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Service line concept gaining strength.

A survey was conducted in August 1988 to determine the extent to which service lines are being developed in hospital settings. The survey also attempted to determine the involvement of physicians in the planning, implementation, and successful operation of service lines. Responses were obtained from 324 (27 percent) of the 1,198 hospital-based physician executives who received the survey questionnaire.

Approximately 49 percent of the respondents to a survey conducted at my request by the American Collge of Physician Executives indicated that they operate service fines or "centers of excellence." The greatest variation in responses was found between the smallest and the largest hospitals. For facilities with fewer than 200 beds, 24 percent operate with service lines, compared with 67 percent of facilities with 500 or more beds. The remainder of this report will deal only with those respondents who indicated their institutions operate with service lines. The results of the survey are summaried in the table on page 30.

The survey questionnaire included a list of various service lines and asked respondents to note which lines were currently in operation. The most prevalent service lines chosen by hospitals were cardiopulmonary, emergency care, intensive care, and oncology. Service lines that were not included on the survey form but that received frequent mention as "centers of excellence" were rehabilitation, diabetes, gerontology, and neurology. Multiple service lines were indicated by 96 percent of the hospitals that said they had developed service lines.

A number of items on the survey questionnaire focused on the planning process for service line implementation. Most respondents said they relied on internal sources for development of the service line concept. Only 25 percent of the respondents indicated that an external consultant was hired to assist the institution in the planning process. A majority of hospitals (65 percent) elicited the assistance of the medical staff in the service line planning process. Active involvement on the part of physicians was a popular methodology used to gain medical staff support or "buy-in" for the service line concept. Another approach used by hospitals for this purpose was explaining to physicians how service lines could positively affect their practices through greater hospital investment in state-of-the-art technology, increased patient referrals, streamlined management of patient care, and improved quality of care.

Another portion of the survey addressed the organizational structure that supports the operation of service lines. Hospitals employed both a medical advisor and an operations director for each service line in 67 percent of the cases. Most hospitals, however, do not have a service line medical advisor to oversee the operation of all service lines. Instead, 79 percent of the respondents indicated that their institutions employed a vice president of medical affairs. Questioned as to whether support services such as nursing and housekeeping were decentralized and bundled under each service line, only 13 percent of the respondents indicated that this type of structuring was used.

The final portion of the survey questionnaire attempted to determine the financial and conceptual success of service lines in the hospital setting. Forty-seven percent of the respondents believe that service fines have made a positive financial contribution to their hospitals' bottom lines. (Twenty-two percent of the respondents chose not to respond to this item.)

One-half of the respondents indicated that members of the medical staff considered service lines to be successful. Twenty percent of the respondents described their medical staffs as indifferent to or boycotting hospitals' decisions to develop service lines. Finally, the survey revealed that only 3 percent of the hospitals have abandoned the service line concept after experiencing it to be financially or conceptually unsuccessful.

The survey results demonstrate that the service line concept is becoming increasingly prevalent in health care facilities throughout the country. In addition to the hospitals that have already adopted this concept, a significant number of respondents noted that they were considering development of service lines. Medical staff involvement in the planning, implementation, and operation of service lines appears to be a significant factor in their success. In cases where the medical staff was not actively involved throughout the planning process, it was likely that the concept was perceived as unsuccessful. Despite the large percentage of hospitals that are developing or have implemented service lines, financial and conceptual success has not been overwhelming. This may be due to the newness of the service line concept in the health care industry. It appears that further experience is necessary to make an accurate assessment of service lines in terms of their potential for success and their impact on traditional hospital organizational structures.


Jerry L. Hammon, MD, FACPE, is Senior Vice President, Medical Affairs, and Tracy L. Davis is Administrative Resident, Good Samaritan Hospital and Health Center, Dayton, OH.
COPYRIGHT 1989 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1989, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:hospital service lines
Author:Hammon, Jerry L.
Publication:Physician Executive
Date:May 1, 1989
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