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A Neurologist's Guide to Hospital Reorganization

Joe Cantlupe, for HealthLeaders Media, February 24, 2011

Among the organizational changes was creation of a Center for Neuroscience and Behavioral Medicine under one roof, in essence, to coordinate aspects of care, Packer says, referring to his neuroscience specialty. In the process, various executive duties were changed and clinical programs underwent reorganization. Meanwhile, the number of board-certified or eligible child neurologists for the program tripled to more than 30 over a decade.

"A stated premise of this new administrative structure involved breaking down artificial divisional barriers to allow the development of multidisciplinary, patient-centered programs, so as to overcome 'turf' issues and [a] 'silo mentality," Packer and his colleagues wrote. "For the Neuroscience and Behavioral Medicine Center, all programs that dealt primarily with conditions of the central and peripheral nervous system would operate under the purview of the center, without constraints of determining if these were 'owned" by neurology, neurosurgery, psychiatry, psychology, genetics, child development or physical therapy."

Within the divisions under the center "we made it clear to the division chiefs at least 50% of the goals had to be common goals, they have had to be shared goals," he tells me. "We use the multiple goals of the division chiefs to make sure we are working together. We don't let turf stand in the way." In that way, "multidisciplinary programs" were carried out, Packer says.

As programs grew, "turf issues were minimized by promoting the approach that all disorders primarily centered on nervous system function were the primary responsibility of the center and not of individual subspecialties or divisions, and the center would set priorities and determine the optimal program structure," according to Packer's report.

Besides issues involving care, "a unique component of the center's structure" involves its administrative and financial responsibility. Since 2001, the center has met its financial targets, and patient revenues for the center have increased from $50 million to more than $77 million anticipated in 2010, according to Packer.

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