Developing Service Lines in a Healthcare System: It has been the executive director of the Women’s and Children’s Hospital for the past 10 years
at Best Health Memorial Hospital, which is the flagship hospital in a major healthcare system. Five
other hospitals in the healthcare system are located within a 50-mile radius of Best Health
Memorial Hospital. As executive director, Ella provides leadership to approximately 600
professional staff members who report directly to 12 different managers. The managers also report
to 5 directors who provide leadership for the women’s surgical areas; labor, delivery, recovery,
at Best Health Memorial Hospital, which is the flagship hospital in a major healthcare system. Five
other hospitals in the healthcare system are located within a 50-mile radius of Best Health
Memorial Hospital. As executive director, Ella provides leadership to approximately 600
professional staff members who report directly to 12 different managers. The managers also report
to 5 directors who provide leadership for the women’s surgical areas; labor, delivery, recovery,
and prenatal services; maternal and infant services; and neonatal intensive care services. In
addition, one director is responsible for professional development and research and supervises the
clinical nurse specialists who are assigned to each of the clinical areas.
clinical nurse specialists who are assigned to each of the clinical areas.
Developing Service Lines in a Healthcare System
Ella reports directly to the CNO, who also is responsible for executive directors of other major
divisions, including acute care (including oncology, orthopedics, and general medical-surgical
care), critical care and emergency services, rehabilitative services, and home health and hospice
services. Ella is one of four nurse leaders who direct women’s and children’s services for the
hospital in the Western Regional Health System. The Women’s and Children’s Hospital at Best
Health is the largest in the healthcare system, and the other hospitals include the following: (1) one
suburban hospital with a small delivery rate of approximately 900 annual deliveries; (2) one urban
hospital with an annual delivery rate of approximately 1,500; (3) an urban hospital with an annual
delivery rate of approximately 3,500 and a level II neonatal intermediate intensive care nursery;
and (4) one suburban hospital located approximately 50 miles from Best Health with a strategic
plan to develop a new maternity service line with a level II neonatal intermediate intensive care
nursery. All of the other hospitals have transfer agreements with Best Health’s Women’s and
Children’s Hospital for high-risk perinatal and neonatal transports for tertiary care. Beyond the
transfer agreements, there is very little coordination of efforts or sharing of resources among the
five hospitals. For more, please visit Source
divisions, including acute care (including oncology, orthopedics, and general medical-surgical
care), critical care and emergency services, rehabilitative services, and home health and hospice
services. Ella is one of four nurse leaders who direct women’s and children’s services for the
hospital in the Western Regional Health System. The Women’s and Children’s Hospital at Best
Health is the largest in the healthcare system, and the other hospitals include the following: (1) one
suburban hospital with a small delivery rate of approximately 900 annual deliveries; (2) one urban
hospital with an annual delivery rate of approximately 1,500; (3) an urban hospital with an annual
delivery rate of approximately 3,500 and a level II neonatal intermediate intensive care nursery;
and (4) one suburban hospital located approximately 50 miles from Best Health with a strategic
plan to develop a new maternity service line with a level II neonatal intermediate intensive care
nursery. All of the other hospitals have transfer agreements with Best Health’s Women’s and
Children’s Hospital for high-risk perinatal and neonatal transports for tertiary care. Beyond the
transfer agreements, there is very little coordination of efforts or sharing of resources among the
five hospitals. For more, please visit Source
Developing Service Lines in a Healthcare System
Ella has assumed the informal leadership among the other directors of maternity and newborn
services at the other hospitals, and she is respected for her national reputation as a leader in
women’s and children’s services. Ella is a frequent speaker at national conferences associated with
maternal newborn health and children’s health services. She has recently attained her PhD in
nursing with an emphasis on nursing leadership, is certified by the American Nurses Credentialing
Center (ANCC) and the American Organization of Nurse Executives (AONE) in nursing
leadership, and is certified in high-risk perinatal services by the Association of Women’s Health,
Obstetric and Neonatal Nurses (AWHONN). Ella is also a frequent contributor to journals specific
to maternity, newborn, and women’s services.
services at the other hospitals, and she is respected for her national reputation as a leader in
women’s and children’s services. Ella is a frequent speaker at national conferences associated with
maternal newborn health and children’s health services. She has recently attained her PhD in
nursing with an emphasis on nursing leadership, is certified by the American Nurses Credentialing
Center (ANCC) and the American Organization of Nurse Executives (AONE) in nursing
leadership, and is certified in high-risk perinatal services by the Association of Women’s Health,
Obstetric and Neonatal Nurses (AWHONN). Ella is also a frequent contributor to journals specific
to maternity, newborn, and women’s services.
Developing Service Lines in a Healthcare System
The president of Western Regional Health System and his executive team have decided to
develop specialty-focused service lines for women’s and children’s services, cardiac services,
orthopedic services, and cancer services. Other service lines will be developed in the future
depending on the effectiveness of these four service lines in reducing variation in care, redundancy
of services, and costs associated with patient care protocols. It is also hoped that the service-line
structure will improve market share and recognition for excellence with improvements in quality
outcome indicators, physician and patient satisfaction, and coordination of care across both
inpatient and outpatient services related to each of the specialties. To initiate the vision for service-
line integration, four corporate vice president positions are announced with star performers in each
of the service lines selected for the new role.
develop specialty-focused service lines for women’s and children’s services, cardiac services,
orthopedic services, and cancer services. Other service lines will be developed in the future
depending on the effectiveness of these four service lines in reducing variation in care, redundancy
of services, and costs associated with patient care protocols. It is also hoped that the service-line
structure will improve market share and recognition for excellence with improvements in quality
outcome indicators, physician and patient satisfaction, and coordination of care across both
inpatient and outpatient services related to each of the specialties. To initiate the vision for service-
line integration, four corporate vice president positions are announced with star performers in each
of the service lines selected for the new role.
Questions
- How do you think that the president’s announcement to move to a service-line platform and the centralized decision to appoint service-line vice presidents in contrast to an open recruitment process affected the system service-line initiative?
- What do you perceive the differences are between a confederation of hospitals and a fully integrated healthcare system?
- How would you strategize to minimize the fears and anxiety of entity leaders in the development of a system-wide service line?
- In this case, what are the apparent barriers and contributors to system integration for the service lines?
- In your opinion, how much autonomy in decision making and marketing and promotions should each entity have in an integrated healthcare system?
- What are the factors that might affect the decision to honor entity autonomy in contrast to system integration and centralization of decision making and marketing and promotional activities?