PwC presents four things that can undermine the benefits of scale among newly merged hospital systems. Here they are, as summarized by Becker’s Hospital Review:

1. Individual facilities operate with too much autonomy within the system. 

2. The system doesn’t work to overcome the tendency among hospital leaders to operate independently. 

3. The merger fails to emphasize the importance of cost synergies.

4. Leaders prioritize the short-term goal of closing the deal over the long-term goal of integrating the new entity.