The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Service Centers: A Hospital-Based Initiative

Patricia A. Doorley, MS, RRT Wednesday, November 6, 1996

In January 1994 the University of Virginia Medical Center, a 580-bed academic medical center, undertook a reorganization initiative that resulted in the formation of three distinct administrative divisions - Patient Care Services, Administrative Services, and Financial and System Services. The impetus for this initiative was to improve the Medical Center's ability to provide patient-centered care in a cost-effective manner by establishing an organizational structure based on a service continuum, as opposed to functional departments. The result was the dissolution of the majority of clinical departments (including nursing, respiratory care, physical therapy, clinical pharmacy, occupational therapy, social work, and nutrition) and the formation of service centers. The service centers were organized under the Patient Care Service division, which became the focus of the organization and the primary customer of the remaining two divisions.

The Department of Respiratory Care at the University of Virginia Medical Center in January 1994 was a large clinical department employing 121 FTEs, of which 95 FTEs were credentialed respiratory care practitioners. The reorganization initiative resulted in the dissolution of the department and the deployment of all respiratory care practitioners to seven service centers within the Patient Care Service division. Respiratory care practitioners are now employed by specific service centers and function as members of direct care teams. The direct care teams are responsible for providing integrated, interdisciplinary patient care to the patient populations served by the service center. Each direct care team is supported by a Quality Support Team and the service center's Forum, which currently serves as the coordinating body for all initiative undertaken by a service center.

Discipline specific issues and functions that extend across all service lines, for example respiratory care standards of practice and equipment purchases, are addressed by discipline specific teams that are chaired by a "Lead" practitioner. Currently the Respiratory Care Practice Committee serves this function at the Medical Center. It consists of one representative from each of the seven service centers providing respiratory care services, a representative from clinical engineering, and the Medical Director for respiratory care services. The "Lead" Respiratory Care Practitioner is elected by members of the discipline and serves in this capacity for two years. The "Lead" reports directly to the Chief Operating Officer of the Patient Care Services Division and is responsible for communicating with management regarding discipline specific issues that must be addressed institution-wide.

The transition to this organizational structure has posed many challenges, but has also presented many opportunities for the professional growth of respiratory care practitioners. The major organizational challenge has been to change the culture within the institution from one that specifically recognized the discipline-specific skills of each practitioner to one that recognizes that each health care professional, regardless or discipline, possesses a variety of skills that can contribute to achieving the goals of the service center. The major challenge for each respiratory care practitioner has been to independently establish himself/herself as an expert in respiratory care and to incorporate his/her expertise in to the care plans of the interdisciplinary team. For the respiratory care practitioner willing to invest the time and energy required to demonstrate that he/she can effect positive outcomes in the patient care environment - whether that be through the efficient provision of direct patient care services or through the implementation of a quality enhancing strategy - this organizational structure offers unlimited opportunities for professional growth, development and recognition.

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