Structuring Hospital Service Line Management for Success

The service line model for clinical specialties can provide many benefits through its integrated design and focus. To receive the full benefits of this model, however, hospitals need to create a management structure that fosters independent innovation as well as alignment with the hospital's strategic plan. Peggy Crabtree, RN, MBA a vice president, and Robert Minkin, a senior vice president of The Camden Group, a national healthcare consulting company, describe how to optimize a service line's management structure to drive financial growth and clinical excellence.

Empower service line leaders
For service lines to be truly effective, their leaders need the authority to make strategic decisions that can result in real changes in costs and quality. "In the most mature of these [service line] models, typically the leader is considered to be the CEO of that particular clinical service dimension," says Mr. Minkin, who is also a former CEO of Exempla Saint Joseph Hospital in Denver. "It is important that physicians and the remainder of that organization see the service line leader as someone who is empowered to make key decisions that are otherwise reserved for people in the C-suite."

The hospital C-suite can empower its service line leaders by fully committing to the service line model. "Realize what the benefits are — it allows you to partner with your physicians much more deeply and effectively. Embrace the idea that the hospital and management staff are going to work more closely together to define how the clinical process is operated," Mr. Minkin says.

Start with a dyad

A service line is typically run by a leader who manages the overall operation of the service line and its role in the hospital's strategic plan. This business leader usually partners with a physician who oversees clinical practices. While in smaller hospitals one person may be responsible for both business and clinical areas, most hospitals follow the partnership model, according to Mr. Minkin.

This dyad leadership requires transparency and communication to be effective. "Over time you develop trust and open communication when you realize that you're really working together in setting the strategic direction," says Ms. Crabtree, who is a former executive director of the cardiovascular and imaging service line at Huntington Memorial Hospital in Pasadena, Calif. "Having key physicians and/or a medical director there, helping to champion what you're doing, makes a difference. Sharing successes, being available to physicians and being responsive to issues they identify is critical."

It is also helpful for the business service line leader to have a clinical as well as management background Ms. Crabtree says her nursing degree combined with her business degree, gave her credibility with physicians and helped her succeed as a service line leader.

Appoint managers
Reporting to the dyad should be a team of subspecialty managers. In an example from The Camden Group, an orthopedic service line may have councils for joint replacement, spine care and sports medicine. These councils would report to the dyad, which includes an executive physician director and the service line/department director, and would provide input and problem resolution for operational issues vs. day-to-day oversight.

The managers are the go-to people to handle everyday problems. It is critical that the service line leader not be pulled into these day-to-day issues, but instead focus on the broader, overarching goals and challenges of the service line. "You want the [service line leader] to be leading strategic efforts and building partnerships and doing things that are going to drive the kind of change you want," Ms. Crabtree says. "It's very easy to get pulled into day-to-day problem solving, then lose sight of what you need to be doing strategically to grow the service line." Establishing a management structure that clearly delegates responsibilities is thus crucial to supporting service line leaders.

More Articles on Hospital Service Lines:

Developing a Cardiovascular Service Line: Shifting From a Vertical to Horizontal Mindset
Service Line Leadership vs. Management: Why Hospitals Need Both

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

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