Across the last decade, we frequently received questions from members about the definition of “center of excellence” (COE). While we still receive occasional questions about COEs, more recent questions have focused on “Institute” models. What is an institute and how is it different from a COE? And why would a hospital establish or brand one versus the other?
As a caveat, there is no official definition of COEs and institutes, with the exception of a few COE credentialing programs for specific services. Hospitals apply both terms broadly and inconsistently, which is part of the reason that members have questions about the definitions. The rigor with which the terms are used at one institution is not consistent at other institutions, although we have seen some patterns to the way these terms are used.
Center of excellence
Branded “centers” or COEs became common across the last decade as hospitals tried to highlight the quality of particular clinical services. The term connotes different levels of structure at different institutions. Generally, the term is used in reference to a specific package of services aimed at treating a specific disease—for example, bariatric surgery services, stroke care, or breast care. COEs tend to be narrower in the range of services included than a service line.
The most precisely defined COEs are bariatric surgery centers of excellence (for more information, read here or here). Two accrediting bodies have created specific and measurable criteria that bariatric surgery programs and physicians must meet to receive official COE designation. The criteria include existence of specific pieces of program infrastructure, baseline surgeon and hospital experience levels as measured in volumes, achievement of clinical quality requirements, and data submission to an outcomes monitoring database.
This type of COE is relatively uncommon, though insurers are beginning to establish similar criteria for their own designation of COEs. The Joint Commission has also begun to certify institutions in care for specific diseases, the most popular of which are certifications for stroke and joint replacement.
More commonly, however, hospitals self-designate services as “centers of excellence” with varying rigor of standards. Some self-branded COEs offer well-organized infrastructure and services, shared facility space for participating providers, extra emphasis on quality, or above average outcomes, but many COEs are little more than marketing strategies with no dedicated infrastructure or administrative support beyond a webpage or a triage telephone number for patients.
To some degree, “Institute” seems like a synonym for COE, and some organizations do view the two terms as interchangeable (for more information, see the study Cardiovascular Institute of the Future or our Original Inquiry report, Overview of Regional Neurosciences Institutes). Certainly some have been willing to apply the term “Institute” with the same lack of rigor as COE, and increased “Institute” branding is likely partly attributable to a market saturated with COEs.
The term “Institute,” however, is generally intended to convey a different type of program than does COE. Where COEs are somewhat narrow in their focus on a particular disease or therapy, institutes tend to take a broader focus, often along the lines of a full service line. Given the difficulty of using “Service Line” for external branding purposes, “Institute” can be a much more consumer-friendly way to market a high-performing service line. We’ve seen three characteristics, alone or in combination, that seem to be typical of institutes:
Institutes offer a comprehensive set of services: Not just core services, but advanced services and supporting services. The range of services often spans the entire continuum of care, not merely the acute care procedure. For example, a neuroscience institute would likely offer care for stroke and spine patients, as well as for lower volume services like neuro-oncology. It might also include ambulatory infrastructure like movement disorder clinics and memory clinics.
Institutes are often physician-led and collaborative: Care would also be more patient-centric, bridging the gap between medical and procedural specialists, like a heart and valve institute with both cardiologists and cardiac surgeons. Institutes can leverage physician leadership to set minimum standards for physician participation in the institute and can establish incentives to standardize care across employed, integrated, and loyal physicians.
Institutes frequently have a research or academic component: This final criteria is less consistent, but may be particularly important for specific service lines like oncology, where a “cancer institute” (a program that conducts research) may be distinctly different from a “cancer center” (a full-service treatment program). This research or academic component helps institutes maintain and convey its advanced clinical care offerings.
Institutes may eventually become as common as COEs, but institutions that rebrand services lines as institutes without meeting at least some of the above criteria may experience some backlash as to the accuracy of their branding.
For comparison, service lines are broad collections of related services, usually grouped by provider specialty (e.g. cardiovascular services and orthopedics) or, in some cases, by patient population (e.g. womens’ services). Service lines are used to deploy strategy across high priority services, most often to facilitate volume growth. Service lines often have a dedicated administrator as well as a medical director. Service lines serve internal business and clinical functions but are less visible to the public. The term “service line” is rarely (if ever) used in marketing.
Don't forget to log in to advisory.com to subscribe to this blog. By logging in, members of the Marketing and Planning Leadership Council can also access numerous resources on service lines, including our recent executive briefing Transforming Service Lines for Risk-Based Payment. In addition, a recent Original Inquiry report provides a good overview of the formal COE designations that hospitals may choose to pursue.