Service Line Management: Implementation and Impact

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Service Line Management Implementation and
Impact

• Overall Funding Period
• July 1, 1999 - August 31, 2002
• IAB Funding Period
• July 1, 1999 - December 31, 2000

2
The Research Team

• Boston University
• Martin Charns,DBA
• Gary Young, JD, PhD
• Linda Pucci, MPH
• Victoria Parker, DBA

• UNC
• Lucy Savitz, PhD, MBA
• Arnold Kaluzny, PhD
• Kerry Kilpatrick, PhD

3
Two Funding Sources - Leverage Resources

• Center for Health Management
  Research/Center for Organized Delivery
  System Funds
• National Science Foundation (NSF) Funds

4
Goal

• To understand best practices for implementing
  service lines and the value they offer integrated
  health care systems.

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Research Questions

• Do service lines affect decision making and
  outcomes?
• Do service lines affect the systems ability to
  innovate?
• Do different forms of service lines have
  different effects?

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Research Questions

• Do clinical process innovations lead to
  development of service lines?
• Should service lines be implemented through one
  big step or a series of smaller steps?
• What are best practices for implementing service
  lines?

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Collaborative Partners

• Baylor Health Care System
• Ascension Health
• Banner Health System
• Summa Health System
• UNC Health Care
• Novant Health System

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Service Lines Studied

• Behavioral Health
• Cardiovascular
• Cancer
• Orthopedics
• Geriatrics
• Womens Health
• With site specific tailoring.

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Employee Survey

• ObjectiveCompare employees in Service-Line
  Divisional Structures with employees in
  Functional structures relative to their
  perceptions of the patient care environment where
  they work.

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Survey Methods

• Participating Sites 11 hospitals, each in one of
  5 systems.
• Target Population Nurses and therapists in
  6 clinical areas.

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Scope of Employee Survey Data Collection
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Sampling Procedures

• Stratified random sample of up to 50 employees
  from each available clinical area (tenure gt 1
  year).
• Questionnaires mailed to approximately1200 nurses
  and therapists. Second mailing to
  non-respondents.
• Questionnaires received from 642 nurses and
  therapists for response rate of approximately 54.

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Survey Measures for Patient Care Environment1

• Patient-Centered Care 4 items (e.g., There are
  service goals aimed at meeting patients and
  families expectations)
• Teamwork 4 items (e.g., A spirit of cooperation
  and teamwork exists)
• Professional Development 4 items (e.g.,
  Resources for professional development specific
  to my discipline are readily available)
• Job Satisfaction 4 items (e.g., All thing
  considered, I am satisfied with my job)
• 1 Response format for all items consisted of
  5-point Likert scales (Strongly Disagree-Strongly
  Agree). All four survey measures had high
  reliability (Cronbachs alpha gt .80).

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Organizational Structure of Clinical Areas by
Hospital1
1 DDivisional PParallel FFunctional
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Key Descriptive Statistics
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Analysis

• Key Variables
• Organizational Structure for Clinical Area (from
  site visits) Service-Line Divisional, Parallel,
  Functional.
• Survey Measures Patient-Centered Care, Teamwork,
  Professional Development, Job Satisfaction.
• Data Analysis
• Examined statistical relationship between an
  employees survey responses and the
  organizational structure for his/her clinical
  area.
• Random-effects model for each survey
  measurecontrolled for employee tenure, employee
  occupation (nurse vs. therapist), clinical area,
  hospital size (beds), hospitals HMO activity,
  and hospitals lagged financial performance.

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Mean Employee Scores for Survey Measures by
Organization Structure (survey measures range
from 1-5)
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Implementation Approach for Service-Line Divisions

• ObjectiveFor employees in service-line
  divisional structures, compare survey responses
  of those whose service line was implemented
  discontinuously versus those whose service line
  was implemented incrementally.

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Analysis

• Sub-sample 116 nurses and therapists
• Key Variables
• -Implementation Approach (from site visits)
  discontinuous, incremental
• -Survey Measures Patient-Centered Care,
  Teamwork, Professional Development, Job
  Satisfaction, Communication and
  Outlook Communication--4 items(e.g., I
  understand why the hospital has implemented
  a service line),
• Outlook--5 items (e.g., The service line will
  cause the quality of care to improve)

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Mean Employee Scores for Survey Measures by
Implementation Approach (survey measures range
from 1-5)
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Reconciling FindingsNegative Findings

• In staff survey, we found few differences among
  organizational structures within facilities
• Where there were differences, divisional
  structure lowest
• Several systems have attempted and then abandoned
  implementation of service lines
• Baylor, Sharp

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Reconciling FindingsPositive Findings

• Others note importance of service lines to their
  strategy
• Novant, Summa
• Qualitative data generally positive
• Focus on business
• Innovation

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Organization Design Problem Similar to Other
Industries

• Product vs. function
• HP
• GalaxoSmithKline
• Each structure has advantages and disadvantages
• Pendulum of change

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Reconciling FindingsExplanations

• Findings related to service lines highly related
  to implementation process
• Burning platform to lever change
• Overcoming resistance staff and leadership
• Discontinuous process
• Some barriers highest for parallel structures
• Moving rapidly to divisional structure avoids
  some barriers

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Barriers Continuum Score
Continuum Score
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Reconciling Findings Explanations

• At IDS level, difficult to implement divisional
  structure
• At IDS level benefits to parallel structures
• Small systems look much like facilities and are
  able to implement divisional structures

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Implications IDS-level

• No single optimal structure
• Benefits to IDS-level service lines in how they
  support system strategy
• Observed benefits to coordination within clinical
  area across IDS
• Parallel structures facilitate this

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Implications Facility-level

• Lacking strong evidence on advantages of
  divisional structure, its selection depends on
  other factors such as strategy, skills of
  managers, desire to alter status quo
• The evidence we have suggests use of
  discontinuous change process