Structure, Support, and Strategy are Keys to Successfully Growing Hospital Service Lines, New CNO Says

Nurse leader fills service gaps and needs by networking, partnering, and recruiting.

Even before becoming CNO at CoxHealth, Beth Polivka knew what it took to grow a service line.  The nurse leader, who has 25 years of nursing experience and spent eight years as director of nursing at the six-hospital Springfield, Missouri health system, had already successfully done so during her tenure overseeing the women and children’s service line.

Polivka was responsible for coordinating women and children's care at several locations throughout the health system to ensure the patient experience was similar everywhere.

HealthLeaders talked with Polivka about her experiences growing and developing the service lines at CoxHealth and lessons for nurse leaders in doing that work in their own organizations.

This transcript has been edited for clarity and brevity.

HeathLeaders: What were some of the methods you used to grow the women and children's service line?

Beth Polivka: We have quarterly meetings among the service line leaders. I led the women and children's service line here at CoxHealth, so within my own service line, I'm networking, meeting, and discussing with our various hospital campus service leaders for that service line.

We identified a need for a better model of care for pregnant women who are either opioid users or in a medication-assisted treatment program. [Even if] they're being compliant and working their program really well, we know that at delivery, there will be effects that we needed to better manage. That was an opportunity where we could grow better services for those moms and we worked on that together as a health system.

We also use a third-party vendor that gives us national forecasting and our regional forecasting, and they have subject matter experts. Where does the market tell us we need to grow? What outpatient services are there going to be more demand for? It allows you to have those conversations earlier and sooner so that by the time the needs are arriving, you have a strategy plan around that.

HL: How has the women and children service line changed and grown from when you first began leading it?

Polivka: As a community hospital system, we recognized and made it a system strategy to grow our pediatric specialty support. We had amazing pediatricians, we had a great team of neonatologist and pediatric intensivists, but where we recognized we had the gap was on the specialty side.

And so we worked with our pediatric providers—neonatology, pediatric intensivists, and pediatricians, both inpatient and outpatient—and had some strategy discussions with them [about their] biggest pain points. We identified our pediatric GI, pediatric endocrinology, and … pediatric neurology. Working with the pediatricians and that team, we've successfully recruited staff for those sub-specialties.

We also have a partnership with St. Louis Children's Hospital, which is part of the BJC Collaborative of hospitals across Missouri and a couple surrounding states. We recognized we would not have the volumes where it makes sense to be able to have full-time specialists within the system, so consequently, a lot of children who needed those services were having to travel to either Kansas City or to St. Louis.

We began reaching out, and in May of 2020, we opened our pediatric specialty center in Springfield, a clinic where all of our CoxHealth-employed pediatric specialists are located, which allows for great collaboration among the providers. Often, children with diseases are seeing a [pediatric] GI and a [pediatric] neuro as part of their care. By putting all those folks in one space, it really allows for amazing collaboration among the providers in determining care. The center is also the location for our five rotating clinics that come from St. Louis Children's Hospital. Those specialists drive down and several of them do surgery, all in the benefit of keeping our children locally, which is an amazing thing to do for those parents. They're not having get off work, they don't have to travel, and care can be given right here.

HL: Are there plans for CoxHealth to expand service lines into other areas right now?

Polivka: A lot of the focus within other service lines is [about] how we—especially through the use of telemedicine—[can] support our critical access hospitals and get patients the care that they need [close to home]. Just like our children's service line is saving our children and their parents a trip to St. Louis and to Kansas City, the other service lines are focused on how we can deliver that care to people within their own community.

HL: Which services lines do you think will become more important—to CoxHealth and health systems in general—within the next five years?

Polivka: Oncology and behavioral mental health are definitely going to be a focus.

We are aware of the effects of the pandemic; particularly, No. 1 is mental health or behavioral health. We're watching because of our behavioral health service line. Patients that are seeking care now are coming in much more ill, and so we know as a result of the pandemic and the added stress, mental and behavioral health is going to be key.

I think one of the concerning trends as well facing our healthcare industry as a whole is the impact on preventative medicine, such as [routine health] screenings. [For example], a study our CEO shared with us said that, as a result of the pandemic, young women were skipping their cervical screenings for cancer and the statistics were alarming.

[In] oncology care, those screenings—cervical, mammograms, colonoscopies—are essential to catching disease early and providing the ability to treat in a smaller way, compared to when you have full-blown disease. It's not isolated only to oncology; it also includes many borderline diabetics and folks who get a little twinge of chest pain who would normally go get that taken care of and evaluated by their primary care physician.

What we're seeing is an uptick in the acuity of illness that patients coming into the hospital are having.