From Silos to Service Lines: Integrating Care to Meet Hospital Goals

The increasing emphasis on hospital-physician alignment and coordinated care has caused many hospitals to change their clinical department structure from the traditional silo model to a service line model. Service lines are designed to promote integrated care and collaboration, while the silo system tends to create a segmented organization with little communication or partnership between separate departments. Peggy Crabtree, RN, MBA, a vice president, and Robert Minkin, a senior vice president of The Camden Group, a healthcare consulting company, explain how adopting a service line model can help hospitals meet quality and cost goals.

Market forces
"We're starting to see a significant increase in hospitals embracing the service line structure because the market is demanding demonstrable value at a fixed price," says Mr. Minkin, who is a former CEO of Exempla Saint Joseph Hospital in Denver. "For current value-based initiatives, such as bundling, hospitals have to demonstrate specific clinical outcomes that the buyer or payor can depend upon. The service line structure facilitates those outcomes."

Tracking metrics
Service lines typically monitor their performance using a clinical report card. Mr. Minkin suggests including finance, clinical quality, patient satisfaction and efficiency categories with specific metrics for each on the report card. For example, the service line can track supply cost-per-case as a measure of financial performance and readmission rate as a measure of clinical quality. Ms. Crabtree, who is a former executive director of the cardiovascular and imaging service lines at Huntington Memorial Hospital in Pasadena, Calif., says hospitals should pay particular attention to metrics that payors look at when developing contracts with providers. Complication rates and door-to-balloon time — a cardiology metric that measures the time from a heart attack patient's arrival to the time angioplasty is performed — are some of the metrics payors will examine, she says.

By continually monitoring performance, the service line can adapt its strategies to meet and exceed local and national benchmarks. The service line's leadership, which typically consists of a physician and a non-physician executive, helps drive standards of care to meet both quality and cost goals. The service line's integration of physicians and clinicians who are expert in a certain clinical area can meet these goals more effectively than silos, which are often uncoordinated.

"Once you can demonstrate predictable outcomes clinically, you have reached nirvana in service line leadership," Mr. Minkin says. "You can take it to market and hopefully create a distinctive relationship with various payors that will prefer your organization over your competitor." He says the hospital can use service lines and their ability to drive high-quality, cost-efficient care to become the center of excellence in different clinical areas, attracting payors who rely on dependable, low-cost services for success.

More Articles on Service Lines:

The Cardiovascular Service Line Approach: Creating Value in Organization Structure
4 Trends and Best Practices of Service Line Co-Management Relationships

10 Critical Success Factors for Building a Leading Neurosurgery & Spine Program

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