Service Lines, A New Way to Manage:
The service line model has actually been around for decades, however the emphasis to improve quality, efficiency, customer satisfaction, and alignment between hospitals and physicians suggests that service lines may be resurrected once again to accomplish these improvements.
The focus for service lines is quite simple; it is organizing care for a specific population. For this writer, service lines align with population health management where a cohort of patients with the same disease is cared for. For example, orthopedic, cardiovascular, cancer, and labor and delivery patients all have specific needs where a team led by an administrator and physician who identify benchmarks for positive outcomes, develop protocols, and continually monitor quality and cost is the vision for service lines.
Every model has some opportunities and for service lines the dilemma, it seems, is that service line responsibilities can be somewhat “fuzzy” when identifying specific job responsibilities and organizational structure for reporting.
This organization chart offers an example of the departmental leader’s reporting mechanism; for example, the CV Nursing Director reports to both the Administrative Director and the Chief Medical Officer.
If the Administrative Director is not a nurse, the CV Nursing Director will also report to a Chief Nursing Officer or designee at the administrative level. In addition to defining a reporting system, at times there is territorial confusion since job responsibilities oftentimes overlap within the administrative structure. Clearly defining job responsibilities can mitigate territoriality challenges.
There are benefits to implementing a service line model:
⦁ Patient focus
⦁ Improved quality of care and patient safety
⦁ Improved continuity of care
⦁ Improved coordination of care
⦁ Alignment with strategic goals and a shared and common vision
⦁ Ability to rapidly respond to market changes
⦁ Standardization of care (overall management) with protocols
⦁ Normalization for resource allocation (staff, beds, capital, etc.)
⦁ Enhanced accountability
⦁ Personnel retention
⦁ More efficient cost management
⦁ Management of limited resources (cost, revenue, personnel, space, physicians, etc.)
⦁ Proper sizing of programs
⦁ Expertise in marketing services
⦁ Improved collaboration between administration and physicians
In addition to benefits, there are always opportunities to improve a process/model like service lines:
⦁ Determine which service lines to institute – where are your strengths
⦁ Solid organizational chart with a defined reporting mechanism
⦁ Job description for each position with no or minimal redundancy
⦁ Determine profitable service lines based on data
⦁ Assess profitability of each service line at regular intervals
⦁ Define the budgeting process and accountability
⦁ Develop metrics to measure service line performance
⦁ Identify success factors for each service line
⦁ Determine how patient visits will be allocated, MS-DRG or ICD-10; plan for ICD-11
⦁ Focus on outcomes
⦁ Invest in the continuum of care which includes the community
Transforming health care requires leaders to rethink and redesign current models of care delivery that will take organizations into the future. Service lines may do just that for organizations, both large and small, which want to realize cost-savings, efficient processes, improved outcomes, and what it will take to be successful for the future.
“A pessimist sees the difficulty in every opportunity; an optimist sees an opportunity in every difficulty!” — Winston Churchill
Host: Diane Bradley, PhD, RN, NEA-BC, CPHQ, FACHE, FACHCA, Regional Chief Clinical Officer
Bradley has more than 30 years clinical management experience having previously served in leadership positions in acute-care, long-term and behavioral healthcare facilities. In the past, she also served in the U.S. Army as Chief Nurse of a 400-bed field hospital and large Army Medical Centers.
Bradley earned a Doctorate in Healthcare Administration from Baylor University; a Master’s degree in Nursing Administration from St. John Fisher College; a Master’s degree in Public Administration from SUNY Brockport; a Bachelor’s degree in Nursing from Alfred University; a Bachelor’s degree in Psychology from the University of Rochester; and a Diploma in Healthcare Administration from Baylor University in Fort Sam Houston.
She is also Certified in Nursing Administration, Advanced through the American Nurses Credentialing Center and a Licensed Nursing Home Administrator in New York State. In 2010 and 2011, Bradley became a Baldrige Examiner. She is also a Fellow of the American College of Healthcare Executives and the American College of Health Care Administrators. Bradley is currently serving as the President of the New York Organization of Nurse Executives.