Abstract
Abstract: The results of a multimethod, qualitative data collection approach reveal a high level of consistency between early-stage dynamics identified in implementation and dynamics viewed within life cycle theory as more observable during the birth stage of development. This finding supports the idea that service line implementation unfolds similarly compared with other types of structures. In addition, it presents a more complex view of service line implementation at any given point in time by linking its unique aspects with issues and dynamics particular to the developmental stage in which the structure exists. The organization examined was the Behavioral Health Service Line of the Upstate New York Veterans Healthcare Network.
Service lines are multidisciplinary, have a clinical care mission, and provide a mechanism for integrating personnel and services across professional disciplines and delivery sites.1 Deriving from the product line management approach used in other industries, service line management is meant to improve both quality and cost-effectiveness of health care services.2 In health care, service lines ideally achieve integration. This integration takes the form of more holistic management strategy, a population-based approach to health care delivery, greater collaboration among health care professionals, and resource allocation for services rooted in "bottom-up" assessments of program needs.3,4 The service line model may be a "responsive" structure that health care organizations can use to adapt quickly to environmental demands.
The present study attempts to identify the organizational dynamics accompanying the early stage of service line implementation within a public sector health care organization [i.e., the Behavioral Health Service Line (BHSL) of the Upstate New York Veterans Healthcare Network (Upstate NY VHA Network)]. This is an underemphasized issue as most prior works on service or product lines focus on one of two issues: (a) the benefits of moving to such a structural form and (b) the contingent nature of form adoption (i.e., how internal and external conditions produce particular types of service line approaches).5 Identifying the organizational conditions and management foci, which facilitate initial service line implementation, enables health care managers to plan more effectively around how best to transition to the service line structure, how to gain increased employee buy-in for the new structure, and how to create the right kind of "enabling" environment within which the service line approach can succeed. In short, it illuminates how managers can navigate the organizational changes associated with the service line transformation.
The paper focuses on two specific questions: (a) What are the most visible organizational dynamics seen in the early implementation stages of a service line structure-in this case, a structure that has achieved increased service quality and efficiency? (b) How are these dynamics similar or different from dynamics that might be evident in the early implementation stages of other structures that differ from the service line? In attempting to answer these questions with data, ideas from organizational life cycle theory are used as an interpretive lens. Life cycle theory deals with all stages of organizational existence not only the early or "birth" stage. However, it is useful for predicting the generic characteristics that are more observable during early-stage implementation of any organizational structure. There is also precedent for using life cycle ideas in studies of singular rather than multiple organizational "life" stages.6,7