Healthcare organizations, including organizations that deliver spine care, are considering structural changes to their organization that will facilitate better patient outcomes and deliver higher value care.
Alok D. Sharan, MD, Gregory D. Schroeder, MD, Michael West and Alexander R. Vaccaro, MD, PhD, examined how an organization's structural design impacts spine care in an article recently published in Clinical Spine Surgery. They offer three organizational design structures to optimize the value of care:
1. Functional structure: In this organizational structure, professionals with similar skills work together, such as coders working in a coder department or those with a marketing background all sharing a workspace. For providers, this structure translates into departments of orthopedic surgery, neurosurgery, and physiatry working separately.
While hospitals traditionally employed the functional structure, it promotes silos and doesn't encourage collaboration across units. Additionally, when members of the medical department aren't working with the administrators setting a budget or contracting with vendors, a lack of alignment could impede reaching overall goals.
Patients are often confused with the fragmented system and struggle to reconcile information when they receive conflicting messages from specialists in different departments.
2. Product structure: This organizational structure is exemplified in the automotive industry; traditionally, automobile manufacturers organized their companies around parts of the car. However, GM's former CEO Alfred Sloan began organizing his company around products such as the Buick or Cadillac with each division including a set of individuals who made engines specifically for that car, and each group had its own financial metrics. In healthcare, hospitals can organize around service lines so providers and employees focus on a disease.
Spine service lines could organize around specific spinal issues and develop protocols to optimize outcomes. The product structure eliminates service duplication, such as patients seeing multiple specialists and undergoing redundant tests. The structure is also limber to integrate additional treatments or protocol based on new evidence and the organization can achieve economic efficiency.
The specialized focus in product structure can lead to better patient outcomes, but coordination and communication between diseases is challenging.
3. Matrix structure: This organizational structure is a hybrid between the functional and service line structures. An organization with a matrix structure may have employees and providers dedicated to specific diseases within units such as a spinal disorder or arthritis unit. Functions like marketing and billing could have individuals assigned to multiple units, allowing units to share resources.
The matrix structure promotes a disease-focused approach but leaves room for accountability to slip if employees don't have a clear concept of how to allocate their time and focus. This structure also requires flawless communication to avoid silos.
Ultimately, the best structure for an organization depends on their goals. An organization focused on superior outcomes for disease management likely will succeed with a service line approach while an organization with the goal of sharing resources would do better with a functional approach.
"As healthcare organizations transition to a value-based system matching up the organizational structure to the strategy will be critical to survive in the future," concluded the article's authors.