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Hospitals Rethink the Service Line

Joe Cantlupe, for HealthLeaders Media, March 25, 2013

Patients' expectations for care are changing how orthopedic, cardiac, and oncology services are delivered, as a more educated patient population is increasingly active and engaged in the care process. "They are ready to participate in their care. They are doing research online and asking questions and using social media," Loos adds.

Coordination of cancer care

Oncology service lines are among the most popular and the most important for hospital revenues. As a disease with a single name but thousands of variations, cancer requires many treatments, as well as types of care. That is just one of the facts that can make running a high-functioning oncology service line complex.

At Indiana University Health System's cancer centers, leaders identified inconsistent levels of cancer care through the system and determined that they needed a more coordinated service line, says Schwartzentruber. Before IUH moved ahead, hospital officials identified several key goals: Achieve buy-in from internal stakeholders, create benchmarks to measure progress in the system, and compare its plan with other systems, he says.

The numbers alone were telling the story of the need to improve an oncology service line, says Holly Goe, RN, MSN, vice president of cancer services at IUH.

"Obviously we have a lot more cancer survivors than we did 10 or 20 years ago. We're making sure that we continue to provide what care survivors need, treating [cancer] more as a chronic disease than we have in the past," says Goe. "One of the first things we had to do was integrate all the sites and create buy-in. We brought all the leaders together [to decide] how we should move the service line forward."

As leaders developed the program, they did so with the recognition that cancer patients need a comprehensive model of care, Schwartzentruber says. All employed and independent oncology practice sites were to include patient navigation, use of clinical pathways to drive treatment decisions, plans of care and treatment summaries for each patient, and the multidisciplinary approach to care, including access to a broad array of cancer clinical trials, he says.

"When the vision was created, we realized we needed to be comprehensive throughout the cancer journey, from diagnosis through survivorship," Goe adds. In addition, the hospital created outpatient programs for palliative care and survivorship programs for cancer care.

As part of the change, hospital officials created a service line administrative and clinical management team to ensure all operations carried out at network sites are consistent with tactical goals. That leadership at the IUH system includes the medical director, the leadership council, and Goe as vice president of cancer services. Each facility within IUH has an operational leader and medical director. The oncology leadership council includes physician leadership and administrative leaders responsible for all representatives of the practices and sites.

Importance of data

Data improvements have been necessary to keep track of potential problem areas in service lines. Allina Health's enterprise data warehouse has the ability to track, report, and analyze care over time to allow the health system to understand clinical outcomes, utilization, and costs, according to Wheeler. A financial officer and a physician leader have been assigned to each clinical service line as part of the data warehouse oversight. They report to an executive committee, which includes presidents from each of the hospitals.

"The data infrastructure is one of the keys to all we do, with the other being the engagement of caregivers and patients," she says. "The EDW continues to expand and gives those in a position to improve care information on the greatest opportunities to do so.

"It does so from an aggregate population level all the way down to an individual level," she adds. "We would not be able to understand our outcomes improvement without the integrated data warehouse. It is vital to our future of demonstrating quality and value to all we serve."

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