Bozic Value-Based Health Care in Orthopaedics

Chapter 16: Orthopaedics as a Service Line

budgets that may make it difficult to satisfy surgeons who are seeking newer equipment or technologies that require substantial capital outlay. Administrators are also reliant on surgeon volume and an anticipated increase in volume to be able to demonstrate service line success. Therefore, common goal alignment with transparency is central to sustainability of an orthopaedic service line. Culture Development Service line development and commitment from all stakeholders revolves around establishing a culture of trust. 16 An important aspect of building trust is clearly articulating common goals that provide all staff members and physicians a clear direction and sense of purpose. Transparency can be further optimized by making all data accessible to staff so there is no confusion on how decisions and changes are implemented. Identifying tasks that can be improved upon easily during the first year of service line inception is prudent to further help instill trust among all participants. After fostering an environment of trust, data (accessible to staff) should be used to pursue and outline strategic priorities focusing on growth, pos itive contribution margins, operational excellence, and decreasing variation in Orthopaedic service line success is dependent on the creation of a forum for mean ingful dialogue between stakeholders and clinicians devoted to the process. 4,13 Interactions between administrators and orthopaedic surgeons may be erratic and contentious, usually occurring in response to obstacles and issues rather than pro active discussions. Therefore, establishing open communication is a challenging yet fundamental task for service line viability. The development of an orthopaedic steering committee is generally a method health systems use to cultivate an envi ronment for the exchange of ideas and concerns. Decisions made during commit tee meetings should be implemented in a timely manner to further establish trust and rapport among stakeholders. Involvement of majority and/or all stakehold ers, including administrators and clinicians, may not only help address trepidation but also improve compliance. 4,9 Because administrative and business training is often lacking during medical education, physicians may aspire to obtain business and financial education to help minimize vulnerability. Similarly, hospital admin istrators should educate themselves clinically on trends, emerging technologies, and procedural value related to orthopaedics. 6,13 Open communication and multi disciplinary care continue to be the focus of an effective service line, especially as legislative reform has driven health care from being volume and margin driven to expenditure management. 16 OPEN COMMUNICATION

being value driven based on quality and performance. 4 LEADERSHIP STRUCTURE OF A SERVICE LINE

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An ideal orthopaedic service line requires a leadership structure that includes par allel clinical and nonclinical personnel. A surgeon champion and administration champion are at the top and in charge of the constituents who report to them. A clinical (registered nurse, nurse practitioner, certified physician assistant) and

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Value-Based Health Care in Orthopaedics