Imagine a $20 million business setting up shop down the street from you. It would have at least 50 employees; a leadership team would be held accountable for growing the business; there might even be a board of directors. To manage a business of this size without a well-defined organizational structure, an established governance process, and a full-time leader would be a recipe for failure. Unfortunately, this is often how health systems manage their service lines. At many hospitals across the country, service lines are overseen by part-time administrators who have limited authority and lack the strategic orientation to effectively manage the business. Ideally, service lines would be understood and managed the same way as that new business down the street. As full-fledged businesses, they need full-time leadership and a defined governance structure.
Evolution of Service Line Leadership
Historically, health systems have considered hospitals to be their profit centers and the sources of new programs and ideas. Clinical services were limited to those offered inside four walls; service line managers were typically administrators who supported a department chair or managed a team of “operators.” It was (and still is) common for service line leaders to manage multiple, often unrelated, hospital-based operational units. For example, one service line leader might manage orthopedics, laboratory services, and the wound center. This makes it difficult to create synergies between the services and build a seamless transition of care.
With the shift of services from the acute space to the ambulatory space, it has become even more critical for service line managers to assume leadership for the entire patient care continuum. The nuances of this particular management role require the ability to make sure the right individuals are in place to guide service lines and organizations all the way from effective strategic planning to successful operational execution.