Hospital leaders who are successful managers today are successful because they manage change. The great hospitals leaders by now have become masters at it. But there’s a difference between change you can see coming (bundled payments, EHR implementations, declining reimbursements) and change that shows up unannounced on the front door.

That’s often what it feels like when a huge, publicly traded company acquires a smaller physicians group. It can feel like a long-lost uncle suddenly showing up at your doorstep, which is to say it’s not always all harmonious. If that physician’s group is the one managing your emergency department, or if it’s your hospitalist group, or some other major provider then it can require a particular set of strategies — and a lot of finesse — to manage the change.

Here are some considerations for hospital leaders who suddenly find themselves with a major new partner, one that they never chose:

1. Alignment. You can be sure the new physicians group has a strategy, but what you can’t be sure about is whether it’s your strategy. Since you never chose this group, the first question is whether the new company you’ll be contracting with shares your hospital’s goals. Start the discussion early so that everyone understands the direction you’re trying to go.

2. Commitment to quality. Consolidation amongst physician’s groups is hardly ever a decision about quality, but rather one of market forces. Of course, everyone claims to be all about quality, but there are often disconnects between the marketing and the reality. A good practice is to do some due diligence here and ask to see some solid empirical historical data on the quality metrics most important to you.

3. Cultural fit. There are pros and cons to partnering with a large, national group, but one thing is for sure: There will be a shift in corporate culture if your previous group was a smaller regional player. Large groups will bring certain stakeholders (often shareholders), processes, and ways of communicating that are different from what came before. It is important to consider whether the new way of doing business improves or degrades hospital services.

4. Attrition and retention. Certain people deal with change well, and others do not. In any transition, your staff will use this as a time to reevaluate their own path. Some will leave and some will stay, and all of them will have questions about what will change under the new group. This is a time when over-communication will reduce stress — and help retain your best people. It’s also a good time to identify those most impacted across the entire organization, seek their input, and ensure their concerns are being well considered.

Perhaps the best advice is the most obvious: Consider shopping around. If it’s clear your new hospital partner isn’t a good fit, pick up the phone and talk to your peers at other hospitals. Reach out to the new group’s competitors and see if they have more to offer. Unexpected change can be exactly the right opportunity to see what else is out there.

Kyle Bray is chief operating officer, MEP, and blogs at  blogs at The Shift.