Hospitals Rethink the Service Line

Joe Cantlupe, for HealthLeaders Media , March 25, 2013

Over the years, Allina Health tried repeatedly to make changes to its service lines, and each time, it was unsuccessful. "Four times it was tried in our organization and it failed," recalls Wheeler. The clinical service lines were based primarily on operational and business practices but failed to improve coordination of clinical programs, she adds.

In those attempts, Allina initiated changes to service lines to cut costs and make them "more efficient in terms of resource use." That was a mistake because "there was very limited engagement of those who made care decisions—the patients, the doctors, and other caregivers," Wheeler says. "While well-intended, it did not get directly to the real mission of the organization—providing exceptional care—and so didn't speak to the true interests and motivation of the clinical community."

So the healthcare system conducted a strategic review of clinical service lines. A 2010 Allina blueprint dubbed "clinical service lines" addressed the way the organization planned to improve. It said that employed and independent physician partners would be involved in a leadership structure, along with "active involvement" of patients in advisory committees. In the meantime, it adopted "deliberate implementation of processes that first and foremost facilitate improvements in clinical care." From the C-suite to the emergency department, Allina officials reviewed many systems throughout the country to study ways to improve its service lines.

"Like most U.S. healthcare organizations, Allina's current delivery model is based largely on location of services," the blueprint states. "Care processes, quality outcomes and operational efficiency vary across providers and sites of care. This variation may not serve patient or community need. Clinical service lines offer a foundation for a more fully integrated care delivery model that serves patient and community needs across the continuum of care by improving clinical quality, patient experience, and operational efficiency, and reducing total cost of care."

Allina took significant steps to change the focus of its service lines via the strategic plan, Wheeler says. "Fortunately, if you have the clinical folks define with the patients the best care, efficiencies follow through by reducing unhelpful treatments and costs are reduced. We focused on building the clinical service lines around care conditions of the patients."

Allina Health began to concentrate on high-volume service lines, such as cancer, neuroscience, spine care, women's health, and mental health, and in the past year added gastrointestinal care because of a growing need. The oncology programs focused on breast and lung care. The provider also developed programs focusing on underserved populations, through its Allina Mental Health system and Sister Kenny Rehabilitation Institute.

The health system revised its organizational leadership team over service lines with a physician governance committee that reports to the Allina board of directors. It also improved alignment of physicians through a physician network. "We continue to build these service lines and balance them as rapidly as possible to benefit more patients, while focusing on building them incrementally to focus and do the programs well," Wheeler says.

With this transformation, Allina sees service lines as core areas of hospital care that could flourish. Service lines have the potential to "increase the value of care, provide better outcomes and experiences for patients," Wheeler says. "I think you will not only see service lines surviving nationally, but they are representative of a structure that everyone is going to need."

The Christ Hospital initiated Vision 2020, a strategic plan that includes revamping its overall service line structure with designs on greater efficiency for inpatient as well as outpatient needs. Part of the plan includes clinical service portfolio and medical staff development, says Herb Caillouet, MS, PT, executive director of the musculoskeletal services for the hospital.

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