Aligning a Service Line -- Taking a Good Program to the Next Level

Environment – Large Children’s Hospital with nationally ranked Cardiac Services Program

Goal -  “Raise the bar” of program excellence, patient outcome, profitability, and overall morale by aligning key players, clarifying overall mission and expectations and crafting a high performance team approach among diverse professionals.

Hurdles to Goal  – Issues of control, history of non-alignment derived from the different structures, allegiances, and governance of 3 major players – Pediatric cardiologists, surgeons and the hospital medical staff, and a increased need to collaborate in building an aligned service line model among highly skilled professionals.


The pediatric cardiologists function as a private practice, the surgeons are affiliated with the academic medical center and the hospital provides all medical staff including nurses, intensivists, and other key service line personnel.  Against these constraints, the physician leaders and key hospital leaders have begun a program to address all issues and chart a collaborative course for the future.

The restraining issues are not due to a lack of professional skill or knowledge as outcome and volume data indicates continued improvement. Limitations to taking the program “to the next level” have been caused by difficulty in communicating and setting aligned goals across institutions and professional identity. While referrals within the service line are handled smoothly, potential improvements in program performance cannot occur unless there is a higher degree of collaboration, dialogue and teamwork.


The Levin Group designed and facilitated a series of “Advances” in order to:

  • Craft a common vision and co-destiny
  • Define measurable goals to attain the vision
  • Address and resolve difficult issues between team members
  • Raise the level of dialogue to open and honest discourse for solutions

All physicians and key administration staff were interviewed to more deeply understand their frame of reference and relevant history. Brought together, the group explored, in depth, common vision, program goals, and areas of alignment.  They focused on what “team” really means and how people must behave and collaborate across the system to improve effectiveness and outcome.  Current and desired “programs” as a function of available competencies, interest, competitive advantage and research needs were also defined in this initial session.



At the conclusion of the “Advance,” the group agreed upon:

  • Common program priorities,
  • Standardized approaches
  • Additional competencies needed in the system
  • Re-affirmation of the core mission as a service line

Following the Advance, individual sessions were conducted to produce deeper inquiry into the dynamics of the group including

  • Issues of control
  • Autonomy and power definitions
  • A clearer understanding of expectations
  • Allocations of roles
  • Clarity in decision-making

If these dynamics are not addressed, any higher level planning will unravel in the heat of day-to-day patient and management issues.  Therefore, it is essential to follow-up and maintain this dialogue to deepen the process and access the more difficult issues that ultimately impact collaboration.

Resolving these issues and attaining the program objectives results in a win for the cardiologists and the hospital in terms if increased quality of patient care, volume, community confidence and recruitment/retention as well as a win for the surgeons in terms of numbers of cases, patient outcome, and professional prestige.

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