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Service Lines – When Your Organization Can’t Support the “Proper” Model

August 28th, 2007

by Christopher Cornue

Literature suggests that the “proper” Service Line model consists of all operational and other entities reporting up into a Service Line Director or Vice President. So, for example, in the Cardiovascular Service Line, the Vascular Lab, Catheterization Lab, Surgery Components, etc. would report into the Cardiovascular Service Line Director and it would be his/her responsibility to oversee the functions contained within this Service Line (e.g., physician recruiting, establishment of quality & operational metrics, operational oversight of these areas, FTE oversight, capital acquisition oversight, etc.).

But, what do you do when you are in a financially strapped institution? Furthermore, what do you do when you are in an organization that is slow to move away from the “silo” mentality toward a “matrix” one, as the previously mentioned “Proper” model would support? I have spent time in such an environment, which is moving in a thoughtful & deliberate manner from the “silo” model to the integrated “matrix” model. To support this direction, and address the immediate needs around Service Lines, I have created a structure that provides administrative support across the silos, and partners that with strong clinical (mostly RN) oversight in each of the key Service Lines in which we are concentrating. This is one approach, which obviously has pro’s and con’s associated with it. In the “pro” column – one can align individuals in an interdisciplinary manner; rally people to support a focus on a specific service line; integrate quality, financial, growth and satisfaction metrics to support the service; etc. Among those items in the “con” column – there is a lack of direct responsibility over all the components within a service line; control is more dispersed among several individuals; not all “key players” are aligned and “bought into” the efforts of the service line; and fiscal and capital priorities are more difficult to direct or influence. There are other models out there … if your organization is unable to adapt the “ideal” model, what has worked for you? Furthermore, has the implementation of the “ideal” model worked?

Regardless of which model to use … a focus on 2-3 key service lines, supported by the full organization, is probably all that should be attempted in a given period (e.g., fiscal year). A focus on more than 2-3 will dilute organizational efforts for fully supported, integrated, and successful service lines. It is clear the service line structure will continue to evolve in response to external (and internal) forces. I guess we all need to buckle up and make sure we’re able to be flexible and adapt the structure that best suits our respective organizations – and make that model successful!


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