Developing a Cardiovascular Service Line: Shifting From a Vertical to Horizontal Mindset

At a recent event in Chicago, Suzette Jaskie, president and CEO of MedAxiom Consulting, and three service line leaders representing different hospitals from across the country — Christine Bent, senior vice president-clinical services lines, Allina Health in Minneapolis; Michele Molden, executive vice president and chief transformation officer, Piedmont Healthcare in Atlanta; and Julie Younger, chief administrative officer, Mercy Health System's Iowa Heart Center in Des Moines — discussed efforts to build integrated, aligned service lines in a panel session.

The four women, who meet regularly to discuss service line development, shared highlights of their last meeting together in Atlanta, including challenges and best practices in cardiovascular service line integration.

Allina Health, Piedmont and Mercy are all currently operating integrated cardiovascular service lines and are all considering or working toward shifting their organizations to a service line-based structure. Developing horizontal service lines is an important step in moving your organization toward coordinated care, said the women, but they agreed their own experiences were filled with challenges. 

Determining horizontal, vertical responsibilities

The transformation toward a service-line based structure involves moving from a vertical structure of healthcare delivery (based on sites or locations of care) to a horizontal one (based on services lines). According to Ms. Molden, it is through horizontals that strategy and metrics are set and where collaboration takes place, while the role of the verticals is to execute the strategy.

Ms. Molden called the integration of Piedmont's cardiovascular service line "probably the most disruptive innovation our organization has ever experienced." She explained that as the process moves forward to other service lines, many employees may have very different jobs than they do today.

Ms. Younger explained that bringing together vertical providers in a horizontal service line can result in "turf issues" if steps aren't taken to reduce competition and encourage collaboration. To be successful, physicians must be given leadership roles and allowed to drive the process, she said.

Ms. Bent noted that the transformation has resulted in a somewhat duplicative management structure at Allina Health (with service line managers and department managers overlapping duties in some cases). However, she believes that will slowly be worked out as vertical managers begin to take on more responsibilities around execution while horizontal managers focus on care redesign and strategic issues.

All agreed, though, that the results were very much worth the effort. "We create more value for our hospitals and communities by aligning," said Ms. Bent.

"Is it the right model? It absolutely is," she added. "It's really focused [on] the value."

A new role for CEOs, COOs

The three also discussed how the shift toward horizontal service lines will transform the responsibilities of a health system's C-suite.

Ms. Molden believes many systems will move away from individual hospital CEO roles and instead appoint a chief operating officer or chief administrative officer for each hospital that will be responsible for operations and execution, rather than strategy. She explains that hospital CEOs today have been incentivized to "maximize the sub-unit" rather than the system as a whole. She believes those incentives will change dramatically in the future. 

Some have referred to this current leadership model as a "castle mentality," and Ms. Molden added it will be a slow process to dismantle but will be a real win for patients and providers. "We'll actually be serving our patients, rather than ourselves."

More Articles on the Cardiovascular Service Line:

From Silos to Service Lines: Integrating Care to Meet Hospital Goals
Ideas and Concepts to Improve Cardiovascular Program Profitability
8 Strategies to Increase Hospital Service Line Revenue, Reduce Costs

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