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The
Changing Role of the Service Line Leader: The Next Iteration
by Mary Nisbet
As business owners and entrepreneurs, service line leaders
must reinvent their roles and stay close to the troops as
markets and strategies shift. What are the core competencies
that will serve the business most effectively? How has collaboration
changed the business milieu? What tactics for managing physician
office relationships are effective? How can service leaders
focus their energies to do the right things? Why is accountability
the secret weapon for the savvy service leader? These challenges
are significant. In a healthcare world that is becoming more
complex and intense, service line leaders must find the internal
resources they need to cut to the chase and focus on the heart
of the business: the patient.
The service line leader’s plate is remarkably full.
Strategic direction, financial management, team development
and competencies, relationship management, quality improvement,
innovation, service excellence, and staff satisfaction…
a tall order, even under optimal circumstances. In the face
of all these priorities, how can a service line leader focus?
The answers aren’t simple. As the role of the service
line leader “morphs” over time, it becomes clear
that time and energy must be targeted to doing those finite
things that will move the strategic agenda and serve the patient.
If service line leaders can concentrate their efforts on a
handful of business strategies, then much can be accomplished.
These strategies include:- Becoming the clinical, strategic and operations expert
- Leverage social capital
- Build and exceptional team
- Forge stronger physician relationships
- Embrace accountability
Carving out research and development time is easier said than
done. Most service line leaders and healthcare managers overall
are spending too much time in meetings…and not enough
time learning. The service line leader must keep a finger
on the pulse of the clinical business: seeking out innovation
and advances, learning what’s going on out there, and
sharing information with the team: front line staff, physicians
and the organization at large.
As the “business and clinical guru”, the service
line leader must be the “go to” person for the
latest information, which can gleaned from Internet sources
such as Inteliheath, WebMD, CEOExpress and other web sites.
At The Snowmass Institute’s annual Service Line Management
conference, a group of 30 service line leaders indicated that
they spend less than one hour each week on research and development
activities, such as Internet research, reading, and simply
thinking about how to “connect the dots”.
They also argued that it is unlikely that time and energy
can be allocated unless other things can change, such as the
amount of time spent in meetings. An excellent exercise to
undertake is a meeting assessment. Look at two weeks on the
calendar and determine what percentage of time is spent in
meetings. Next, review the meetings for content and strategic
importance. At which meetings is the service line leader’s
presence really necessary? Can others be trusted to do the
work? Is the organization’s modus operandi to include
everyone so that all of the corporate fingerprints are included?
Carve out time by exiting extraneous meetings on a temporary
or permanent basis.
Of course, this exit strategy has to be discussed with those
in charge if the committees and their membership. In addition,
service line leaders should discuss with their immediate supervisors
the plan to pare down meeting commitments in order to spend
quality time on research and development.
After mining Internet and other sources for nuggets of information
and innovations, sharing the information broadly will provide
a source of up-to-the-minute learning for the team. When reviewing
competitor web sites, service line leaders should search broadly.
Oncology service line leaders, for example, should focus their
efforts on their own markets and beyond… including nationally
known centers of excellence. Use of e-mail flash reports and
other venues, such as the employee newsletter, break rooms,
and leadership meetings will keep the broader audience updated
on the most current issues and opportunities affecting the
service line.
Getting closer to the business also involves getting closer
to the team. Understanding the organization’s and the
service line’s level of social capital is critical.
Social capital is “the stock of active connections people:
trust, mutual understanding, shared values and behaviors that
bind people and make cooperative action possible.”(
In Good Company: How Social Capital Makers Organizations Work,
Cohen & Prusak). It is as much an asset as financial capital
and can be tapped when organizational changes or initiatives
are underway.
The signs of social capital are distinct and may vary depending
upon the service line. The state of the service line’s
social capital can differ from that of the organization overall
Signs of strong social capital include:
- Trust among team members
- Hallway discussions and decision making
- Manageable bureaucracy
- Strong retention
Conversely, signs that social capital is negative include
suspicion and mistrust, and mega meeting calendar, hordes
of bureaucratic hoops, and high job vacancy rate. How can
the service line leader influence social capital? First by
understanding it and how it came to be either positive or
negative. Does service line social capital differ from that
of the organization at large? Why? If social capital is waning,
the service line leader must assess his or her contribution
to its status. If trust among managers is low, then the front
line staff will model the same behavior.
Building social capital takes time and commitment. Front line
staff’s trust will build when service line leaders engage
them in decision-making, keep them informed, value staff’s
contributions and “walk the mission and values talk”.
Part of waling the talk is taking stock of the team individually
for succession planning, retention of steady performers, and
identification of employees who are not meeting expectations.
Service line leaders (and leaders at all levels) must be prepared
to elevate the star performers as well as address those whose
behaviors do not reflect mission and values. A long-term employee
who is a clinical expert but is a customer service train wreck
must be addressed to clarify performance expectations.
Technical competency is clearly a top priority for clinical
staff and the organization’s commitment to quality.
However, service and team competencies are just as important
as a reflection of commitment to service excellence and staff
satisfaction. Service line leaders must evaluate their teams
in all aspects of their performance. Identifying the star
performers will enable he leader to engage the stars in process
improvement and mentoring processes; the stars are the organization’s
future leaders. Those employees who are steady and reliable
form the foundation of the service line operation. Marginal
employees who contribute little, “stir the pot”,
and take an inordinate amount of management time for conflict
resolution must be addressed… either through coaching
for improved performance or assistance in leaving the organization.
Service line leaders must spend the majority of their time
with the stars… it’s the stars who will give momentum
to the strategic plan and influence their colleagues to achieve
excellence.
The support of both human resources and senior leadership
to this process is pivotal. The service line leader must work
collaboratively with these two key areas in order to assure
that the team evaluation process fits with organizational
management philosophy. Those organizations that do not endorse
this depth in team evaluation, mentoring and succession planning
will experience negative impact in both the strategic and
operations arenas.
Building a superior team involves focusing inward on service
line operations as well as outward on collaboration. The complexities
of health care demand collaboration among departments and
service lines; without it, care is fragmented, service and
quality suffer, and teams remain walled off from the rest
of the organization. Health care must be viewed as an organic
whole, with systems thinking applied to the important work
of patient care.
The service line leader must exhibit strong leadership competency
in order to mentor the same behaviors in his/her team. Stated
collaborative goals with shared services and with other service
lines can accomplish a number of important objectives. First,
the focus upon the patient and providing excellent products
and services is maintained by cross-pollination. The women’s
health service line and the cardiovascular service line can
collaborate on women and heart disease programming; the rehabilitation
service line can collaborate with the orthopedics service
line to create a joint care center. The possibilities are
endless, but many opportunities are missed because collaboration
isn’t a stated expectation.
Articulating expectations for collaboration is the job if
senior leadership, who should describe what collaboration
“looks like” in the organization and how collaboration
will be pursued. Some organizations require that service line
leaders state collaborative objectives as part of their business
plans; others include both shared services and service line
leaders in this expectation. Since what gets measured usually
gets done, creating performance metrics for these collaborative
objectives will help assure their success.
This issue is particularly important in elevating the role
of shared services in strategic success. After all, how successful
can service lines be without a true partnership with shared
services departments? The “intersection” between
service lines and shared services in the most often overlooked
issue in services lines as a healthcare business model. Managing
this intersection, defining mutual expectations and responsibilities,
and creating performance metrics can be hard work, but is
worth the effort!
The ‘service-line shared services relationship’
is one that can’t bye defined just once. The relationship
and expectations change as the service line’s focus
shifts with market demands and clinical innovation. Scorecards
provide the architecture for defining how shared services
and services lines contribute to achieving corporate strategies.
Shifting the mental model from departmentally driven operations
ins the job of both service line and shared service leaders.
The internal, inward focus upon teams and collaboration, while
important, must not keep the service line leader from focusing
outward as well upon key customers: the physician and the
physician office staff.
With relationship building as a core competency for service
line leaders, this key relationship can’t take a back
seat to day-to-day operations. Physician relationship management
has to be a carefully developed strategy that takes the service
line leader out of operations to the physician’s turf.
The strategy can’t be pursued alphabetically; the approach
to the service line physicians must be carefully crafted in
concert with the medical director. Which physicians should
be approached first? What is the historical relationship with
the organization? What is the level of social capital with
the practice? What opportunities for improvement exist? Service
line leaders must not focus upon “fence sitters”
or those who bring little business at the expense of those
who are the mainstay of the organization. Defining the strategy
is as important as its implementation, which must be pursued
rigorously. What get scheduled get done.
After determining which practice will be approached, the service
line leader must forge or improve the relationship with the
practice administrators. Often, this key person is ignored
because building social capital involves the service line
leader leaving the clinical arena. But meeting with practice
administrators on their turf sends a clear message of importance
and priority. The addenda should include issues of mutual
importance as well as fact finding; the practice administrators
can be a gold mine of information about what’s working
well and what isn’t.
Another key person the service line leader needs to build
a relationship with is the office scheduler, who wields tremendous
power ad is often off the radar screen for service line leaders.
The office schedulers have the power to shift business “under
the table” and are often surprisingly eager to assist
when asked. Some service lines create a Surgery Schedulers
Advisory Committee whose role is to provide feedback and input
into operational process. By elevating the importance of this
key relationship, service line leaders can build stronger
bonds with physician offices and often see a definitive positive
shift in business as a result.
Service line leaders have tremendous depth of responsibility
and some struggle to keep focused on both operations and strategy.
Successful service line leaders have revealed that the secret
to their success is what they refer to as the “freedom
of accountability”.
Mature service line organizations have learned that the equation
for exceptional outcomes is accountability + authority = performance.
Vesting service line leaders with true accountability allows
them to:
- Prioritize their efforts to yield results
- Pursue collaboration across the organization
- Make though decisions about the team
- Spend time with the people who can move the agenda
- Make budget decisions within reasonable parameters
- Drive to new levels of performance
Senior leaders who describe the boundaries and then get out
of the way find that service line leaders can produce remarkable
results when given the authority to do the job. Exceptional
care, engaged physicians and staff, effective use of resources,
and exceptional performance are the results of accountability
that is well defined and understood.
Last but not least, one of the most often ignored or forgotten
elements of service line leadership is a simple concept: fun.
How often do leaders forget to stop, celebrate achievements
and milestones, and have some simple fun with their team?
Remember – those rare moments bond teams in a way that
formal ceremonies can’t touch. One perioperative services
director bought in a gas grill and cooked lunch for the physicians
and the OR team after a key volume goal was met. Over hot
dogs and hamburgers, the entire team chatted, laughed, and
enjoyed a simple meal. Those special moments breathe new life
and momentum into service line strategies… social capital
is accrued at a remarkable rate.
For a service line leader struggling to find time for the
important things, fun with the team has to be on the short
list. After all, how many meetings are worth giving up in
order to achieve that kind of team bond? …at least one
or two! |
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