place while capacity sits elsewhere

It’s frustrating because the solution feels obvious. Use the full organisation. But the structure doesn’t allow it.

Why Co-Design Feels Messy

Co-design sounds simple. Let people shape the model, and build something better together. In reality, it gets uncomfortable.

As ideas form, people see what might change. Roles may shift, and responsibilities may move. Some people want input, but others want certainty. That tension is real. It can feel like something hidden is going on, even when it isn’t.

So, leaders need to stay steady. If they open the process, they must follow through.

The Shift That Changes Everything

The biggest fix is clear ownership.

If two layers lead the same work, confusion follows. So the model must draw a clear line.

• Divisions take full responsibility for delivery
• Site roles support, coordinate, and enable
• Decisions sit with those who own outcomes

This clears the noise. People know where they stand.

Making It Work Day to Day

There is no perfect time to implement change. So, you start, then adjust. Teams align over time, leaders step into new roles, and things settle. It can feel messy, but direction matters more than perfection. When structure supports action, everything starts to move.

How Operating Model Design Improves Alignment and Performance

Many organisations have strong teams and good services. Still, results don’t match that strength. The issue is not people. It is how the system works.

When services sit in silos, each part does well on its own. But together, they fall short. You face one shared demand, yet teams respond in different ways. That slows everything down.

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Why Alignment Changes Results

When teams align, performance improves quickly. You start using the full strength of the organisation.

You begin to see:

• Faster access to care
• More consistent outcomes across sites
• Better use of staff and facilities

Clearly, the problem is not effort. It is how work connects.

Why Purpose Must Be Clear

A merged organisation needs a clear purpose. Without it, services drift and stay fragmented. The goal is simple. Bring services together so they stay sustainable, deliver high quality, and use scale properly.

However, this brings tough choices. Some services must move or combine to work better. That part is never easy, but it is necessary.

What Changes Beyond Structure

Structure alone won’t fix alignment. People must also change how they work. When teams plan together, they start to question differences. Why do outcomes vary? What can we fix? That thinking drives improvement.

Moreover, shared tools and regular contact help teams stay connected. Distance matters less when people actually talk and solve problems together.

What the New Model Enables

The new model creates clarity. Divisions now own delivery across the organisation. Below them, clinical directorates handle work closer to the front line.

This removes confusion and speeds up decisions. Leaders take clear responsibility, and teams know who leads.

However, these units are large and complex. So organisations must invest in strong leadership. alignment turns scattered strength into real performance.

What Operating Model Design Requires from Leaders

An operating model is not just structure. It shows how work really happens each day. If the written model does not match reality, problems show up fast.

Teams feel the gap, and ownership becomes unclear. So the first goal is simple. Make design match daily work.

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Why Clinical Leadership Still Drives Delivery

Even after change, delivery stays close to clinical teams. That is where real decisions happen. Large clinical directorates now sit at the centre. 

These are big, complex units, and that scale helps. Teams can reduce variation, improve outcomes, and learn faster by working together.

When teams share data and reflect on results, improvement becomes normal. It stops being a one-off effort.

Where Alignment Still Needs Work

Variation does not only sit in clinical services. It also shows up in corporate functions. Different systems and processes often remain across sites.

This creates delay and confusion. The next step is clear. Bring these services together and simplify how they work.

For example, organisations often need to:

• Remove duplicate systems and processes
• Create one consistent way of working
• Improve efficiency without losing quality

It sounds simple, but it takes real focus.

What Leaders Must Get Right First

Before changing structure, leaders must be clear on purpose. Without that, everything drifts. They need to agree on what the organisation is trying to achieve and how teams should work together. That shared direction guides decisions.

What the New Model Enables

The new model creates clear ownership. Services that were once split now sit under one leader, so action becomes faster. However, structure alone is not enough. 

Local leadership matters most. People rely on their direct leaders every day. So organisations must invest in strong leaders at that level. When purpose, structure, and leadership align, the model starts to work.

Conclusion

In short, post-merger structure often starts strong, but it doesn’t last. Teams try hard, yet things feel stuck. That frustration is real, and it points to one issue. The model no longer fits the work.

However, this is not about people. It is about clarity. When roles overlap and ownership feels shared, decisions slow down. Then progress stalls, and teams lose momentum.

Operating Model Design fixes this by drawing clear lines. It shows who owns what, and who supports whom. So people stop guessing, and they start acting with confidence.

That said, change will feel uncomfortable. Some roles shift, and some habits break. People may resist at first, and that is normal. Leaders must stay steady, clear, and honest.

Moreover, leaders must stay close to daily work. They need to listen, adjust, and guide teams through the change. If they stay distant, the model won’t hold.

When structure, purpose, and leadership align, things click. Work flows, decisions speed up, and teams finally pull in one direction. That is when the organisation starts to work as one.

FAQs

Why does operating model design need regular updates after a merger?

Change does not stop after the merger ends. Work evolves, and pressure shifts. So the model must keep up. If it stays fixed, gaps grow, and performance drops.

How does operating model design affect staff morale?

Clear roles reduce stress and confusion. People know what to do, and who leads. However, unclear models frustrate teams. That lowers trust and slows effort.

Can operating model design impact patient experience directly?

Yes, it does. When teams align, care becomes faster and more consistent. However, poor structure creates delays, and patients feel that quickly.

What role does data play in operating model design decisions?

Data shows where problems sit. It highlights delays, gaps, and uneven results. So leaders use it to guide change, not guess.

How long does it take to stabilise operating model design changes?

It takes time, and patience matters. Teams adjust step by step, not overnight. However, clear direction speeds up this process.