Service Line Leadership vs. Management: Why Hospitals Need Both

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"Great managers understand what they did yesterday, what they have to do today and what they have to do tomorrow. Great leaders understand who they were yesterday, who they are today and who they want to be tomorrow," says Ira Kirschenbaum, MD, chairman of the department of orthopaedic surgery at Bronx-Lebanon Hospital Center in New York City. While there are many factors that differentiate a service line leader from a service line manager, the focus on "what" versus "who" is the essence of this distinction. Leadership is not necessarily superior to management and vice versa; in fact, a service line needs both types of skills to succeed.  

Two heads are better than one

A hospital-based service line should have a physician leader, such as a chairman of the department, who serves as the CEO of that service line, according to Dr. Kirschenbaum. This person provides leadership in fulfilling the service line's mission. A service line also needs a non-physician leader, such as a department director, who serves as the COO of the service line and manages operations.

The non-physician leader should have dual reporting responsibilities — one to the chairman of the department and one to a hospital C-suite executive, such as the hospital COO, Dr. Kirschenbaum says. "If [the department director] only reports to the physician, it would be the equivalent of a physician group in a hospital that's only pushing the physicians' agenda. You need someone on the service line who's going to represent the interests of the hospital," he says. Even if the chairman of the department is employed by the hospital, a second leader who understands the business and financial needs of the hospital can help drive success of the service line.

Divide and conquer
Operating a service line with two leaders not only ensures the hospital's needs are represented, it also allows the chairman and department director to divide the responsibilities of leading a service line. The chairman, or CEO, of the service line should support the department's strategic identity, while the department director, or COO, should oversee operational effectiveness, Dr. Kirschenbaum says.

In these roles, the CEO of the service line may focus 70 percent of the time on leadership and 30 percent on management. In contrast, the department director may need 70 percent of efforts focused on management and 30 percent on leadership, according to Dr. Kirschenbaum. Using a mix of leadership and management skills will allow the two service line leaders to promote both the identity of the department — "who" it is — and its efficiency — what it does. Their combination of skills will help the department stay true to its mission, which is one of the main duties of service line leaders.

Furthermore, dividing these responsibilities between two people enables the leaders to give equal attention to both identity and operations. "[No] business makes the CEO also the COO and CFO, so why are we doing that in healthcare?" Dr. Kirschenbaum says.

"You cannot run a service line with the best office manager you have. You need a [C-suite-level leader] with you, because that's efficient." Structuring a service line with two senior leaders is one of the keys to a service line's success, Dr. Kirschenbaum says. "You will fail if you don't do it this way. It's not 'you may' fail. You will fail."

More Articles on Hospital Service Lines:

From Silos to Service Lines: Integrating Care to Meet Hospital Goals
The Cardiovascular Service Line Approach: Creating Value in Organization Structure

4 Trends and Best Practices of Service Line Co-Management Relationships

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