Herding Bengal Tigers: How to Manage a Hospital Orthopedic Service Line

One of the challenges of managing a service line is coordinating physicians, clinicians and other staff to create a single, unified organization that delivers high quality care efficiently. To accomplish this task, a service line leader needs to first recruit talented individuals, and then bring the individuals together to form a functioning group. Ira Kirschenbaum, MD, chairman of the department of orthopaedic surgery at Bronx-Lebanon Hospital Center in New York City, explains how to recruit physicians for an orthopedic service line and integrate them in a team.

Recruit talented individuals
Dr. Kirschenbaum says the biggest mistake healthcare leaders make in recruiting is hiring someone to fill a vacant position even if the applicant is not a great fit for the position. Instead, he suggests focusing on hiring the best talent first, and considering open positions second.

For example, he says if he needs a hand surgeon but the applicants did not meet all the qualifications, he would not hire one of the applicants despite the need for a hand surgeon. If he happens to meet a very talented trauma surgeon, Dr. Kirschenbaum says he would hire him or her even if there is not an opening for a trauma surgeon at the time. "Almost no one who works for me was hired when I needed someone for that service line," Dr. Kirschenbaum says. "I hired him [or her] based on the best talent available at that moment. Now we have the fastest growing spine service line in New York because we hire talent."

Form a team

Recruiting talented physicians is only half the battle, however. A service line with very talented individuals who do not work well together will likely fail, because an efficient service line depends on streamlined, integrated care. "That's what managing high-level service lines is all about," Dr. Kirschenbaum says. "You have to move individual success into a hospital's definition of success in their business plan. That is the greatest challenge."

He likens the need for a connected service line group to the need for a unified basketball team. "It is getting the individual talent of basketball players to work together as a team to get to the level of success that the owners define," he says.

Forming a team of talented individuals may be particularly difficult in an orthopedic service line. Dr. Kirschenbaum says bringing orthopedic surgeons together and aligning their goals with those of the hospital is more difficult than herding cats — it's like "herding Bengal tigers." This analogy points to the independence and skill level of talented orthopedic surgeons. "Orthopedic surgeons are very independent characters. If they're going to work within a hospital culture, they need to be a team," he says. "If you could find a way to manage high-level, independent and high-producing doctors and work as a team unit, that's the dream team."

Creating this team depends largely on recruitment, but it also relies on the strength of the hospital service line leader. Dr. Kirschenbaum recommends the chairman of the department, who typically leads the service line, should train him or herself in business and leadership skills, such as learning Six Sigma techniques. "It's the only way you're going to overcome the challenges," he says.

More Articles on Hospital Service Lines:

Structuring Hospital Service Line Management for Success
Developing a Cardiovascular Service Line: Shifting From a Vertical to Horizontal Mindset

Service Line Leadership vs. Management: Why Hospitals Need Both

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