Turnipseed William D, Lund Dennis P, Sollenberger Donna
University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.
Ann Surg. 2007 Oct;246(4):585-90; discussion 590-2. doi: 10.1097/SLA.0b013e318155a97d.
Academic medical centers, which have traditionally been relatively inefficient, have increasing difficulty in meeting the missions of patient care, teaching, and research in a progressively competitive medical marketplace. One strategy for improved efficiency in patient care while keeping quality high is utilization of a product line matrix. This study addresses the outcome of utilizing a product line strategy consisting of 3 service lines during the past 5 years at the University of Wisconsin Hospital and Clinics (UWHC).
Service lines in heart and vascular surgery, oncology, and pediatrics have been organized since 2001, and report directly to hospital leadership as a product line. Service line leadership consists of a combination of medical leaders plus representatives of hospital administration, and service lines are allowed direct access to resources for program development, marketing, and resource allocation. Measurements of patient numbers, market share, length of stay, net margin, and patient satisfaction have been gathered and compared with the preproduct line era.
In the 3 service lines, UWHC has seen variable but steady growth in patient numbers, enhanced market share, positive net margins, and improved patient satisfaction during the period of measurement. During this same period, the insurance milieu has resulted in consistent downward pressure on reimbursement, which has been offset by improved patient care efficiency as measured by length of stay, enhanced preferred provider status, and gains in market share. Scorecard measures of quality are also being developed and show enhanced teaching and research opportunities for students and trainees as well as improved Press Ganey patient satisfaction scores.
At UWHC, the development of a product line matrix consisting of 3 service lines has resulted in more patient care efficiency, enhanced patient satisfaction, improved margin for the hospital, and enlargement of teaching and research opportunities. The key to successful implementation of the product line concept is a close working relationship between the hospital administration and service line medical leadership.
传统上相对低效的学术医疗中心，在日益竞争激烈的医疗市场中，履行患者护理、教学和研究使命面临越来越大的困难。提高患者护理效率同时保持高质量的一种策略是采用产品线矩阵。本研究探讨了威斯康星大学医院及诊所（UWHC）在过去5年采用由3个服务线组成的产品线策略的结果。
自2001年起，心脏和血管外科、肿瘤学及儿科学的服务线已组建，并作为一个产品线直接向医院领导汇报。服务线领导由医学领导者与医院管理代表组成，服务线可直接获取用于项目开发、营销及资源分配的资源。已收集患者数量、市场份额、住院时间、净利润及患者满意度的测量数据，并与产品线实施前的时期进行比较。
在这3个服务线中，UWHC在测量期间患者数量有不同程度但稳定的增长，市场份额增加，净利润为正，患者满意度提高。在同一时期，保险环境导致报销费用持续面临下行压力，但住院时间所衡量的患者护理效率提高、优选提供者地位增强及市场份额增加抵消了这一压力。质量记分卡指标也在制定中，显示学生和实习生的教学及研究机会增加，同时Press Ganey患者满意度得分提高。
在UWHC，由3个服务线组成的产品线矩阵的发展带来了更高的患者护理效率、更高的患者满意度、医院利润提高以及教学和研究机会的扩大。成功实施产品线概念的关键是医院管理部门与服务线医学领导之间密切的合作关系。
