Carve-Out Chaos: Why Day 1 Isn’t as Simple as It Sounds

Carve-out acquisitions are a growing part of healthcare M&A integration, offering health systems a way to divest business units quickly. However, hospital integration support during the critical Day 1 transition is essential to prevent operational disruptions and keep patient care uninterrupted.

Carve-outs may look clean on paper—divesting a business unit, onboarding a new partner, flipping the switch. But in reality? The handoff is rarely that simple.

Unlike traditional M&A deals that allow time for integration, carve-outs often demand a “big bang” transition—where IT systems, HR processes, even phone lines and scrub colors switch over on Day 1.

And the truth is: patients don’t stop showing up to the ED just because your organization is in transition.

Taming the Chaos: 3 Keys to a Smoother Day 1 Transition Planning

Based on years of leading post-acquisition integrations and providing hospital integration support, here’s what I recommend for keeping things calm(ish) during a carve-out.

1️⃣ Create a Detailed Transition Services Agreement (TSA) Plan

You can’t transition every system and process on Day 1. A clear, comprehensive Transition Services Agreement (TSA) is essential.

✔️ Identify which services need to continue temporarily

✔️ Define roles, responsibilities, timelines, and costs

✔️ Reduce stress, confusion, and last-minute firefighting

2️⃣ Establish a Command Center

You need a physical and virtual hub to manage the go-live.

✔️ Daily huddles with leadership

✔️ On-site presence to support clinical staff

✔️ Open Teams or Zoom line for real-time troubleshooting

Command centers keep things focused, collaborative, and human—even when chaos hits.

3️⃣ Build the Right Team

You can’t do this with your existing staff alone.

✔️ Internal champions to lead operations

✔️ Contract staff to fill gaps quickly

✔️ Integration partners to coordinate the work

This blended model keeps clinical teams focused on care while your transition stays on track.

Seen It Firsthand

During the Wake Forest Baptist Health–High Point Medical Center go-live, we experienced all the chaos (and all the camaraderie) that comes with a big bang transition. If you were there—drop me a note!

Planning a Carve-Out?

At Chandler Healthcare Advisors, I help healthcare organizations design healthcare M&A integration strategies that work in the real world—avoiding burnout and keeping operations steady from Day 1 onward with expert hospital integration support.

💬 Planning a carve-out or navigating post-LOI chaos? Contact me

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