Service Line Ins and Outs Making the Strategy

Service Line Ins and Outs – Making the Strategy Work 2009 ACHE Congress on Healthcare Leadership Bill Vanaskie - COO, Maricopa Integrated Health System, Phoenix, AZ Cecily Lohmar - Principal, New Heights Group, Huntersville, NC American College of Healthcare Executives © New Heights Group 1

Session Objectives • Understand the challenges in implementing service line management in healthcare and its implications on the organization • Learn how to determine the most appropriate approach to service line management for your organization • Identify strategies for addressing the key barriers to successful implementation of service lines American College of Healthcare Executives © New Heights Group 2

The Challenges • Fully understanding the strategy and implications • Focusing on the right structures and services • Engaging physicians • Integrating service lines with traditional structures and functions Source: 2008 survey of strategy executives sponsored by New Heights Group/ Healthcare Forum for Strategy American College of Healthcare Executives © New Heights Group 3

Understanding the Service Line Strategy American College of Healthcare Executives © New Heights Group 4

The Fundamentals • An organizational model borrowed from other industries (think P&G, Saturn) § More closely aligns operating units with the customer base (patients) § Traditional hospital model aligns with staff and physicians • Has been adapted for use in healthcare § In its adaptation, basic intent has been forgotten: • To design, organize, and manage a distinct area of the enterprise to create a product of greater value American College of Healthcare Executives © New Heights Group 6

Foundation President and Chief Executive Officer Strategic Planning Corporate Development Office of General Counsel Chief Operating Officer Nursing Professional Services Support Services Cardiac/ Surgical Radiology Materials Management Women’s Health Labs Food Services Medicine Oncology Medical Records and Archives Ortho and Neuro Pharmacy Case Management Services Psychiatric Services Emergency Services Nursing Development Quality and Medical Affairs Clinical Effectiveness Treasury Hospital Effectiveness Internal Audit MD Staff Office and Research Financial Planning and Analysis Environmental Services Patient Escort and Security Property Management Therapeutic Services: • Rehabilitation • Respiratory Therapy Facilities and Engineering Biomedical Engineering In House Agency Ambulatory Care Services American College of Healthcare Executives © New Heights Group Finance Financial Operations and Admitting Program Planning and Execution Program Administration Marketing and Communications Physician Support and Outreach Human Resources Organization Development Chief Information Officer Information Systems HR Planning and Communications Personnel Administration Planning and Market Research The traditional healthcare silos established to support the staff, not the patients 7

President and CEO VP of Corporate Development VP of Systems and Finance VP of Managed Care VP of Medical Affairs Executive VP and COO VP of Human Resources Director of Cardiology Services VP of Facilities Development Director of Oncology Services VP of Support Services Director of Behavioral Health Services VP of Patient Care Services Director of Women/ Children Services Service lines bring a different mix of staff together to support patients American College of Healthcare Executives © New Heights Group Director of Long Term Care 8

When is a Service Line Strategy For You? Organizational Needs Functional Service Line Strategic Orientation Departments Services/patients Competitive Orientation Low High Control over resources, costs, and performance Low Moderate Continuum of care Low High Rapid decisionmaking Low High Stable Changing Flexibility American College of Healthcare Executives © New Heights Group 9

What is Your Objective? • Greater focus on “mission critical” services - those services of most importance to organizational success (core service lines) • Strategic ‘watchdog’ to monitor and respond to market changes • Enhanced operational efficiency • Greater alignment with physicians • More appropriate allocation of organizational resources – human and capital • Expedited decision making; enable organization to assess vulnerable areas and adjust rapidly to changes in submarkets • Keep up with the other guy American College of Healthcare Executives © New Heights Group 10

What Constitutes a Service Line? • In practice, no consistent definition applied. § Delivery settings (rehabilitation) – do stroke patients go through similar continuum as sports patients? § Demographic populations (women’s) – are needs of young women at all similar to those of older women § Revenue centers (surgery) – is the continuum of care even similar for trauma as it is for pediatric ENT? • A patient population that travels through the same continuum of care; typically defined by group of diagnoses (cardiovascular) § Beginning to see subgroups of service lines develop (thoracic, vascular) American College of Healthcare Executives © New Heights Group 11

Selecting the Service Line Model That’s Right for You, Not Them American College of Healthcare Executives © New Heights Group 12

Service Line Models - The Continuum High Implementation Challenge Service line organization Low Service line management Service line leadership Service line marketing Low Ability to Create/Add Value American College of Healthcare Executives © New Heights Group Consumer industry models Hybrids adapted for healthcare High 13

Service Line Marketing • • Focus: marketing only No authority/ accountability across functional areas or departments Pros üEasy to implement üMinimal culture change needed üCreates market perception of coordination American College of Healthcare Executives © New Heights Group Cons üNo ‘there, there’ üNo mechanism for delivering on market image üPotential to backfire – promise more than deliver 14

Jones Hospital Marketing Leadership Management Organization Entrenched in traditional culture Strong traditional culture; focus on departments, not patient groups Traditional culture, but starting to focus on market vs. internal departments Market oriented culture; adapts easily to change Strategic Orientation Operational vs strategic orientation Begin thinking strategically about service lines Achieve dominance in key service lines Manage the healthcare dollar and patient experience Management Leadership Equate service lines with advertising Strong, oriented around functional departments Management team understands and ‘thinks’ service lines Very strong, visible, active Little to none Potential, but not yet identified Yes, strong Market Dynamics Competition not strong; visibility is primary need Strategic thinking needed to reverse volume trends Key service line competitive; consumer expectations rising Competitive, need for differentiation strong Consumer expectations high Information Systems Limited ability to analyze individual service line performance Basic financial and market performance available at service line level Full P&L available by service line Information systems must cross campuses and departments Culture Physician Leadership American College of Healthcare Executives © New Heights Group 15

Critical Success Factors – Service Line Marketing • Do § Validate that your product is worth marketing § Prove you can deliver on any promises § Try to get at least one physician behind your efforts § See a longer vision – is the endgame or a means to a different end? § Seek to understand your service line market before your campaign • Don’t § “Dump” this in marketing’s lap; leadership must still own service and strategy § Market without measurable performance objectives – volume, payer mix, etc. American College of Healthcare Executives © New Heights Group 16

Service Line Leadership • • • Service line leaders are champions and thought leaders Matrix relationships across organization Support by planning, marketing, finance, recruitment, other staff functions CEO Service Lines Service Line Support Planning/Marketing Finance Pros üCulture change not significant üGood stepping stone to advanced structure üCreates momentum and visibility üProvides physicians with ‘go to’ person American College of Healthcare Executives © New Heights Group Nursing Ancillaries Cons üNo authority to affect operational change üReliance on matrix relationships challenging in a silo culture üRisk losing physician interest without operational change üOperations ‘trump’ strategy 17

Carnegie Hospital Marketing Leadership Management Organization Culture Entrenched in traditional culture Strong traditional culture Traditional culture; not resistant to change Culture adapts easily to change Strategic Orientation Operational vs strategic orientation Begin thinking strategically about service lines Achieve dominance in key service lines Manage the healthcare dollar and patient experience Managemen t Leadership Equate service lines with advertising Strong, oriented around functional departments Management team understands and ‘thinks’ service lines Very strong, visible, active Physician Leadership Little to none Potential, but not yet identified Yes, strong Market Dynamics Competition not strong; visibility is primary need Strategic thinking needed to reverse volume trends Key service line competitive; consumer expectations rising Competitive, need for differentiation strong Consumer expectations high Information Systems Limited ability to analyze individual service line performance Basic financial and market performance available at service line level Full P&L available by service line Information systems must cross campuses and departments American College of Healthcare Executives © New Heights Group 18

Service Line Management • Service line managers have accountability over operational departments affecting their service line • Service line managers both operational and strategic leaders • Typically report directly to COO or CEO • Senior leadership active support critical Pros Cons üSingle accountability for performance enables greater focus üMore responsive to change, and more aware of market needs üPhysicians and consumers have clear ‘go to’ person üSignificant culture change within organization üDifficult to manage both service line and functional departments American College of Healthcare Executives © New Heights Group 19

St. Somewhere Health System Marketing Leadership Management Organization Culture Entrenched in traditional culture Strong traditional culture Traditional culture; not resistant to change Culture adapts easily to change Strategic Orientation Operational vs strategic orientation Begin thinking strategically about service lines Achieve dominance in key service lines Manage the healthcare dollar and patient experience Management Leadership Equate service lines with advertising Strong, oriented around functional departments Management team understands and ‘thinks’ service lines Very strong, visible, active Physician Leadership Little to none Potential, but not yet identified Yes, strong Market Dynamics Competition not strong; visibility is primary need Strategic thinking needed to reverse volume trends Key service line competitive; consumer expectations rising Competitive, need for differentiation strong Consumer expectations high Information Systems Limited ability to analyze individual service line performance Basic financial and market performance available at service line level Full P&L available by service line Information systems must cross campuses and departments American College of Healthcare Executives © New Heights Group 20

Cardiovascular Service Line Management Executive Director Administrative Assistant Director, Cardiac Nursing 5 WT, 5 G, 5 ET, CCU, 6 D, 6 T, CVSU, CV Outcomes Director, Invasive Cardiology CATH, EP, CNIL, CPIU, Pre-Post Care, CVOR Director, Preventive Cardiology Administrator, WS Cardiology Preventive Cardiology, Heart Failure Clinic, Lipid Clinic, CV Research Kimel Park, Kernersville, Yadkinville, Wilkes American College of Healthcare Executives © New Heights Group Project Manager, Mobile Cath Lab Medical Director, Lipid Clinic 21

Service Line Organization • • Complete organizational redesign Functional departments become support to service lines; no independent identities Multiple campuses run by site administrator who ensures service line needs are met on site Senior leadership take on dual roles – site administrator and service line leader Pros üShift entire culture often easier than mixing traditional and service lines üPlaces emphasis on patient experience rather than departments; fosters strong consumer orientation üAligns service-specific patient care requirements across continuum American College of Healthcare Executives © New Heights Group Cons üCulture shift difficult for many üPhysicians – dual relationship with service line leaders and site administrator üStructure only possible in a few organizations üDifficult to hold particular department accountable for achieving broader goals 22

Health System Leader Cardiology Pediatric Oncology OB / GYN Ambulatory Behavioral Health PROS CONS • Service line teams are important in obtaining institutional support from key players • Avoids ambiguity over authority and accountability • Technical specialists with knowledge in one area are brought together • Scarce or expensive resources can be best utilized • Aligns service specific patient care requirements across the continuum • Information systems overhaul needed to support change • Service line managers’ lack of authority over physicians and functional departments limits ability to increase revenues and control costs • Relies on integrated systems to manage the flow of information • Changes medical staff structure • Matrix structure often confusing • Outpatient services can be difficult to fit in to service lines and system structure • Culture change VERY difficult American College of Healthcare Executives © New Heights Group 23

All Saints Medical Center Marketing Leadership Management Organization Culture Entrenched in traditional culture Strong traditional culture Traditional culture; not resistant to change Culture adapts easily to change Strategic Orientation Operational vs strategic orientation Begin thinking strategically about service lines Achieve dominance in key service lines Manage the healthcare dollar and patient experience Management Leadership Equate service lines with advertising Strong, oriented around functional departments Management team understands and ‘thinks’ service lines Very strong, visible, active Physician Leadership Little to none Potential, but not yet identified Yes, strong Market Dynamics Competition not strong; visibility is primary need Strategic thinking needed to reverse volume trends Key service line competitive; consumer expectations rising Competitive, need for differentiation strong Consumer expectations high Information Systems Limited ability to analyze individual service line performance Basic financial and market performance available at service line level Full P&L available by service line Information systems must cross campuses and departments American College of Healthcare Executives © New Heights Group 24

Focusing on the Right Things: Portfolio Analysis American College of Healthcare Executives © New Heights Group 25

Components of a Portfolio Analysis • Hard components: § Market assessment § Financial assessment The foundation • Soft components: § Operational § Quality • Softer still § Physician leadership § Physician interest American College of Healthcare Executives © New Heights Group Used in rating services and determining actions and priorities 26

Market Assessment Percent of total volume indicates organization’s reliance on service Compare case mix index against comparable facilities – are we seeing the same patient types? Comparing ALOS against regional/national norms provides some indication of operating and quality performance American College of Healthcare Executives © New Heights Group 27

Market Assessment Market size measured by use rates to control for population size; compare against regional and national rates to see if discrepancies exist. Review trends. Reviewing regional draw shows how far beyond service area service draws from; relevant for some orgs only. Future opportunities can be found in use rate changes due to ‘normalization’, demographics, technology and other external forces. American College of Healthcare Executives © New Heights Group 28

Financial Indicators Other measures may include payor mix, % government payor Contribution margin measures financial performance before overhead and indirect expenses. American College of Healthcare Executives © New Heights Group Organizational reliance measures percent of total net income attributed to that service line. 29

Service Line Summary American College of Healthcare Executives © New Heights Group 30

Pulling it Together • Rating scale developed for each indicator evaluated • Services measured against each other • Score provided for each rating • Provides evaluation of both current and future opportunities • Serves as decision making guide, not recommendation itself American College of Healthcare Executives © New Heights Group 31

Service Line Rating - Surgical American College of Healthcare Executives © New Heights Group 32

Understanding the Results • Highest scores – these are the ‘mission critical’ services: § The 20% that drive your revenue § They should be getting the disproportionate share of your resources to grow/thrive § This is where you service line emphasis should be • The middle range: § Invest after investment in above, only if you can improve position § Be very selective; maintain skepticism § What is the opportunity to improve operating performance? § What is the opportunity to improve market position? Is this realistic? • The lowest scores: § Can you divest/outsource to minimize your losses but maintain service? § Objective is to keep it viable if truly needed in community, but investment is minimum American College of Healthcare Executives © New Heights Group 33

Engaging Your Physicians American College of Healthcare Executives © New Heights Group 34

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Why Is This An Issue? • Why can’t we get physicians engaged? • Once we get them engaged, why do they disengage? American College of Healthcare Executives © New Heights Group 36

Why Physicians Disengage • Data disillusionment • Process paralysis # 1 Reason: Physician sees NO ACTION • Focus on the hospital not physician If service line leaders aren’t given the ability to take some action, or if this is not structured into implementation in some way, you are almost guaranteed to lose the physicians American College of Healthcare Executives © New Heights Group 37

Factors that motivate physicians and hospital managers A Physician A Hospital Manager Is autonomous; makes decisions alone Uses teamwork; is probably involved in line reporting Is collegial; values and celebrates differences Is collaborative; values a common culture Works one-on-one Works primarily in groups Is patient oriented Is organization oriented Is empathetic Is objective Is crisis oriented Is a long-range planner Is quality oriented Is cost oriented Enjoys immediate tangible results Must often delay gratification and enjoy process Is accustomed to controlled chaos Has a planned schedule with inherent flexibility Sees people as material or objects Sees people as resources to be managed Is a doer and decision maker Is a delegator; gets things done through others Is reactive Is proactive Is authoritarian in practice style Delegates authority; deals with people as equals Has a specialist orientation Has a generalist orientation Is a classical scientist Is a social scientist Is discipline oriented 2/19/2021 Is socially oriented Slide 38

Engagement Models • Service line management teams Increasing complexity • Medical directorships • Physician advisory groups • Management services agreements • Clinical institutes American College of Healthcare Executives © New Heights Group 39

Service Line Management Teams • Physician/Service Line Leader • Physician/Nurse Clinician/Service Line Leader Team co- manages the service line. Size, complexity of organization drives need for duo or trio team. American College of Healthcare Executives © New Heights Group 40

Team Roles and Responsibilities: Duo Physician/Medical Director Service Line Leader • Utilization management • Physician engagement • Physician recruitment/ retention • Evidence based practices • Quality initiatives • • • Marketing Program development Financial performance Service line metrics Staffing ratios Patient satisfaction Very effective model. Requires committed physician with specific job description American College of Healthcare Executives © New Heights Group 41

Team Roles and Responsibilities: Triad Physician/Medical Director • • • Utilization management Physician engagement Physician recruitment/ retention Evidence based practices Nurse/Clinician Director • • Most effective in larger, more complex organizations, academic centers Service Line Leader • • Marketing Program development Financial performance Service line metrics Evidence based practices Quality metrics Staffing ratios/practice patterns Patient satisfaction American College of Healthcare Executives © New Heights Group 42

Medical Directorships • Plan before you write! • Organizational strategy § Type of organization and degree of responsibility dictates job description what is the overall organizational plan/strategy § Detail areas of responsibility and specific actions expected § Accountability clearly defined, e. g. cost, quality, throughput etc. § Relationship to other formal structures like Med Staff listed and defined § Reporting relationships both up and down • Compensation must be at Fair Market Value American College of Healthcare Executives © New Heights Group 43

Advisory Groups • Physician advisory groups must report to a person with authority to effect change § Hospital role to facilitate meetings, provide necessary information, solicit input • Groups geared around specific tasks § Strategy and program development § Operations and utilization management § Quality improvement and evidence based guidelines • Key to effectiveness of advisory groups is hospital’s willingness to respond to recommendations American College of Healthcare Executives © New Heights Group 44

Selecting Your Advisory Group • One physician group or multiple groups represented? • Referring physicians or service line specialists? • Expectations on loyalty or none? • Quality criteria? • Expectations on confidentiality? • Expectations on competition? American College of Healthcare Executives © New Heights Group 45

Management Services Agreements • Contractual relationships with a group of physicians • Depending on depth of agreement, may include group management of: § § § Unit/provider staffing Quality improvement Utilization management Equipment selection New program development • Payment for services related to performance in quality, cost, program development, patient satisfaction American College of Healthcare Executives © New Heights Group 46

Example: Management Services Agreement • Base Fee $335 K • Includes § Orthopedic trauma services, orthopedic spine services, total joint services § Physicians responsible for coordination of services that promotes quality, efficient patient care, utilization review and fostering quality assessment programs § Incentive compensation: over $700 K at risk • SCIP quality measures • Patient Satisfaction • Cost Savings American College of Healthcare Executives © New Heights Group 47

Clinical Institutes • Clinical and business structure designed to integrate hospital and a group of physicians to pursue service line development • Amalgam of above strategies • Creates a separate entity designed to develop service line • Most staff remain under hospital; institute staff mostly ‘virtual’ American College of Healthcare Executives © New Heights Group 48

Institute Model • Management Services Agreement Health System Institute • Professional Services Agreement Independent Physicians • Medical Services Agreements Dept. of Surgery Dept. of Medicine American College of Healthcare Executives © New Heights Group 49

Institute Example Total Joints Hospital Business Development Medical Directors Sr. VP Business Development Admin Secretary Institute Advisory Board Institute Director Nurse Navigator Orthopedic Surgery-Upper Extremities Orthopedic Surgery-Lower Extremities Sports Medicine Neurosurgery. Simple/ Complex Spine Data Analyst (Research) ½ time Spine Center Occupational Health

Engagement Models Pros Cons Management Team Fully engage physician champion Buy in from throughout organization often easier Doesn’t necessarily address other physicians Complexity of managing with two or three individuals; personalities, style, etc. Matrix even more challenging Medical Directorships Flexibility to tie service line leadership into directorship responsibilities, or create specific medical director for service line Incorporate accountability for service and quality goals across service line Facilitate communication with administration Model the relationship for peer physicians within the service line Unless specific to service line, physician may not champion service Service line could get ‘lost’ in other responsibilities Medical director not always the ‘leader’ needed to effect change Comments Very effective when changes in medical staff practice patterns are needed Same for triad model when changes in nursing orientation needed Models are not mutually exclusive American College of Healthcare Executives © New Heights Group 51

Engagement Models Pros Cons Comments Advisory Groups Seeks consensus around all service related actions/decisions Enhances buy in by the providers Involves time for meetings Must include the “right” physicians or ALL the physicians When used properly, can be very effective MSAs Physician gain sense of operations, control Incentives aligned Difficulty getting physicians to agree Selection of physician leader may or may not be champion Rarely have all physicians involved, meaning some ‘losers’ Can be very effective when operational and/or medical staff changes needed to turn around service line Clinical Institutes Flexibility to explore all of the above Maintain arms length distance from hospital Complexity Physicians still able to compete outside of institute Exclusivity can alienate other physicians Can be exclusive about physician participation through medical services agreements Models are not mutually exclusive American College of Healthcare Executives © New Heights Group 52

Integrating Into Existing Operations Business plans Management structures (matrix) Financial plans (budgeting) Reporting metrics Evolving service lines American College of Healthcare Executives © New Heights Group 53

Service Line Manager Department Manager Does This Look Familiar? American College of Healthcare Executives © New Heights Group 54

The Hierarchy of Planning Mission Vision Why are we here? What do we want to be? Strategic Plan What are we going to do? Service Line Plans Operating Plans Financial Plans How will key service lines support strategy? Facility Plans How do we get there?

Integrating Budgeting – Some Options • Service line managers and department directors jointly develop budgets. • Service line managers submit budget requests to key relevant department directors. The request is “rolled up” into the overall departmental budget at the discretion of department director. • Department managers are charged with articulating how they will address service line needs in their budget. Support for service lines part of performance evaluation. • Service line managers review department budgets against service line priorities and point out their consistency or inconsistency to leadership. Leadership makes the final decision. • CFO as arbiter – Dept manager develops dept budget. Service line leader/manager presents needs to CFO. Final budget decision determined by CFO. American College of Healthcare Executives © New Heights Group 56

Cardiology Scorecard American College of Healthcare Executives © New Heights Group 57

Financial Reporting Clarify Contribution vs. Profitability American College of Healthcare Executives © New Heights Group 58

Some level of matrix management is inherent in service line management unless you are restructuring entire organization around service lines American College of Healthcare Executives © New Heights Group 59

Matrix Management • Matrix management is a deliberate organizational structure § It IS NOT a loosely defined structure § It IS a blending of project and functional management • It requires a mature leadership team, especially at the top • A matrix structure can not be assumed to work; it must be structured to work • Varies by type of organization – no one matrix fits all organizations American College of Healthcare Executives © New Heights Group 60

Matrix Challenges by Model Low Implementation Challenge Service line marketing High Service line leadership Service line management Service line organization Low Matrix Needs American College of Healthcare Executives © New Heights Group The ‘lower’ the complexity of the service line model, the more reliant on the matrix structure High 61

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What Makes Matrix Models Succeed? Or, how do you do it right? • Roles and responsibilities are clear throughout • Everyone feels a sense of ownership • Everyone feels a sense of empowerment • All are moving towards a common goal/vision Check each of these in your current matrix structure – what’s missing? American College of Healthcare Executives © New Heights Group 63

Evaluating Your Matrix Structure • Do your support staff have a clear understanding of their roles and responsibilities in service line development? § Is this written down in their job description or an add on? • Do clinical staff have a clear understanding of their reporting relationships under the matrix? § Who do they report to and for what? § Does leadership support this fully? § Do functional managers fully understand support the matrix? Is their relationship with matrix manager spelled out? • Have you thought of everyone? § Senior leadership often left out § Ancillary staff as well as nursing American College of Healthcare Executives © New Heights Group 64

Clarify – Write Down Full Reporting Structure American College of Healthcare Executives © New Heights Group 65

Assigning Roles and Responsibilities • As you define what’s in your service line, the matrix relationships will become clearer. § Services that are clearly ‘in’ will likely be directly managed in a management model, with a matrix back to functional manager § Services that are indirectly ‘in’ the service line may be matrixed to the service line leader/manager and directly managed by functional manager § Support services are typically a matrix relationship with that functional department unless the service line is large enough to warrant a full time person • e. g. neuroscience service line has 2 physician liaisons directly reporting to service line leader and indirectly reporting to Director of Physician Relations American College of Healthcare Executives © New Heights Group 66

Examples Leadership Model • Direct Report § Planning Analyst § Physician Liaison • Matrix Reporting § § § Cath Lab Coronary Care Unit Cardiac Surgery Team Cardiac Diagnostics Marketing Financial Analyst American College of Healthcare Executives © New Heights Group Management Model • Direct Report § § § Planning Analyst Physician Liaison Cath Lab Coronary Care Unit Cardiac Diagnostics • Matrix Reporting § Cardiac Surgery Team § Marketing § Financial Analyst 67

Consider Partnership Agreements • Cross-divisional partnership agreements can help minimize the disconnects under a matrix structure. • Agreements identify expectations of the matrix relationship and outline basic operating principles for the relationship. • Partnership agreements may address elements such as the following: § § § Standard operating procedures, needs for flexibility Required lead times for reports, information, data, etc. Expected turnaround times/cycle times, response times Potential irritants and high-priority elements Means of communicating concerns, dealing with problems and issues American College of Healthcare Executives © New Heights Group 68

Parting Thoughts… American College of Healthcare Executives © New Heights Group 69

If you are thinking of service lines…. 1. Define your objective clearly – what are you trying to achieve through the strategy § Do you understand the organizational commitment you are making? 2. Go through a portfolio analysis to determine what service line(s) make most sense for you § The effort is worth it! 3. Determine the model that best fits your organization and needs § Outline the organizational structure with all matrix relationships 4. Educate senior leadership and get buy-in and true commitment to plan § Must “walk the walk” not just “talk the talk” 5. Identify service line team § Leader/manager – internal or external candidate § Physician champion § Team members American College of Healthcare Executives © New Heights Group 70

If you have already ventured into service lines • Is it achieving the objectives you set forth? § Do you have the right model? Is it consistent with your objectives? § Is your team fully on board? § Does your physician champion understand their role? § Are your matrix relationships clear across the organization? § Have you given it enough time and senior leadership support? Has your whole team made the commitment? • Are you ready to evolve to next level? Questions to ask: § Do you need to evolve? § Are people (leadership and line staff) thinking service lines or functional departments? § Do we have a champion in medical staff and senior leadership? § Review checklist • Has your position changed in key areas to support evolving to stronger management structure? American College of Healthcare Executives © New Heights Group 71

Questions? American College of Healthcare Executives © New Heights Group 72

Bill Vanaskie, Maricopa Integrated Health System bill. vanaskie@hcs. maricopa. gov 602 344 -1258 Cecily Lohmar, New Heights Group Cecily@reach-newheights. com www. reach-newheights. com 704 895 3410 American College of Healthcare Executives © New Heights Group 73

Some Interesting Reading • Service Line Strategies for US Hospitals, The Mc. Kinsey Quarterly, July 2008 • Transforming US Hospitals, The Mc. Kinsey Quarterly, February 2007 • The Secrets to Successful Strategy Execution, Harvard Business Review, June 2008 • Designing Product and Business Portfolios, Harvard Business Review, January/February 1981 • Promise-Based Management: The Essence of Execution, Harvard Business Review, April 2007 • Is It Real? Can We Win? Is It Worth Doing? : Managing Risk and Reward in an Innovation Portfolio, December 2007 • How to Make a Team Work, Harvard Business Review, December 1987 American College of Healthcare Executives © New Heights Group 74