What does it take to implement a new orthopedic service line at an organization? Healthcare Purchasing News had the opportunity to sit down with Christine McCracken and talk about how to implement one at your organization.
McCracken is an occupational therapist who has spent 12 years as a clinician and 15 years in healthcare leadership, starting and improving service lines, focusing on orthopedics. She has a bachelor’s degree in occupational therapy from Western Norway University of Applied Sciences, a master’s of business management from Walden University, and a post-professional doctorate in occupational therapy from Rocky Mountain University of Health Professions. Chris is a certified and licensed occupational therapist and a certified project management professional. She holds a fellowship from the American College of Healthcare Executives (ACHE). She has served as a Baldrige examiner for the Tennessee Center for Excellence. She currently serves as the president for East Tennessee Healthcare Executives Affiliation, an independent chapter of ACHE.
What is an orthopedic service line?
Any service line, not just orthopedic, refers to an approach to care where you are looking at the entire care episode from the patient's perspective. What that means is trying to align all the services for a particular group of patients. Orthopedics would be one, but even in a subspecialty of that, you might have hip and knee replacement as the main focus of your service line.
So, for each particular group of patients, there is a specialization for that type of patient, which obviously increases the depth of knowledge and skill. For instance, if you're a surgeon who only does those types of procedures, you'll have a much higher volume than those that do general orthopedics.
The service line helps to standardize the process through using evidence-based practices to ensure that there is as little variation as possible. Once it has been proven that a certain method or a certain evidence-based practice is the best, then one ought to be following that. And so, this type of approach benefits the patients because everything is better coordinated. There’s better communication and collaboration, which ultimately leads to better outcomes, but it also benefits the organization because you’re improving cost efficiency. You also avoid duplication of certain services or processes and very often a good service line ends up being a center of excellence. That in itself helps with marketing to patients and actually retaining and recruiting staff too, because people want to work for the best.
Who or what needs to be included when planning a new service line?
In the question itself is one of the key ingredients to this service line, which is to know who the stakeholders are and include all of the stakeholders so that it is truly a well-rounded service. And we’re not just barging ahead with doctors and nurses and then ignoring everybody else.
What’s involved in adding a service line, first and foremost in my opinion, is leadership commitment. If you have that commitment, you can mitigate almost any other challenge, whereas if you don’t have that commitment, it’s easy to lose sight of the process, streamlining, and the need to follow best practices. When things get tough, we might have to make decisions that are maybe not so popular. Every time the entire team needs to know that decisions are made in favor of how a service line needs to run.
As for key stakeholders, you would have a few either formally or informally and influential physicians who agree to be part of the service line and that will then help drive the initiatives and it will help drive other physicians to buy in. It will also help with commitment to the service line to try to get everybody to kind of come along. You also need a subject matter expert, such as a service line administrator who is dedicated to making this approach work. That is very helpful because there is a lot of pulling the strings and coordination that has to occur. Service line work goes across the traditional departments of a hospital or a clinic because, again, the service line looks at the entire episode.
And I think a big key to adding a service line is just being aware that it requires persistent and frequent education and communication to everybody who's involved, because again, this is a little bit of a different approach to care and it's not intuitive to people who have worked in healthcare for many years.
The last thing I would mention is having an actual service line team that consists of percent additive representatives for all the stakeholders so that we can understand the concerns of the frontline workers, the patients, etc.
How can one plan for staffing when starting an orthopedic service line?
You would expect to have board certified orthopedic surgeons—it's very helpful to have nurses who are certified by the National Association of Orthopedic Nurses. The team in general should be structured in such a way that everybody works at the top of his or her license. Meaning that if you're a doctor, you do the things that only a doctor can do. If you're an RN, you do the things that only an RN can do and so forth.
Any final words of wisdom?
Again, I would repeat the importance of maintaining that solid commitment to the approach, because if you let it filter out or slide away from you, it's hard to get it back and you have to be persistent with how you are going to run your program—meaning researching best practices and so forth. We don’t allow people to make things up as they go along.
Additionally, data is a huge component to the ongoing success and continuous improvement of the program. So, you have to make good processes for collecting, analyzing, and reporting performance data to stakeholders on a regular basis to ensure that everyone is informed and engaged. Also, you need this for continuous performance improvement because you can quickly see if something is starting to go in the wrong direction and make corrections from that.
