In the past, CV service lines were typically organized around the acute enterprise with the key aim of growing volumes. But now, market pressures like mergers and acquisitions of hospitals and physicians, total cost management, cross-continuum care efforts, and the shift of many procedures to be primarily outpatient are causing CV leaders to reassess the structure of CV service lines.

As a result, progressive programs are innovating CV service line organizational and governance structures accordingly. In fact, over 80% of CV leaders say they are reorganizing, have reorganized in the last three years, or plan to do so in the next three.

There is no one-size-fits-all organizational structure. Instead, each organization’s reporting structure must develop to meet its strategic aims and respond to its unique realities. To help you choose and implement a service line structure that works for you, we’ve collected benchmarks, sample organizational charts, and models of governance structures that can guide your decision-making process.

Purview of the CV service line is expanding

In a recent survey, we asked members to indicate which services, units, and functions report directly to CV, indirectly in a matrix reporting structure, or externally to another department. The results, presented in the graphic below, give a picture of the components of the typical CV service line.

Overall, we find that the purview of the CV service line is expanding beyond just the acute care space. Outpatient CV clinics and prevention and wellness now predominantly report up through the service line, and it is not common for physician offices to even report to CV as well.

CV service lines are also developing reporting relationships with important support services. The majority of service lines have a directly reporting clinical data abstractor, and transition coaches, community outreach staff, financial analysts, and marketing representatives also frequently report either directly or indirectly to CV.

Sample CV organizational structures

Organizational structures delineate who reports to whom, and the scope of accountabilities that fall to the CV service line and service line administrator. Through our research, we identified six institutions whose reporting structures serve as models for others with similar characteristics and strategic goals.

• Moving from department to service line: Crowell Hospital – Crowell, a pseudonymed AMC, created a reporting structure that moved services from their traditional departments of medicine, surgery, and radiology into the purview of the service line over time, and has allowed incorporation of ambulatory services into the service line’s purview. Download
• Scaling across system sites: OhioHealth – OhioHealth’s system-wide CV organizational structure ensures cross-site consistency in service line administrative structure, committee structure, physician structure and the strategic planning process. Download
• Orienting toward outpatient care: Kander Care System – At Kander, a pseudonymed system, CV reports up through the system’s ambulatory business unit, incentivizing population health management rather than acute care financials. Download
• Reorganizing around CV diseases: Mercy Hospital Springfield – At Mercy, CV services are primarily organized around specific conditions, reflecting how patients seek care rather than specialist silos. Operational units such as diagnostics and procedural labs work across all disease-based units as needed. Download
• Integrating employed physicians: Carolinas HealthCare – Carolinas merged the reporting structures of the hospital and a large physician group, creating a heart and vascular institute that emphasizes physician leadership and shared oversight of inpatient and ambulatory services. Download
• Promoting care redesign: Duke University Health System – Duke built a reporting structure that helps support rapid cycle clinical redesign projects related to bundled payment success by creating a “quality and growth” vertical, bringing interventional labs, quality, information technology and communications under common purview. Download

Sample CV governance structures

A governance structure is the infrastructure through which administrative and clinician stakeholders develop and carry out initiatives to advance the service line and its goals. At minimum, a governance structure includes an executive steering committee that sets the strategic plan and an operations committee to implement it, while additional committees may address quality, performance improvement, and other ad hoc initiatives.

Through our research, we identified several governance structures that aid specific goals of a service line reorganization.

• Integrating quality and strategic oversight: South Miami Hospital. Download
• Transitioning from department model to a service line: Wake Forest Baptist Medical Center. Download
• Centralizing service line authority across a system: Mount Carmel Health. Download
• Expanding the service line across the care continuum: Cone Health. Download
• Emphasizing care redesign: Duke University Health System. Download