Service Lines = Successful Strategy Execution?

Gary Neilson et al reported on a 5 year study of factors contributing to effective strategy execution in 1,000 companies, government agencies, and not-for-profits in over 50 countries in their June, 2008 Harvard Business Review article The Secrets to Successful Strategy Execution . Their opening observation "A brilliant strategy, blockbuster product, or breakthrough technology can put you on the competitive map, but only solid execution can keep you there. You have to be able to deliver on your intent. Unfortunately, the majority of companies aren't very good at it..." is frightening. Their conclusions were illuminating and relevant to our experience in health care - which has undergone massive and repeated restructuring in recent years: "Structural change can and should be part of the path to improved execution, but it's best to think of it as the capstone, not the cornerstone, of any organizational transformation. In fact, our research shows that actions having to do with decision rights and information are far more important..."

In an effort to achieve the Institute of Medicine's "6 Aims" for patient-centric and efficient care delivery, and to accomplish important quality and safety goals, health care delivery organizations have evolved from relatively vertically managed, discipline oriented, bottom-line driven structures to multi-disciplinary, horizontally integrated, "balanced outcomes" focused structures. This change is reflected in the evolution of cross-disciplinary "service lines" that seek simultaneous economic and clinical efficiencies and that partner physician leaders with administrative leaders to achieve results.

But service lines have not consistently achieved their full potential in delivery organizations. There is frequently ineffective alignment between legacy vertical leadership (e.g. Physician Chairs and Chiefs, Administrative Managers/Directors) and emerging, horizontally oriented service line leaders. Has this redesign resulted in a successful "end run" around the failures of companies to execute on strategy or have we followed the same path to failure by creating brilliant structures without the clarity of decision rights and freedom of critical information flow to required to support leadership effectiveness? What has/has not worked in your organization?