| Course | DHA 711 Administration of Complex Health Care Systems (DHA/711) |
|---|---|
| Week | 7 |
| Paper type | Strategic decision critique |
| Length | about 1,153 words, 4 double-spaced pages plus title page and references |
| Format | APA 7 student paper |
| School | University of Phoenix |
| Program | DHA |
| Updated | September 2026 |
Free sample paper for DHA 711 Week 7
Seven Miles Apart: A Critical Analysis of a Network's Acquisition of Its Nearest Competitor, Three Years Later
[Student Name]
University of Phoenix
DHA/711: Administration of Complex Health Care Systems
Week 7 Assignment
[Instructor Name]
[Date]
The network, the acquired hospital, the deal, projections and outcomes are composites written for a model paper; research findings come from the sources cited.
Three years ago, the network announced that it would acquire a 160-bed independent hospital seven miles from its own regional hospital on the coastal plain. The press release promised better care, lower costs and a stronger future for the community. The regional vice president, who had not been involved in the decision, was asked by the board's strategy committee to review it. This paper critiques the decision: its rationale, process, evidence and results.
The Decision and Its Rationale
The network gave three reasons. First, a larger rival network had approached the independent hospital, and acquisition would prevent a competitor from establishing a foothold. Second, combining the two hospitals would allow services to be consolidated, such as moving cardiac surgery to one site and obstetrics to the other. Third, the network projected $18 million a year in savings from shared purchasing, administration and information systems.
The Decision Process
The process was fast. The board approved the deal within four months of the first conversation. Due diligence focused on finances, facilities and legal liabilities. It did not include an analysis of quality at the independent hospital, a community impact assessment or consultation with physicians at either hospital. Commercial insurers were informed after the agreement was signed.
The Competitive Context
The rival network's interest was real. It had acquired two hospitals in the adjacent county and was recruiting physicians in the network's service area. Network leaders feared that a rival foothold would pull referrals from the academic center and weaken the regional hospital. That fear shaped the decision's speed and framed acquisition as defensive, a framing that made alternatives seem riskier than they were.
What the Evidence Said About Quality
Research available at the time, and since, tempers the quality promise. A study using Medicare claims and Hospital Compare data compared 246 hospitals acquired between 2009 and 2013 with 1,986 control hospitals and found that acquired hospitals slipped on patient experience, about nine percentile points relative to peers, no significant changes in 30-day readmission or mortality and improvements in process measures that could not be attributed to the change in ownership (Beaulieu et al., 2020).
What the Evidence Said About Prices
Research also points to price effects. Using claims from employer-sponsored insurance, Cooper and colleagues found that prices at monopoly hospitals were about 12% higher than in markets with four or more competitors and that mergers between near neighbors, roughly five miles apart or less, pushed prices up by over 6%, whereas mergers of hospitals far apart did not (Cooper et al., 2019). Seven miles apart, the two hospitals fell close to the range where price effects appear. Two hospitals this close together were competing for the same patients, and the merger ended that competition.
What the Evidence Said About the Trade-Off
Cutler and Scott Morton describe consolidated systems as offering the ability to coordinate care across practitioners and sites, offset by the potential for higher prices through market power, since insurers struggle to bargain with one of a few systems; each consolidation generates some benefit and some harm, depending on the facts (Cutler & Scott Morton, 2013). The network's case rested on coordination; the evidence required it to show that benefits would outweigh the market-power costs.
Outcomes After Three Years: Quality
Quality outcomes at the acquired hospital were mixed. Mortality and readmissions did not change significantly. Patient experience scores declined in the first two years, which staff attributed to turnover and changes in scheduling and billing. Process measures improved after network protocols were adopted.
Outcomes After Three Years: Prices and Costs
Commercial prices at the acquired hospital rose to network rates, an increase of about 11% over three years, above regional trends. Realized savings reached about $9 million a year, half the projection, mainly from purchasing. Information system conversion cost more than planned.
Outcomes After Three Years: Services
Consolidation moved cardiac surgery to the network's hospital, and outcomes remained strong. Obstetrics moved to the acquired hospital, increasing travel for some families by up to twenty minutes. The acquired hospital's inpatient psychiatric unit closed, a change not mentioned in the original announcement.
Outcomes for Staff and Community
About 120 administrative positions were eliminated. Physicians at the acquired hospital reported lower morale and several left. Community members were divided: some welcomed investment in facilities, while others felt the loss of an independent local institution and of psychiatric beds.
Alternatives Not Seriously Considered
The critique identified alternatives that deserved attention: a clinical affiliation without acquisition, sharing specific services such as cardiac surgery through a joint venture, or allowing the independent hospital to join the rival network and competing on quality. Each would have carried risks, but none was analyzed.
What Was Knowable at the Time
Fairness requires judging leaders on what they could have known. Research on price increases after nearby mergers had been published and discussed widely before the deal, and studies questioning quality gains from consolidation were emerging. A quality assessment of the independent hospital was feasible with public data. The information needed for a more balanced decision was available; it was simply not sought.
A Balanced Judgment
The acquisition was not a failure. Services were rationalized, facilities improved and cardiac care consolidated safely. But the decision process was narrow, the projected savings were optimistic, quality gains were not demonstrated and prices rose, consistent with research on nearby mergers. The rationale of preventing a competitor's entry served the network more clearly than it served patients or payers.
Good Decision, Bad Luck, or Weak Process?
Separating process from outcome is essential. Some disappointments, such as staff turnover during a regional labor shortage, reflected conditions beyond leaders' control. Others, such as untested savings projections and the absence of a quality or community assessment, reflected weaknesses in the process that better practice would have addressed.
What Payers Experienced
Commercial insurers reported higher costs for their members in the region, and one large employer moved to a narrow network plan that excluded the acquired hospital for elective procedures. The state's insurance regulator asked the network for information on price increases. These reactions show that payers are stakeholders whose responses can limit the gains leaders expect.
Lessons for Future Decisions
The regional vice president recommended five changes for future transactions: include quality and community impact assessments in due diligence, consult physicians and community leaders before signing, test savings projections against published evidence, commit publicly to measurable community benefits such as maintaining specific services and commission an independent review two years after closing.
Conclusion
The acquisition of a hospital seven miles away delivered some of its promises and missed others. Research finds acquisitions often worsen patient experience without improving mortality or readmissions and that nearby mergers raise prices, a trade-off consolidation research describes. A fair critique credits the service improvements, faults the narrow process and draws lessons that could make the next strategic decision stronger.
References
Beaulieu, N. D., Dafny, L. S., Landon, B. E., Dalton, J. B., Kuye, I., & McWilliams, J. M. (2020). Changes in quality of care after hospital mergers and acquisitions. New England Journal of Medicine, 382(1), 51-59. https://doi.org/10.1056/NEJMsa1901383
Cooper, Z., Craig, S. V., Gaynor, M., & Van Reenen, J. (2019). The price ain't right? Hospital prices and health spending on the privately insured. The Quarterly Journal of Economics, 134(1), 51-107. https://doi.org/10.1093/qje/qjy020
Cutler, D. M., & Scott Morton, F. (2013). Hospitals, market share, and consolidation. JAMA, 310(18), 1964-1970. https://doi.org/10.1001/jama.2013.281675
What the DHA 711 Week 7 instructions ask
The seventh DHA 711 assignment often asks students to critique a strategic decision in a health system. Students typically describe the decision and the reasons leaders gave for it, evaluate the decision process, compare the rationale with research evidence, assess alternatives that were or were not considered, examine outcomes for patients, communities, staff and payers and draw lessons for leaders. Where students pick a decision from their own organization or the news, documented facts should anchor every claim. Strong papers judge the decision fairly against what was known at the time, use evidence rather than hindsight alone, consider multiple stakeholders and distinguish good decisions with bad luck from poor decisions.
How this DHA 711 Week 7 example is built
The press release announcing the acquisition, with its promises of better care and lower costs, opens the paper. The decision and its rationale are described: preventing a rival network's entry, consolidating services and capturing efficiencies. The decision process is evaluated, including what due diligence covered and what it missed. Research on quality after acquisitions and on prices after nearby mergers tests the rationale, and the competitive pressure behind the deal is explained. Outcomes after three years are examined for quality, prices, services, staff and community. Alternatives that were not seriously considered are identified. A balanced judgment, a distinction between weak process and bad luck and lessons for future strategic decisions close the paper.
DHA 711 Week 7 grading rubric: where the points go
The critique week is typically graded on a fair and evidence-based evaluation of a strategic decision. Graders look for the decision and rationale described accurately, the decision process assessed, rationale compared with research evidence, outcomes examined for multiple stakeholders, alternatives considered, a distinction between process quality and results and practical lessons. Health economics and quality research on consolidation strengthens the critique, as long as it is applied to the specific facts of the case. Judging the decision against what was knowable at the time earns credit. Including community and payer perspectives also earns marks. Clean doctoral writing and correct references complete the grade. Critiques that rely on hindsight or only on the organization's own claims usually score lower.
DHA 711 Week 7 help: mistakes to avoid
Many DHA 711 Week 7 critiques either praise a decision because leaders did or condemn it because results disappointed. Separate the quality of the decision from its outcome. Ask what the decision makers knew, what evidence existed, which alternatives they weighed and how they involved stakeholders. Compare their stated rationale with research on similar decisions. Then examine outcomes for patients, staff, payers and the community, using data where possible. Name alternatives that deserved attention, even if leaders rejected them for good reasons. Finally, draw lessons that could improve future decisions, such as better due diligence, commitments to the community or independent evaluation, and say who should act on each.
Related DHA 711 sample papers
Other DHA 711 week samples
- DHA 711 Week 1: Complex Health Systems
- DHA 711 Week 2: Theory Applied to a System
- DHA 711 Week 3: System Structure Analysis
- DHA 711 Week 4: Strategic Planning Across Units
- DHA 711 Week 5: Multi-Organizational Management
- DHA 711 Week 6: Governance Structures
- DHA 711 Week 8: System Recommendations
More DHA sample papers
DHA 711 Week 7 questions, answered
What does DHA/711 Week 7 usually ask for?
The seventh complex systems paper often asks students to critique a strategic decision, evaluating its rationale, process, evidence, alternatives and outcomes for multiple stakeholders.
Where can I find a free DHA 711 Week 7 sample paper?
Read the acquisition critique above at no charge; notes explain each judgment. Share the decision you are analyzing, and the opening paper is on us.
Do hospital acquisitions improve quality?
A study of 246 acquired hospitals found acquisition associated with modestly worse patient experience and no significant change in readmission or mortality rates, with inconclusive effects on process measures.
Do hospital mergers raise prices?
When the merging hospitals sit close together, yes: claims data show increases above 6% after mergers of near neighbors, but little effect when hospitals are far apart.
How should a strategic decision be judged?
By separating the quality of the decision process, what was known, which alternatives were weighed and how stakeholders were involved, from the outcome, which also reflects luck and events outside leaders' control.
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