A systematic review of the impact of service line management on quality and efficiency

Abstract

BACKGROUND: The healthcare landscape is changing at a pace that traditional management structures are ill equipped to handle. In response to demands for accountability and greater value, service line management (SLM), a popularized concept in the 1980s, has recently gained renewed attention as an organizational tool for improving hospital-physician relationships, coordinating care, and aligning organizational goals, resources, and strategies.

OBJECTIVES: The aim is to systematically review the literature on SLM to evaluate its effects on quality and efficiency in healthcare organizations and to identify factors that may affect success. After evaluating its impact and the potential factors affecting success, this paper will explore SLM’s generalizability and applicability in Hong Kong’s public healthcare system.

METHODS: Using key words, a systematic search of EBSCO, Medline (OvidSP), ProQuest, and PubMed databases was conducted. The reference lists of the literature were further examined to find more articles. The extracted data was evaluated for strengths, weaknesses, opportunities, and threats (SWOT analysis). This analysis was used to identify and explain the organizational and environmental factors influencing SLM.

RESULTS: The initial search yielded 1049 citations. After applying exclusion criteria and reviewing reference lists, 17 articles were identified. The review found that a variety of management structures could be use to achieve organizational objectives. Since each healthcare organization is unique, the structure must be tailored to its internal and external context. Success depends on multiple factors. The internal positive factors or strengths of SLM include enhanced care coordination, communication among staff, multidisciplinary collaboration, leadership, cost finding and planning, integration of information, and greater resource allocation to SLs. The internal negative factors or weaknesses include resistance to organizational change, lack of buy-in among key constituents, lack of internal readiness, inappropriate organizational structures, inadequate leadership skills, difficulties in identifying priority SL, disruptions due to the implementation process, and decreases in funding for non-prioritized areas. Positive external factors or opportunities include the potential for developing a market advantage, identifying improvement areas, enhancing patient safety, and improved public perception. Negative external factors or threats include funding cuts, alterations in reimbursement schemes, advancements in technology, and changes in market forces.

CONCLUSION: Despite the hopeful results and discussions presented in the reviewed articles, there is a lack of strong evidence to support implementation and to identify factors affecting success. This is largely due to the variety of ways in which SLM have been implemented and tailored to the diverse organizational and environmental factors. Despite difficulties in comparing various SLs, hospitals and health systems that fully embrace service line management are finding success. Using the service line approach may create opportunities and confer benefits, but it may also disrupt the provision of care. Thus, physicians and managers must consider the positive and negative impacts and implications of SLM before moving forward.