A few months ago—in a calmer time before the Covid-19 pandemic—I facilitated what felt like the quintessential service line-strategy leader workshop of our times. It was quintessential because it centered around the single most common issue that strategy leaders tend to bring to our service line research team: service line leaders lacking strategy skills. But it turns out, lack of strategy skills wasn't the main problem—it was the perception.
Fast forward a few months, and I find this issue is even more acute in today's environment. Service line leaders I speak with across the country have been charged with crafting a strategy for growth as their health systems try to recover and rebuild from the Covid-19 crisis.
In this post I will share an outline of the challenges and opportunities that I found at pseudonymed "Artway Health." If you work at a health system, do these match your experience? If yes, read on for some suggested solutions.
Bottom line up front: While many service line leaders would indeed welcome training on how to best develop a strategic business plan or use data to guide decisions, I'd argue that without the infrastructure in place to allow them the time, resources, and support to execute on this plan, strategic skills are a moot point. What may seem straightforward for the strategy and planning office is typically having trouble playing out in execution—and strategy leaders must take some specific steps to close that gap.
How 'Artway Health' overcame 3 key challenges to service line strategy
The system I'm calling Artway Health is a midsize health system with strong competition in their market and on the journey from being a holding company to an operating company—not unlike many systems in the country. The system had seen a recent decrease in their market share for one of their top service lines.
In partnership with Artway's Chief Strategy Officer, Advisory Board brought together a multidisciplinary, cross-function, and cross-site group of stakeholders who had unique perspectives into how to tackle growth in this service line. Across the course of a half day, we facilitated exercises to understand their opportunities, surface the root causes keeping them from reaching this growth, and then prioritize top solutions that could be implemented in the short- and long-term to capture greater market share.
Here are three of the key challenges I saw during my time with Artway—and how to overcome them.
1. For service line leaders, the day-to-day was overtaking the strategic priorities. Ten years ago, service line leaders were responsible primarily for quality and operations for their program. Over time, as the industry has evolved, Artway's leaders have had more added to their plate: growth strategy, understanding the implications of health care reform, physician alignment, episodic cost management, care coordination – and not removed the quality and operational necessities. When push comes to shove, clinical emergencies, staffing issues, and keeping the labs running on time was often taking precedence over executing on long-term strategic initiatives.
2. Service line teams don't have the authority or influence they need to actually implement strategic changes. During our discussion, the Artway team recognized that access to outpatient clinics was a key issue to their market capture. Patients had complained they couldn't access physicians when they needed to, leading them to go to a competitor. With that root cause identified, the group decided they should adjust the cardiologist practice hours a few days a week to allow patients to come after work.
Simple, right? Well, no. Because if the conversation had ended there—with the strategy "solution" revealed—they would have gotten nowhere. Even if the CV administrator can identify that problem, they would not have had the ability to convince the medical group to change hours. The only reason Artway was able to make real progress in this working session was the fact that the strategy and physician group leaders were also present, enabling them to share the "aha" moment. As a group, they realized that the strategy and physician group leaders would have to be the ones to initiate the conversation, demonstrate the rationale and executive support for this change, and follow up with operational changes in the clinics needed to support physicians in adjusting hours.
3. Having a service line strategic plan did not guarantee success because it wasn't paired with key elements: follow-up, accountability, and a seat at the table. Artway service line leaders were in theory being guided by a plan that had been set, together with the strategy team, as part of an overall strategic plan process. But then the service line team was more or less on their own in terms of strategy support, until the strategic plan was up for an annual review—or until the data came back two quarters later showing the lack of growth results that all had been hoping for.
The Artway session revealed the need for a stronger ongoing working partnership between service line leaders and the system strategy function. It's impossible to identify in advance the complications service lines will face when trying to execute on a plan. The strategy leaders who were present agreed that there was a clear need to create an infrastructure for service line leaders to provide regular updates on progress and where they need more support to pinpoint issues before they derail timelines, and for strategy teams to brief service line leaders on data and tools that can support their efforts.
How strategy leaders can position service line teams for strategic success
Taking a step back from Artway, I think most system-level strategy leaders have several immediate opportunities to help bridge the gap from "service line strategy" to reality.
- Make sure your service line leaders have a clear line of communication with the strategy department, and know all the resources available to them to support their initiatives.
- Clearly prioritize targeted strategic initiatives for service line leaders—with their input—with realistic timeframes, goals, and accountability measures. And break long-term initiatives into short-term projects that are less likely to fall by the wayside.
- Be pragmatic with how many strategic projects can take place at once on top of ongoing clinical and operational initiatives.
- Schedule a training to walk service line teams through all the data sets available internally or externally (such as through your Advisory Board membership) to help them make data-driven decisions about their service line strategy.
- If your service line is large enough, consider a "Director of Operations" role to support the service line administrator, and allow them to focus on strategic priorities rather than just fighting fires.
Learn more: Your Covid-19 service line impact guide
As elective procedures restart, you’ll need to weigh the impacts of Covid-19 on individual service lines. Different services will likely take different paths to volume recovery, face distinct challenges in clearing volume backlogs, and see some unique impacts to longer term demand.
See our take on the major implications for elective procedures within cardiovascular, orthopedics and spine, general surgery and urology, gastroenterology, imaging, oncology, and OB/GYN.