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Clinical Service Lines in Integrated Delivery Systems: An Initial Framework and Exploration

Victoria Parker, DBA, Boston University
Martin Charns, DBA, Boston University
Gary Young, JD, PhD, Boston University

An investigation of clinical service lines implemented by health care systems reveals a wide range of motivations, organizational arrangements, and implementation issues.

Integrated healthcare delivery systems (IDSs) bring together many facilities and types of care under a common ownership arrangement.  Such systems promise many benefits including economies of scale, improved coordination of care, and elimination of redundant capacity.  However, IDSs are also challenged to provide coordinated, high-quality, and cost-effective services to their patients, who must seek care from multiple institutions, sometimes across wide geographic regions.  Responding to these challenges, some IDS have established clinical service lines that cut across institutional and disciplinary boundaries to organize care around specific diseases, interventions, or populations.

To gain insight into the range of organizational arrangements and implementation issues associated with clinical service line management in healthcare systems, Drs. Parker, Charn and Young assessed the experiences of the members of the Industrial Advisory Board, a research consortium of integrated delivery systems.  Interviews were conducted with senior executives at fourteen healthcare systems ranging in size from two hospitals to more than thirty.  Approximately sixty service lines were operational, planned, or in process across these systems.  During the interviews, researchers inquired about:

  • the clinical focus and organizational structure of each service line,
  • the reasons service lines were adopted,
  • the system’s experiences with implementation,
  • and the overall impact of the service lines.

Researchers found that broadly constituted clinical service lines included mental health, long-term care, and women’s health while more narrowly focused service lines included specific procedures such as heart valve surgery, bowel procedures, and conditions such as pneumonia and kidney disease.  Many of the IDSs used different organizational structures for their various service lines.  (The researchers hypothesize that this may reflect either the varying objectives for service lines in different clinical areas or service lines in different stages of development.)  Asked about reasons for adopting service lines, interviewees most often cited coordination of care and marketing rather than cost finding and planning as their primary motivations.  When market strategy was cited, it was most often in response to competition from another healthcare provider.

Generally, interviewees reported favorable experiences with clinical service lines.  However, all of the senior healthcare executives who were interviewed also observed that service lines offer a mix of advantages and disadvantages.Among the most often cited advantages were:

  • improved focus on planning and decision making,
  • enhanced skills for career mobility,
  • reduced inter-facility friction,
  • improved accountability,
  • reduced costs,
  • and improved focus on clinical areas

Among the disadvantages most often mentioned were:

  • new blockages and backlogs in decision making,
  • stakeholders’ differing expectations of service line objectives,
  • increased political maneuvering,
  • difficulties in giving service line managers sufficient authority and legitimacy,
  • and difficulties in implementing the change.

As a result of their research, Drs. Parker, Charn and Young suggest that healthcare managers who are considering new clinical services lines should clearly formulate their reasons for doing so and choose a structural form consistent with those objectives.  They also recommend assessing the effectiveness of service lines in terms of what a specific structural form could be reasonably expected to deliver.

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