In the past, hospitals were organized around departments or services like the catheterization lab, non-invasive labs, outpatient cardiology offices, etc. In contrast, a service line is organized around programs or patient types regardless of where they originate (inpatient, outpatient, and ambulatory care centers). The goal of organizing this way is to create value by leveraging talent and resources horizontally throughout the organization which focuses on care of patients across the continuum. It is also a reorientation of strategy, resource planning and allocation versus a vertically oriented approach which tends to segregate provider types into independent operating units or silos. There are some that have not been proponents of the service line approach to cardiovascular services as they contend that nearly 70% of cardiovascular care occurs outside of cardiology, i.e., internists, family practice, and hospitalists. Although that may be true, clinical collaboration amongst all of these specialties can assist in solving cardiovascular problems for patients based on mutually agreed upon clinical protocols, communicated by pre-established vehicles. This alone can help to set clinical standards, and work to eliminate unnecessary variation, delivering evidenced based care to patients.
To define the service line, it’s important to determine the patient types treated along the continuum. Additionally a good barometer is to say if 80% of care in a particular area is cardiovascular, then it should be incorporated as part of the service line. For example: is the service line cardiology only or is it a cardiovascular service line? If it’s the latter, then it would incorporate not only cardiology, cardiac and vascular surgery, but also interventional radiology.
What should the structure of the service line be? Success of any service line really depends on the leadership and staff that work within it. Many times, service lines will be led by a dyad leadership model, pairing business and clinical leaders alike whose have joint responsibility to not only lead the service line, but to ensure that best practice standards are in place. Anyone who has attempted to transition to a horizontal versus a vertical service line structure understands the complexities surrounding it. The ability to accomplish this is usually transformative as virtually every reporting relationship and decision making structure is disrupted. It is important to keep the following in mind:
- Take time to understand the skills required for a successful service line leader as it may be quite different than those of a physician leader to departmental manager. Careful selection will be vital to the success of the service line.
- Transformational change can attract many new comers to the table as they are looking for a more enhanced and superior future.
- Transparency of data and objectives will work to build trust and credibility amongst all providers and administrators.
Sharing early victories such as reducing variation in care, successful cost reduction strategies, quality improvement, maximizing efficiencies, can serve to minimize those “naysayers”. Consolidation within the healthcare sector will continue into the future. Therefore, it will be important for hospitals to be aligned operationally, financially and clinically.