When hospitals join health systems, they expect to realize significant cost, revenue, and quality improvements. But in reality, many systems are unprepared to confront the new challenges that come with larger size and thus fail to realize these benefits. For example, systems seeking to reduce costs may find themselves dealing with duplicative services and systems looking to improve quality may find variable clinical outcomes and patient experiences across sites.
Imperfect system service line management exacerbates these problems. The cross-facility collaboration required to capitalize on system scale and deploy standardized clinical practice across sites is difficult to achieve with legacy, site-based service lines that many systems continue to use.
Creating a system structure for service lines can help organizations achieve expected systemness benefits. But leaders face many options when choosing the leadership and responsibilities of system service lines. Ultimately, the right structure for each organization depends on its top challenges to realizing systemness benefits.
We’ve created a five-step toolkit to help leaders develop a service line structure that addresses the organization’s top challenges and positions the system to achieve its goals.
1. Define top goals for service line structure
System leaders must first identify the specific challenges they need the structure to address. Isolating these challenges will indicate the top goals for service lines.
2. Determine system service line responsibilities
Leaders should use the identified goals to determine the scope of responsibilities for the system service lines versus site-based service lines. Assigning appropriate responsibilities to the system level ensures role clarity and accountability, which facilitates progress against the top goal.
3. Develop reporting relationship between system, sites of care
The reporting relationship between the service line’s system-level and site-based leaders should be based on the organization’s culture, current reporting and budgeting structure, and the willingness of service line stakeholders to collaborate.
4. Identify appropriate leadership for each service line
There are many options for service line leadership positions and committees—from a service line chief executive to service line-specific patient and family advisory councils to clinical working committees. The organization’s top goal influences the right combination of leadership options.
5. Determine necessity of cross-service line management
Finally, executives should evaluate whether cross-service line management, charged with managing across system service lines, is necessary to meet the identified goals. This layer of management is especially helpful for ensuring that individual service line decisions align with system goals and priorities.