Strategic vs Operational Management

You are the leader of a service line in an organization that is structured in regional divisons. How would one optimally create an organizational structure to allow for accountability across the spectrum of strategy and management for both the divisions and service line?

You are the leader of an organizational (Women’s) service line that is “responsible” for the strategic plan and growth of said service line.  Currently, the health system is organized under hospital divisions with both physican (Regional Medical Directors) and administrative leaders (CEOs of hospitals) that work as a diad pair for each respective hospital division.  Within these divisions, there are employed and community (non-employed) physicians and advanced practice clinicians working at each site.  The strategic planning and budgeting is done at the division level and not the service line level. Compensation setting is also done at the divison level and not the service line level.  The service line leaders must work in conjunction with divisonal regional medical directors and CEOs to meet overall organizational goals.

The problem:  What is best for the Women’s service line and overall organization may not match what is best for a particular division.  This issue is especially problematic when it comes to establishing quality agendas and management of the groups at the division level.  So how would this group suggest setting up a structure to allow for accountability to both service line leaders and divisonal leaders in order to meet organizational goals?


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Participant comments on Strategic vs Operational Management

  1. This is a great question which our organization is struggling with as well. Geisinger is a health system that has done a lot of work organizing teams around disease states and service lines. Penn is another, even larger health system which has committed to developing IPUs for several service lines. They are re-organizing their orthopedic and cardiovascular care across traditional departmental lines and are working through these issues. Health systems seem to often give physicians (and administrators) big system titles without the tools to create change. In order for service line leaders to control strategy and quality, those leaders need to be able to influence budget, salary, and employment decisions. Otherwise, those leaders are just asking for volunteers to change the way things are done.

    1. Thanks Rawn. See you tomorrow.

  2. I agree with Rawn. For a service line to be successful we have to align the goals, the budget and incentives. The service line has to act as one unit and develop protocols around standards of care (efficient processes of care to get best outcomes), reduce cost by minimizing variation in supplies, common budgets but with regional goals. Not every region is the same and we have to be nimble enough to adapt and adopt best practices.
    We must also align efforts around recruiting and allocate resources to areas in need and sometimes, develop a plan to cross cover.
    This can only be achieved with everyone’s buy in, not just the leaders. The challenge is how to make a compelling argument to make that happen.

  3. This seems to be a common issue in today’s Health Systems with regional campuses. Clear articulation of the system strategies across the service line is a starting point with common practice models (physician payment, service line offerings like testing practices and policies, and similar leadership structure), but then having some regional “culture” that fits the needs of that community and local interests of the physicians. I often think of a “wheel and spoke” approach.

  4. Service lines are a bridges across a healthcare system; in our particular case, across acute sites with very different cultures. System strategy needs to be understood at the local level, but developed fro the top-down. It’s important to listen to local level concerns, but ultimately, these divisions are a part of a system, with the interests of the whole rather than (parts) the central focus.

  5. To me it sounds like a very typical organisational situation. Most organisations have a top down approach, and very seldom do we see a good example of bottom up approach. Perfect Synchronisation of service line and divisional leaders will always be a challenge. Majority of the times, it is the goals and parameters set by divisional leaders which will get higher priorities as it is more organisation centric. Service line could develop a Centre of Excellence approach like what we have seen in the case of NHS wide Orthopedic case. Setting its quality delivery mechanisms soo high, that it becomes standardised across the other hospitals in the chain as well.

    1. Agreed. We have many of our Centers of excellence at our main women’s center. The challenge is aligning service line and regional strategies as we grow and move into different geographic locations/regions. Thanks for your response.

  6. This is a general problem within a lof of organizations. Your serviceline is part of a bigger organization for a reason, but there is no way that goals on a service line level can be defined top-down. In my opinion you (as an organization) should rethink what goals and constraints are defined on the organisational level (in terms of finance, HR and quality) and what is left as responsibility to the departments / service lines. Where to draw the line is situational. Problem you see often is that too much is defined on an organizational level because top management would like to be in control on too much detail.

    1. Matt,
      Thanks for your response. Quality is one area that we have been able “push” across regions under a service line strategy/initiative. I agree that many goals come from the “top down” at the regional/divisional level. We will have to continue to work to find common ground between our service lines and divisions. See you tomorrow.

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