We (mental health) are moving from an hospitalist, acute/crisis based care to one that is vertically integrated with primary care providers and the community. To this end, we are re-organising existing units to work together in a division to provide care for all patients within a certain geographical area. The issue is that the existing units have their own goals in advancing their own areas of speciality. This is to be encouraged given we are a tertiary care center that provide specialist training, a National centre for research and responsible for the national policies regarding mental health.
However, in this re-organisation, we are asking them to work together with other specialities to provide holistic care in a more generalist setting. (Moving away from over sub-specialisation). Existing units/departments will become something akin to think-tanks. Responsible mainly for research, education and ensuring the continual implementation of the latest evidence based treatments. Except for small tertiary clinics/wards, they will mostly work under the new division. The divisions will oversee the actual provision of care. In doing this, it is hoped that there will be less gaps and drops in care, there is less waste and the patient journey from community to primary to tertiary care and back will be seamless (for the patient).
How do we then measure the staff performance (and hence their reporting lines and reporting officers) given that goals of both the existing departments and the new division, i.e. advancing specialist knowledge/skills and the provision of care are important?