Building a Single Service Management Model After a Hospital Merger

Use the VeriSM model as a sequence of decisions, not a documentation exercise. In Define, agree the shared service outcomes: safe patient care, clinical availability, incident response and regulatory evidence. In Produce, design a minimum viable model: one incident process, one on-call directory, common severity levels, shared major incident command and a single service catalogue. In Provide, deliver with federated execution: local clinical teams keep their workflows and super-users, while central teams own standards and tooling. In Respond, use incidents, feedback and audit findings to improve the model.

Do not centralize everything in 90 days. The 47-minute delay to find the right engineer is a mesh failure in resources and information, so fix the on-call directory and shared contact data first. Standardize what affects safety and coordination; leave local clinical configuration to local owners. Run one pilot on imaging and one on the patient portal before scaling. The board should receive a 90-day milestone plan: shared incident command in 30 days, on-call directory in 45, common catalogue in 90. This respects clinical variation while creating a single operating model.

Centralize identity and access, the on-call directory, major incident command, common monitoring, vendor contracts and CMDB standards. These are coordination and safety assets; fragmentation caused the 47-minute delay. Federate clinical application ownership, change planning for clinical systems and local training, with central guardrails. Leave local workflow configuration, super-user support and site-specific escalation to the sites, because clinicians understand patient flow.

The reasoning is that the mesh should place decision rights where knowledge and risk sit. Centralizing everything would break clinical workflows and create a new bottleneck. Leaving everything local would repeat the outage. Use a RACI for each service and a service taxonomy: group-wide, shared, site-specific. For clinical systems, a clinical safety officer should have veto authority. Publish the model and test it with a tabletop outage across two sites. Success is not a single org chart; it is a shared on-call list, one incident process and local ownership of clinical configuration. Review the split after 90 days using incident data.

Separate the board deadline from the operating model. The board can approve a 90-day direction, guardrails and a milestone plan; it should not approve every local workflow. Set up a joint governance group with the two CIOs, a clinical safety officer, the integration lead and a regulator liaison. Define decision rights: group-wide standards and risk appetite at the group; clinical configuration at the sites; incident command under the group major incident process. Build regulatory evidence into the process: incident reporting, clinical risk assessments, audit logs and review records.

The 90-day deadline should deliver a minimum viable model, not full standardization. Sequence: shared incident command and on-call directory first, common severity and reporting second, catalogue and CMDB standards third. Report to the board monthly on three outcomes: time to restore clinical service, cross-site incident handoff and regulatory evidence completeness. If the regulator requires evidence of clinical risk control, do not wait for the new tool; use the existing systems to produce a manual evidence pack. Governance succeeds when the board sees control through outcomes and exceptions, while clinicians keep enough local authority to protect patient care.