Creating Value in Organization Structure - The Service Line Approach - Part 2: Clearly Defining The Scope of Operation

Monday, May 7, 2012 | MedAxiom

What Is The Service Line?

The service line, is in its most simple explanation, is a reorientation of strategy, resource planning and allocation on the horizontal continuum across provider entities, versus a vertically oriented approach segregating provider types into independent operating units, or silos. It is the strategic and operational organization of cardiovascular services in a marketplace, wherever they occur – hospitals, clinic, long term care and the like. The theoretical value in the horizontal or service line approach is created in aligned and not duplicative investment strategy in program, staff, equipment and other resources required serving cardiovascular patients. The service line approach is the true patient-centered approach to the delivery of healthcare services and is organized in the way that cardiovascular patients experience healthcare. By nature, the integration of cardiology organizations with hospitals provides the opportunity for organizational, strategic, operations and financial alignment between organizations serving the same patient populations.

70% of Cardiovascular Care Occurs Outside of Cardiology

Critics of the service line approach complain that specialist focused service lines create silos in and of themselves, citing that the vast majority of cardiovascular care is managed outside of the cardiologist – in primary care settings and with hospitalists. While aspects of this statement may be true, it only drives the point that further collaboration on the genesis of the diagnosis and clinically integrated care with internists, family practice and hospitalists is a logical extension of the service line approach. Clinical collaboration for the purpose of solving cardiovascular problems for patients is based on mutually determined processes to deliver results given established clinical protocols. Care coordination will occur across established communication vehicles, all for the purpose of providing superior care to patients. It is incumbent on the service line to not only set clinical standards for itself, driving to eliminate unnecessary variation and delivering value to patients, but additionally incumbent upon them to set clinical standards upon which coordinated care will be executed. Providing care in a service line orientation does not create a horizontal “silo”, not accessible to the care community, but places the responsibility of creating the clinical standard and protocol, on the service line itself. Here in lies the opportunity to create value.

How It’s Done

Successful service lines have a clearly defined scope of operation. From a clinical perspective, the clearly defined scope would define the patient types treated along the care continuum – which in turn determines the various specialties who would logically participate. For example, is the service line a cardiology service line or a cardiovascular service line? The former would inherently include vascular surgery, interventional radiology in addition to cardiology and cardiac surgery. Operations clarity defines the extent of operational authority and responsibility that the service line would have. Many programs manage clinics, catheterization labs, diagnostic testing labs and operating rooms as part of the service line, but do not manage associated nursing units. Some do.

From an organization structure, scope clarity defines the authority and responsibility for decision making within the service line. For example, is the service line built with physician leaders who have medical director roles that are advisory to the administration, or does the scope of the service line treat the service line like a strategic business unit? In the strategic business unit example, the CV enterprise is accountable for the strategic, financial and operational scope of the business unit, often relative to various approvals and conditions required by the larger institution. In any regard, an aligned approach to a clearly defined scope across traditional silos is the primary service line organization structure.

The service line successful operation, like all operations, is dependent on the leadership and staff that work within the unit. Service lines that are led in a dyad leadership fashion, pairing business and clinical leaders, whose joint responsibility is leading the service line, is rapidly and resolutely earning best practice status. In addition, a multi-disciplinary management team is assembled by examining the combined organization’s functional silos and identifying managers and staff who are focused on cardiovascular services within the functional departments. Empowering that team around a shared vision of excellence for cardiovascular patients is the “go-power” fueling the effort.