Solving the Clinical Service Line Puzzle ? Part 1

Thursday, November 17, 2016 | Larry Sobal

Health systems have long embraced the idea of clinical service lines, but as I blogged back in June, many service lines are underperforming. Although at MedAxiom we are usually engaged by organizations to improve their cardiovascular service lines, we are often asked to assist in optimizing the performance of others. That is because the mechanics of constructing and operating an effective clinical service line has many of the same strategic questions and desired attributes whether it is CV, Orthopedics, Oncology or another area of clinical focus. Let’s explore some of the challenges and considerations that can make the difference between service line mediocrity and success.

To start, many organizations face a common strategic challenge: how to best construct a service line that balances the sometimes conflicting imperatives of its different organizational silos while meeting the needs of patients who flow horizontally across these silos. The diagram below provides an illustration of the different components that need to align for service lines to work.

As health systems put in place different pieces to clinically integrate, we often find that each component becomes a silo with its own strategy and intent, and systemic thinking can be lacking. Adding a service line (or multiple service lines) to this process only adds to the confusion in terms of clarity, prioritization and the ability to collaborate. The confusion can multiply depending on the size and geographic scope of the system. 

Here’s a common scenario. The health system Leadership Team has pronounced the need to create a clinical service line and named a lead executive to be in charge. The bulk of the clinical inpatient work is traditionally performed at one of the hospitals, which sees itself as the Center of Excellence for that service. A newly formed Medical Group now employs both primary care and the specialists who are integral to delivery of that clinical service. Finally, the Health Plan has identified the quality and cost improvement needs for that clinical service, which are necessary for the plan to be competitive in the market. 

Often there is a problem of one or more (or sometimes all) of the horizontal silos being unable to align their interests, and the service line executive not being supported enough by Senior Leadership to overcome the competing priorities. It also may be that there is not an effective service line governance model in place to overcome the resistance. An additional flaw may surface when the service line fails to recognize that patients come in and out of the service line at different points along a continuum of care. Or, it may be that the service lines place too much emphasis on one aspect (such as inpatient) of the care continuum rather than defining the service line broadly enough to include a scope that stretches from primary/preventive care to post-acute care.

As health systems put in place different pieces to clinically integrate, we often find that each component becomes a silo with its own strategy and intent, and systemic thinking can be lacking.

I’ve been a service line executive on numerous occasions in my career and work with many of them today as a consultant, so I know the above scenario is more the norm than the exception. It can be painful and frustrating for those involved.

Fortunately, there are some great service line success stories and organizations who have worked out the dynamics so that their clinical service lines are the leading drivers behind strategic improvement and growth. I’ll cover the successful side of service lines in my blog post next week.

If you are interested in contributing to some service line research, MedAxiom has developed a CV Service Line assessment mechanism, known as MedXcellence, where you can add your CV Service attributes to the database. The survey can be accessed at www.medaxiom.com/medxcellence. Chose the CVSL Survey option to participate. I’ll share some information from the data collected next week.

 

 

Illustration: Lee Sauer

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

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